Bitter Pills:Medicines & The Third World Poor | Page 113

have a rather strict product surveillance activity and also as a result of your
information we have taken corrective measures with respect to Bangladesh, as
well as other countries where this may have occurred." (69)
In January 1982 we wrote to Organon asking for a copy of the revised product
entry. We did not receive this, but in April we were sent a copy of an Organon
'Product Safeguard' for Orabolin which the company advise us they distribute
to doctors in Bangladesh. This contains 'warnings and precautions', but repeats
that "Orabolin drops are especially suitable for use in children" without specifying
any limitations on their use. (70)
ANAPOLON
Organon is not the only manufacturer to have been marketing anabolic steroids
in Bangladesh as body-builders for children. The Bangladesh subsidiary of ICI
produces an anabolic steroid, Anapolon (oxymetholone), under licence from
Syntex. The advertisement on page 107 shows that I CI have promoted this
to doctors as a "potent, safe anabolic agent" with "manifold uses" including
to "promote growth in underdeveloped children", (our emphasis) A number of
the claims made are directly contradicted by the Syntex UK data sheet. British
doctors are warned that Anapolon in high doses "may lead to virilisation in ...
pre-pubertal children" and that it can have "slight'' virilising effects even in low
doses. (7I) The ICI Bangladesh advertisement claims "no effect on liver
function". But the British National Formulary entry for Anapolon states that
"jaundice and liver disturbances are common". (72)
The Chairman of ICI's Pharmaceutical Division has written with the reassurance
that "I believe that your criticism of certain of the claims made does have
substantial justification. I accept that the unqualified use of the word 'safe' is
inappropriate - and more importantly, that the suggestion that the product be
used in children who are under-developed as a result of malnourishment is open
to criticism. Within the ICI international pharmaceutical operations, great care
is taken to ensure that technical claims made for any ICI product are both medically
and scientifically justified ... I find that Anapolon, being a product produced
under licence and sold in only one country, has not been subject to the full rigours
of that system. Steps have immediately been taken to withdraw all copies of that
product leaflet..." (73)
In April 1982 Ciba-Geigy announced their decision to withdraw their anobolic
steroid Dianabol worldwide. Dr. Burley advised us that Ciba had "come to the
conclusion that the balance betweeen the use of the drug in certain medical
conditions such as osteoporosis and anaemia is outweighed by the unfavourable
side-effects when the drug is used either as a vitamin supplement or by athletes
and others wishing to improve their performance". (74)

PAINKILLERS
When a decision is made to withdraw a drug in Europe or the US, the evidence
suggests that it by no means follows that manufacturers will always voluntarily
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