Bitter Pills:Medicines & The Third World Poor | Page 115

remove their product from the Third World market. The problems are illustrated
by two chemically-related painkillers, whose use has recently either been controlled
or completely stopped in a number of developed countries. By contrast, they
continued to be widely marketed in Third World countries for over-the-counter
sale, with no warnings of the dangers.
AMIDOPYRINE
For over 30 years amidopyrine has been known to cause agranulocytosis. This
fatal blood disease kills by destroying the body's protective mechanism against
infection - the white blood cells. As early as 1938 sales in the US were restricted
to a doctor's prescription. In 1963 in response to the consensus of medical opinion,
the drug was voluntarily withdrawn in Britain by one of its leading Swiss producers,
today's Ciba-Geigy, (Ciba and Geigy merged in 1970).(75)
Amidopyrine is only one of a number of drugs, such as chloramphenicol, that
can cause similar fatal toxic reactions. (76) But whereas chloramphenicol is an
inexpensive life-saving drug, invaluable in typhoid epidemics, not only does
amidopyrine not save lives, but it offers few advantages over other 'safer'
painkillers. When the drug also came under suspicion of causing cancer, the Swiss
drug regulatory authorities recommended its complete withdrawal. (77) In 1977
two Swiss manufacturers, Ciba-Geigy (which marketed four amidopyrine-based
products) and Sandoz, with two, announced their intention to remove amidopyrine
from all their formulations by the end of the year. (78) They were to be
reformulated with prophyRhenazone, a chemically-related drug.
Three years later, however, Ciba products containing amidopyrine were still being
sold under the brand-names Cibalgin and Spasmo-Cibalgin in ten developing
countries, and Portugal. In only one case was any warning given about the risk
of fatal agranulocytosis. (79) The drug was still being used for minor pains
including "painful conditions of all kinds e.g. headache, toothache, feverish colds,
chills and influenza".<80) In December 1979 all six Ciba and Sandoz formulations
were on sale over the counter in Mexico. (8I) Ciba explain that they "did not think
that the substitution of propyphenazone was urgent or demanded a product
recall". (82) The reason for withdrawing amidopyrine was ostensibly the cancer
risk, not agranulocytosis (which had been known abou t for so long). Consequently
Ciba decided "to give priority to northern or non- tropical countries where nitrites
are found in higher concentrations" because of the greater consumption of
processed foods "such as sausages and hamburgers, but also beer". (83)
But it was not just a question of the old stocks that remained on pharmacy shelves
in developing countries. As The Lancet reported in November 1981, "There is
evidence that Ciba-Geigy has continued to manufacture preparations containing
amidopyrine and that they have been selling off old stocks of preparations
containing amidopyrine even after registering the new formulations". (84)
Mexican trade statistics for 1978 show that Ciba imported 8,500 kilos of amidopyrine
into the country, with 80% of the supply coming from Switzerland.(85)
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