Bitter Pills:Medicines & The Third World Poor | Page 117

unlikely to arise with aminophenazone (amidopyrine) again." (92)
Dr.Burley explains that Ciba-Geigy stopped manufacture of all aminophenazone
derivatives by December 1981.
DIPYRONE
Some of the most widely sold painkillers in the Third World today contain dipyrone,
a drug that is chemically related to amidopyrine and can also cause fatal
agranulocytosis in an estimated 0.57% of users.(93) Dipyrone has been described
as "about as effective as aspirin". (94) The drug has been completely withdrawn
from the market in Britain and the US on the grounds that "the incidence and risk
of potentially fatal agranulocytosis... far outweigh any benefit that can be derived
from its use". <95)
The balance of risks, however, has been assessed very differently in West Germany,
the home market of some of the leading manufacturers of these drugs. These include
Hoechst, Boehringer Ingelheim, Asta-Werke and Merck, which all market dipyrone
products in the Third World. In West Germany the widespread use of dipyrone
and similar drugs for minor pains is highly controversial. At the beginning of 1982
an expert committee recommended that their use should be restricted to prescription
only. Hoechst and other manufacturers oppose any new restrictions on the grounds
that they are not justified by the risks.(96> At any rate West German doctors and
pharmacists are well aware of the controversy and of the possible toxic side-effects,
unlike many of their counterparts in developing countries.
According to UNCTAD at least ten different leading brands of painkillers containing
dipyrone are marketed in the Third World. (97) In Mexico, for example, the eighth
best-se lling drug on the entire market, Hoechst's NeoMelubrina, contains it, as does
the next most popular analgesic (by sales value and volume), Boehringer's Buscapina
Compositum.<98) Consequently, thousands of patients in Mexico alone, who know
nothing of the possible risks, may be unnecessarily exposed to danger when 'safer'
alternatives exist. (99)
Health authorities may have difficulties in removing these and other products. In
Bangladesh, for example, having assessed the dangers of the uncontrolled use of
dipyrone, Drug Administration officials instructed manufacturers to remove
products containing dipyrone from the market by 1980. This ban encountered local
opposition. Subsequently another government department ruled that the ban need
not take effect until the end of December 1982. (100)

INJECTIONS
There are some drugs that present a major health hazard in developing countries
because they cannot be given safely by untrained drug sellers. One of the most striking
examples is injectable drugs. Injections are very much in demand throughout the
Third World. Many of the world's poor believe that tablets and pills are a secondrate substitute for an injection. Drug sellers are also keen on injections because they
can charge customers both for the actual drug and for injecting it.
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