Bitter Pills:Medicines & The Third World Poor | Page 120
should not be used indiscriminately for any attack of diarrhoea. Nor had the drug
store owner ever heard that he should not sell tetracycline for young children or
pregnant women. The Sumycin packs he sold gave none of the warnings that must
be given in developed countries. (U2) Squibb Bangladesh assure us they have never
promoted Sumycin for the treatment of diarrhoea and have promised to investigate
the retailer in question. (U3)
In the Bangladesh Prescriber's Guide (current in September 1980) doctors are
informed that Upjohn's antibiotic Lincocin (licomycin) is particulary useful for
treating a number of conditions including "acne vulgaris". (ll4) The British
National Formulary, referring to licomycin, stresses that "These antibiotics have
a very limited use because of their serious side-effects". (115)Upjohn inform us that
they do not recommend Lincocin for "acne vulgaris" in any country. They point
out that they have no editorial control over guides like the Bangladesh Prescriber's
Guide, and that they will attempt to have the indication removed from the Guide.
( 6)
" But the scale of the problem of over-use of potentially dangerous antibiotics
is enormous. In 1978, Lincocin was the second best selling drug on the entire Mexican
market. ("7)
Some rich world manufacturers appear to have actively encouraged the misuse of
powerful and potentially dangerous antibiotics for mild infections. For example
in North Yemen the Swiss company, Rivopharm, has marketed Rivomycin Strepto
(a combination of chloramphenicol and dihydrostreptomycin) indicating that the
drug can be given to infants for "common diarrhoea". (ll8)No mention is made of
"the liability of chloramphenicol to produce life-threatening toxic effects,
particularly bone-marrow aplasia..." which in the authoritative words of Martindale
(the pharmacists' 'bible') means that the drug "should never be given for minor
infections". ("9> It was recommended by a Yemeni pharmacist to the author (along
with Entero-Vioform) for a mild attack of diarrhoea.
Rivopharm wrote to us on 11 February 1982 stating: "We strongly object and we
are at a loss to understand the basis of your statement that 'Rivopharm appears to
be actively encouraging the misuse of two powerful and potentially dangerous
antibiotics'. We believe that you overlooked the clear and distinct statement (in English
and French) \_ not Arabic - author's comment^] on the Rivomycin Strepto outer
carton ... that the product is 'to be dispensed on medical prescription'." (l20) This
statement was confirmed in a further letter of 8 April 1982. But by 17 May there
was an apparent change of heart and a more encouraging response from
Rivopharm. "We would like to communicate to you that the leaflet insert of
Rivomycin Strepto is under examination and revision, as part of our regular
revision procedure. This revision will be done with the view to change the leaflet
and in particular to delete the words 'common diarrhoea', which may be misleading
as you have rightly indicated." (I2I)
However greater impetus to drug misuse of this sort comes from local
manufacturers. For instance, in Bangladesh one of the leading local companies
has recommended the use of ampicillin for influenza, coughs, infantile diarrhoea,
boils, even hepatitis (for which there is at present no known drug cure).