Bitter Pills:Medicines & The Third World Poor | Page 163

provided to a number of countries by agencies such as UNIDO, as for example
in the form of a mobile demonstration and training unit equipped to extract the
active ingredients from plants. |28)
The process of vetting and refining herbal medicines by modern scientific methods
can be every bit as expensive, however, as developing new drugs. The cost of
extracting the active ingredient and formulation into modern dosage forms can
destroy the advantages of herbal medicines by pricing them out of the reach of
the poor. As Dr. Hye, then Director of Drug Administration in Bangladesh,
explained: "Mechanisation of production and commercialisation of distribution
have been observed to increase prices of traditional medicines at times far beyond
that of comparable modern drugs." (29) This has been the experience in China
where communes have found themselves paying as much for factory-produced
herbal medicines as they do for modern drugs. Consequently, many communes
choose to keep the costs down by mixing their own traditional remedies from
medicinal plants grown on the communes. (30)
Many Third World governments are fully aware of the pitfalls. Representatives
of the Asian governments attending a WHO meeting in Delhi in 1980, agreed on
the importance of seeing that "the supposedly low cost of traditional drugs and
remedies, which is one of the major advantages of their use, is not lost in
commercialisation and in the enthusiasm to put them in modern pharmaceutical
dosage forms". <31) Furthermore at the first UN meeting on the production of
herbal drugs, held in Lucknow, India, in 1978, participants from a range of Third
World countries agreed that it is not always necessary to go through the expensive
process of extracting the active principle from a medicinal plant, because there
is no real medical need to do so. In most cases, the patient can make do with a
standardised extract, which can be produced cheaply by simple extraction and
purification. (32)

LOCAL SELF-RELIANCE
In fact, the best way to ensure that traditional medicines are used to the best
advantage of the Third World poor is very similar to the approach that WHO
urges poor countries to adopt in using modern drugs. At the 1980 Delhi meeting
it was agreed that the Third World's policy on traditional remedies should be "to
make a proper selection of traditional drugs of established efficacy and safety
for use in primary health care". (33)
The process of cataloguing and evaluating traditional medicines has to be carried
out, not in research laboratories, but in the rur al areas where their use has been
observed over centuries. This empirical knowledge has been passed by word of
mouth from one generation to another but is now increasingly threatened by the
pressures of the modern world. In India, for example, concerted efforts are now
being made to catalogue the medicinal plants known to the tribal people, who
make up nearly a tenth of the population. But it is feared that already much of
their knowledge has been lost.(34)
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