Bitter Pills:Medicines & The Third World Poor | Page 176

if a hazardous substance or production facility is banned, disapproved or restricted
in any country, the presumption will be that it will be treated equivalently for
export purposes." (43) The Declaration also stipulates that governments should
only allow the export of a banned product to go ahead in exceptional circumstances,
after the exporters or the government of the importing country have made a special
case that the benefits expected from the hazardous product would outweigh its
health risks. (44)
An attempt to introduce export legislation along these lines was made in the United
States in 1980 when Congressman Barnes presented a bill to Congress on the Export
of Hazardous Products. It sought to shift the burden of proof so that a case would
have to be made in favour of rather than against the export of a product banned
or restricted in the US. (45) Not only has Congressman Barnes' bill been
abandoned, but in May 1982 the Reagan administration was considering lifting
a 44 year old prohibition on the export of unapproved drugs.(46) However there
is a fundamental weakness in controls that apply only to exports from major drug
producing nations. They can do nothing to stop manufacturers from producing
banned or obsolete drugs in factories overseas.
INFORMATION POLICIES
The major fallacy in rich world complacency about the Third World's 'freedom
of choice' is that this freedom can only be illusory unless regulatory agencies and
drug prescribers receive agood flow of accurate and balanced drug information.
When the question of the need for manufacturers to give full information to Third
World prescribers was raised in the British Parliament in 1979, the Government
expressed a decidedly optimistic view of information provision in developing
countries. In the words of one Government spokesman, "It is likely that many
governments supply information to their doctors reflecting the licensed status of
products in the United Kingdom and in turn, the promotional literature used in
the United Kingdom, which must conform to that approved status ..." (47) (our
emphasis) Rich world health officials imply that the poor world's needs are already
adequately covered by existing sources of drug information that can be tapped
by their regulatory authorities. For example, British health officials point to the
British Pharmacopoeia, and other national quality specifications, which can
provide a reference framework on formulation and quality. <48)
A number of major drug producing nations, including the US, UK, Japan and
Italy, are participating in a WHO Certification Scheme set up to give importing
nations some guarantee of the quality and reliability of drugs on the world
market.<49) Governments that join the scheme undertake to monitor the quality
of drugs produced locally and importers can ask for a certificate indicating whether
a particular drug is licensed for sale on the home market. But the scheme is not
as comprehensive as it might be. WHO itself points out it provides no guarantee
of the quality of drugs once they reach their destination.(50) Moreover, it is being
under-used. Some key drug exporters such as Switzerland and West Germany
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