Bitter Pills:Medicines & The Third World Poor | Page 20

drugs to alleviate painful symptoms, but most vital are those that provide cures
for killing diseases. An outstanding example is the development of antibiotics
targeted to attack life-threatening infections without the patient suffering ill effects.
Antibacterial drugs have made it possible to save lives on a massive scale. Their
success has created what Dr. John Yudkin describes as the "antibiotic mentality'',
the belief in " a pill for all ills". (46)
The fact r emains that medicines cannot tackle the social roots of ill-health. With
a few notable exceptions, such as vaccines and antimalarials, they cannot prevent
disease. But to make any major onslaught on disease, prevention is essential. The
inevitable limitations of medicines are put clearly by a research and development
director of Wellcome, one major British drug manufacturer. He points out that
"drugs are not synonymous with health,... there are many forces for the promotion
of health, including nutrition, education and hygiene. In some parts of the w^orld,
these take priority before more sophisticated medicines are brought into
play." <471
Even vaccines which can be used selectively to protect young children from tetanus,
diphtheria, whooping cough, polio, measles and TB may not all be entirely effective
let alone cost-effective.<48) For example there is evidence to indicate that the antiTB BCG vaccine is of unpredictable effectiveness .|49> It has been suggested that
this may be related to the nutritional status of the recipient. In any case, no drug
can be a substitute for food. Dr. Klouda highlights how vaccines may be an
unrealistic option in terms of cost. "A good health budget will provide about £3
a head in a developing country [ per year ] . The cost for just measles vaccine
for every child in Tanzania, including transport and other costs, came to about
£1.50 in 1977. How can they even think of £1.50 a head for vaccines, which are
not dealing with the major health problems?" '""
Moreover, drugs are powerless to break the cycle of disease in an unhealthy
environment. This is illustrated by the treatment, as against the prevention, of
hookworm anaemia, a disease which is very common in poor communities that
have no basic sanitation. Hookworm larvae thrive in moist soil where they have
been deposited in human waste. The larvae break through the skin of people
walking barefoot and work their way into the small intestine. Lodged in the
intestine, the hookworm parasite leeches blood. A heavy worm infestation can
cause severe iron-deficiency anaemia. If left untreated, an infected person gets
steadily weaker and can die from heart failure. (51)
Hookworm anaemia can be treated effectively with modern drug therapy - worm
pills in conjunction with iron tablets. But so long as the community remains
ignorant of how the disease is transmitted, they will go on using the moist ground
instead of latrines and keep on getting hookworm anaemia. The only long-term
solution is to build latrines. Finding an appropriate method to dispose of human
waste can be both technically difficult and expensive. But people could protect
themselves from the disease if they knew how it is transmitted. For instance, many
could buy cheap plastic sandals as a simple preventive measure. (52) Encouraging
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