Bitter Pills:Medicines & The Third World Poor | Page 33

small number of women will suffer adverse, even dangerous, side-effects from
taking the pill without medical supervision. But if the pill were only available on
a doctor's prescription, as in developed countries, many poor women would have
to go without it, because there are so few doctors and they are expensive to consult.
Consequently, they would be deprived of a relatively safe and reliable
contraceptive, when the risks of pregnancy and childbirth are much greater in
poor communities.
Nevertheless the uncontrolled distribution of drugs on the private market presents
major problems, particularly for the Third World poor. The situation in
Bangladesh, described in a Government report, is in no way atypical of other
developing countries: "Almost all the retail drug shops are owned and run by
non-pharmacists and/or untrained persons. Drugs and medicines, including
dangerous drugs, are often sold as ordinary articles of commerce ... leading to
misuse and waste." (39) Drug sellers are not in business to recommend costeffective treatments. They are out to earn a living.
It is sometimes argued that controls and rationalisation of commercial drug
distribution will be of little benefit to the poor since the main drug consumers
are the rich. There is no doubt that the wealthy in developing countries spend
more on drugs than the poor, but the differential can be surprisingly small. For
example, a study of drug use in a town in southern Brazil revealed that families
in the richest neighbourhood spent only two-and- a-half times more a month on
medicines than poor families from the shanty towns. (40)
But the weight of evidence suggests that it is the poor who stand to gain most
from controls on private drug sales. In the absence of adequate health services,
the poor turn to drug sellers for treatment and advice. An anthropologist has made
a detailed study of where people in a small town in El Salvador go for treatment
when they fall ill. She has found that the commercial drug sellers are an important
source of treatment for rich and poor alike. But it is the poorest who rely on them
most. They cannot afford to consult a doctor as well as buy medicines, so they
go straight to the drug stores.<41) There, they may be victims of pressurised sales
tactics as "clerks and owners consistently recommended more expensive
medications and more medications to their customers seeking health care
advice". <42)
In most developing countries, neither the public nor the private drug distribution
system caters for the needs of the poor. As the Dutch anthropologist who studied
the government and commercial distribution in south Cameroon concludes, "The
present inefficiency favours exactly those who are least in need of medical help
and, moreover, are most able to pay for it. In other words, the current inefficient
medicine distribution perpetuates and aggravates existing inequalities both in
economic and health conditions." (43)
The poor are at the mercy of the drug sellers and the dictates of the market. In
the next chapters we look at the implications of this dependence and examine the
conflict between what the poor need and the rich choose to sell.
26