Bitter Pills:Medicines & The Third World Poor | Page 38

In recent years Third World countries have been doubling their expenditure on
medicines every four years, whereas their GNP has been doubling only every sixteen
years. (22> Pharmaceutical imports average only about 2% of the value of all
commodity imports to developing countries, but according to WHO, "For
developing countries importation of Pharmaceuticals is one of the fastest growing
drains on hard foreign currency..." (23)
Spiralling drug costs present an acute problem for most developing countries
because of their dependence on imports. The Health Minister of Zimbabwe drew
attention to this when he addressed a regional meeting of African pharmacists
in April 1982. "We are all aware that this country like practically every Third
World country, is experiencing the ill-effects of inflation, falling commodity prices,
rising prices of imports leading to unfavourable terms of trade. Foreign exchange
allocations which were adequate for the import of 'essential' medicines a year
or two ago now fall far short of the mark. This is due to the increase in the rates
levied by the traditional manufacturers or agents outside Zimbabwe." (24)
This dependence can have both social and economic costs. In the words of WHO:
"In developing countries the pharmaceutical sector is a captive market which has
an effect on the health care system, and especially on the cost and type of drugs
supplied." (25> (our emphasis) We shall concentrate in this chapter on the type of
drugs marketed in the Third World and look at the question o f cost in the next.

PLACEBOS IN WASTEFUL ABUNDANCE
To recap: developing countries need large quantities of a small number of essential
drugs, above all those that can prevent and treat disease. These include
antibacterials and antimalarials; drugs that are needed for specific conditions (such
as insulin for diabetics), and some key medicines to provide effective relief from
painful symptoms. The terms 'essential' and 'non- essential' are obviously very
loose. Any attempt to evaluate the usefulness of specific drugs is likely to produce
as many views as experts - depending on the criteria behind the selection and where
the drugs are to be used. A clear illustration of the difficulties is that the same
combination of two anti-tuberculous drugs which was defined as extremely useful
by one WHO working group on tuberculosis was rejected by the expert committee
that drew up the WHO Selection of Essential Drugs. (26)
But there is a clear consensus of independent expert opinion on some types of
drugs that are either wasteful or unnecessary or both - and therefore harmful to
the needs of the Third World poor. These have been expressly excluded from the
WHO list. (27) The obvious categories include most combination drugs
(particuarly irrational mixtures such as antibiotics and vitamins); the latest and
most expensive formulations of drugs like antidepressants, and the mass of
multivitamin and mineral tonics, and cough and cold preparations which have
little value except as placebos. l28>
The 'ideal' of what the poor need clashes with the reality of the drug market. In
the words of two senior pharmacologists:' 'Unfortunately a good proportion of
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