Bitter Pills:Medicines & The Third World Poor | Page 41

One of the most glaring examples of demand being wastefully stimulated in poor
countries is for preparations containing vitamin B12. This essential drug is
prescribed in Britain only for pernicious anaemia and other vitamin B12 deficiency
states. In contrast to developed countries, pernicious anaemia is relatively rare
in the Third World. Of course many poor people suffer from dietary deficiencies,
but these are far more commonly due to lack of folate or iron, than to vitamin
B12 deficiency. <36) But vitamin B12 is amongst the most widely sold drugs in
many Third World countries. There were no less than 126 formulations containing
B12 on the Indian market and 160 on sale in Brazil in 1978 , compared with 16
listed in the British National Formulary.(37) Many of the formulations containing
vitamin B12 are mult ivitamins. This is highly wasteful according to the British
National Formulary: "There is no justification for prescribing multiple-ingredient
vitamin preparations containing these substances". (38) (original emphasis)
Moreover, many are tablets or liquids, but since most cases of B12 deficiency are
caused by a problem of malabsorption from the stomach, taking B12 by mouth
is "futile" according to the experts. <39>
Doctors in Brazil have also expressed concern that some of the injectable
preparations of vitamin B12 are sold in highly wasteful dosages. Of the products
marketed in Brazil, 106 ranged from dosages of 5,000 to 30,000 micrograms per
millilitre. They included two formulations sold under the brand name Retar B12
by the British manufacturers, Glaxo. This, despite the fact that in Britain the
highest dosage form recommended or sold by Glaxo for B12 injectables is 1,000
micrograms per millilitre. (401 According to the British National Formulary :
"There is no evidence that larger doses provide any additional benefit in vitamin
B12 neuropathy." 1 4 0

ESSENTIAL DRUGS IN SHORT SUPPLY
In most developing countries private importers and chemists stock a wide range
of expensive- mainly foreign - brands of all sorts of different products. But basic
drugs like penicillin are invariably in short supply and rarely available at all outside
the health service dispensaries. Their low cost makes them a particularly
unattractive proposition for private importers, especially when they are held to
fixed price mark-ups. The situation in Mozambique before independence closely
resembles the reality in other non-drug-producing countries today. Penicillin could
only be bought in fancy film-coated capsules. These were sold in small packs at
several times the prices of ordinary penicillin tablets used in British hospitals at
the time. Only one distributor had even bothered to import oral penicillin. It would
have been against the company's interests to shop around for a good price, so
they chose an expensive brand that guaranteed them a good profit margin
on sales. (42>
Attempts to control profit margins on drug sales in the free market have also acted
as a disincentive on local production of low cost essential drugs. As a result, even
India - a major drug producing nation - experiences shortages of supplies of
essential drugs due to the skewed pattern of drug production. This was highlighted
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