Bitter Pills:Medicines & The Third World Poor | Page 49

But the reality is that people in Bangladesh without safe water supplies and in
a "chronic state of malnourishment" are in no position to buy multivitamin tonics
costing more than a poor family's entire daily income. There are much cheaper
sources of nutrients in local foods. Indeed, the chairman of ICI's local subsidia ry
explained to us that although doctors and drug sellers in Bangladesh add
multivitamin preparations to almost any prescription, he considered that these
products could not represent value for money in a country where spinach, limes
and other fruit and vegetables are readily available. (77)
The growing dependence on vitamin and mineral tonics can have a damaging
impact on the nutrition of the poor. This is the case when they spend money on
tonics instead of food, but it can even present problems when they do not have
to buy them. Dr. Schweiger who worked in rural Bangladesh explains:
"Malnutrition is not treatable at all by drugs and it is the biggest single
problem - malnutrition is treated with food. People will die from lack of calories
long before they die from lack of a particular vitamin. I wonder very much about
the patients I treated with my previous organisation. We gave a lot of multivitamin
tablets there for children with malnutrition and I saw a lot of those children go
slowly downhill because obviously the teaching message of more food requirement
was not really accepted by the parents. If we gave tablets then the feeling may
very well be, well we can't remember all the junk the health workers have told
us, but these tablets 3 times a day is all we need...." (7S|
When we spoke to local company managers in Bangladesh and queried the
relevance of many of their products to the country's needs, most expressed their
sensitivity to the sufferings of millions of their fellow citizens. None tried to suggest
that the major health problems were anything other than malnutrition and
infectious disease. Most argued that, so long as they were not in a position to
help the poor, what harm could there be in catering for the needs of the affluent
minority?
The Marketing Manager of Fisons (Bangladesh) Ltd expresses a view shared by
others which he gives "as a citizen of Bangladesh", "not as a vitamins seller".
He puts the question: "Why, on one hand, as a government, or as a policymaker
of my country, do you allow me to buy and drive foreign cars, enjoy foreign colour
television, put on expensive foreign clothes and smoke expensive foreign cigarettes
and on the other, forbid me to take locally produced (under foreign collaboration)
quality vitamins at locally competitive prices, specially when I think, or my doctors
think that I need to take them! ... Please consider the country's situation in its
entirety and if you cannot provide even sub-standard vitamins to everybody in
the country who needs vitamins, at least do not put a bar on those who can afford
to buy quality vitamins at lesser cost than the sub-standard vitamins". (79)
Critically, the argument hinges on how far medicines can be bracketed with cars,
televisions and clothes, if this means that placebos intended for the well-to-do
are produced at the expense of vital drugs needed by everyone, but particularly
by the poor. The distortions in production in Bangladesh and other developing
countries appear all the more acute when industry has set itself the "obligation"
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