Bitter Pills:Medicines & The Third World Poor | Page 50

of producing drugs that "have full regard to the needs of public health". (8I1>
Dr. Mahler, Director General of the World Health Organisation, is one of a
growing number of people to have reached the clear conclusion that "We can
no longer treat these vital components of people's health as normal commodities
in the market-place. They have to be taken out of the market-place, and other
ways may have to be found to produce these essential drugs." |8 "
But apart from the difficulties of treating medicines as any other commodity,
more holes can be knocked in the argument that the production and marketing
of non-essential drugs does not really hurt the poor. As the ICSS and ICMR point
out, it is misleading to suggest that only the well-off consume these unnecessary
drugs. "They have a demonstration effect which misleads the poor also and
becomes an additional channel for their exploitation." (821
The poor are encouraged to buy multivitamin tonics and other non-essential
products. These are routinely prescribed by doctors and chemists and are often
bought at the expense of useful treatments. Some of the hard-hitting facts are
revealed by a study of precriptions given to a sample of 90 women patients at
an Indian hospital. This showed that when these women returned for treatment,
only 26 had been able to buy all the medicines prescribed on their first visit; 27
had not had enough money to buy more than the first two items on the prescription,
which were almost invariably a tonic and vitamin B-complex; 37 had been too
poor to buy any of the drugs prescribed. |8 "
Of those who had bought all the drugs prescribed, four had had to borrow money;
some even used the cash they had been paid for being sterilised; one found the
money by economising on what she bought with her son's daily wage of 4 rupees
(about 20 pence). She had been prescribed two tonics and vitamin B-complex
capsules. Almost all the prescriptions were identical; with tonics, vitamins and
aspirin at the top of the list, and the important treatment often appeared in only
about fifth position. Most of the drugs prescribed were well known brands. (841
Turning back to our review of the product range of leading foreign manufacturers
in Bangladesh, we discussed the wastage of a poor country's resources on nonessential drugs with the Association of British Pharmaceutical Industries. They
advanced the argument that manufacturers in Bangladesh are merely catering to
demand, and not actively creating the market for non-essential products. (8S| This
is not a view shared by Dr. Hye, the former Director of Drug Administration
in Bangladesh, who states categorically: "Manufacturers are responsible for
creating the demand for non-essential drugs in the first place and they are
stimulating it with promotion sometimes even with forced sales." (86)
An insight into how demand can be create d is given by the "Merck in Bangladesh
Marketing Plan 1980(-1982)" of the local branch of the West German
manufacturers, E. Merck. This reveals that they at any rate have little doubts about
the effectiveness of promotion in creating demand. Merck's biggest selling product
on the local market in 1979/80 was Neurobion, (containing vitamins B1, B6 and
B12).(871 According to the Marketing Plan, Neurobion alone accounts for over
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