Bitter Pills:Medicines & The Third World Poor | Page 51

68% of the total market in neurotropic preparations. The marketing strategy
outlined in the Plan states: "Our objective will be to achieve at least 75% market
share by intensifying more promotional effort..." and that "remarkable results
can be achieved by motivating field force''. The Marketing Plan also reveals that
the "major threat" to business "is that the government may ban import of one
or more of our fast moving items". Thus a key strategy will b e ' 'to maintain very
good relations with government officials in Health and Commerce Ministry to
guarantee importability for our products". <88)
Merck's promotional strategy has obviously paid off. According to Dr. Hye, the
popularity of Neurobion (in its injectable form) is demonstrated by the fact that
in 1980 £77,777 worth of the product was imported. (89) This was equivalent to
1.94% of total imports of all finished drugs in 1980. (90)
Poor countries like Bangladesh have enough problem with the adverse balance
of trade without having to foot the bill for imports of non-essential finished drugs.
(91)
But the unnecessary drain on foreign exchange is not confined to drugs in final
dosage form. The value of imported raw materials in 1980 was 38 times greater
than that of finished drugs. (92) To take the raw materials imports of one
company alone, commenting on the situation in 1980/81 Dr. Hye writes: "Almost
40% of the foreign exchange allocation to Fisons (Bangladesh) Ltd for the import
of pharmaceutical raw materials is used up for making non- essential, practically
useless preparations." (93)
But the non-essential medicines produced with these raw materials are not only
draining valuable foreign exchange, they are also taking up limited production
capacity that could be used to produce the drugs the country really needs. In the
words of the Expert Committee reporting to the Bangladesh Government on drug
policy in May 1982: "Though the multinationals have all the technologies and
know-how to produce sophisticated essential drugs and basic pharmaceutical raw
materials, in Bangladesh these companies are engaged mostly in formulation of
simple drugs including many useless products such as vitamin mixtures, tonics,
gripe water etc." (94) As a result 90 of the 182 essential drugs needed for the public
health services are not produced at all in Bangladesh. (95)
The situation in Bangladesh is not unique. Other detailed case-studies in very
different developing countries have shown up similar problems in production and
wide-scale promotion of drugs which are far removed from priority needs. An
illustration of this comes from the research carried out by a French pharmacist
into the products marketed in Mexico by the three Swiss pharmaceutical giants.
Of 165 products marketed in Mexico in 1978 by Roche, Ciba-Geigy and Sandoz,
only 36 were drugs included in Mexico's selection of 426 drugs essential for public
health care. Of these 16 were formulations on the WHO Essential Drug List.(96)
But some of their top-selling products were hardly 'essential'. <97) For example
as much as 62% of Roche's sales turnover in Mexico in 1978 was made up of just
5 products. (98) One of these was Cal-C-Tose (a chocolate-flavoured mixture of
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