Bitter Pills:Medicines & The Third World Poor | Page 71

When we had expressed interest in his work the salesman enthusiastically offered
to take us on his rounds. Evidently he saw no conflict of interests in regulating
drugs in the mornings and promoting them in the afternoons. He described his
job as handing out free samples and lavishing praise on whatever drugs he was
asked to promote. He had had some training as a salesman, none in medicine
or pharmacology. He candidly admitted that his understanding of medicines was
minimal.'''
In this chapter we look into promotional practices in the Third World and their
impact on the poor. One analyst has commented that, on the logic of the free
market system, industry is "condemned" to promote its products. <41 The
Association of the British Pharmaceutical Industry explains: "It is necessary ...
for the manufacturer, operating as he does in a keenly competitive industry and
serving professions for which freedom of choice is essential, to draw attention
to the existence and nature of a particular product; for example by appropriate
promotional measures and the dissemination of further knowledge and experience
gained in widespread use.'" 51

THE COSTS
From the perspective of the poor, the logic of the market is costly. Promotion
adds to manufacturers' costs, so these have to be passed on to the patient in higher
prices. The United Nations Centre for Transnational Corporations states that
' 'The amount of money spent on promotional competition in the pharmaceutical
industry is extraordinary. Approximately 20% of all drugs sales at the
manufacturer's level goes for promotion".' 6 ' It is estimated that in Colombia the
money spent each year by foreign companies on marketing their drugs adds up
to more than half the country's national health budget. (7)
Promotion aims first and foremost to encourage sales. But it can be very helpful
to prescribers, as two senior pharmacologists point out: "The pharmaceutical
industry plays a very important role in providing information on drugs to the
medical profession and doctors have come to rely heavily on such information
in the choice of a drug." l81 Consequently, promotion can determine what doctors
prescribe. This is illustrated by research carried out in Switzerland which found
a close relationship between drugs that are heavily promoted and drugs that are
heavily prescribed. The study concluded that prescribing 'freedom' is something
of a myth because although they prefer not to admit it, doctors are clearly swayed
by promotional pressures. l91
According to these two pharmacologists, the evidence suggests that "heavy
promotion has to a great extent been responsible for excessive and irrational
prescribing" - problems that are all the more acute in the Third World.(10) After
all, no one could expect a salesman to point out to doctors that a rival product
to the one he is promoting, costing far less, is likely to be equally effective. Nor
is it realistic to expect salesmen to discourage doctors from reaching for the
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