Bitter Pills:Medicines & The Third World Poor | Page 74

Details of manufacturers' spending on promotion in the Third World are not made
public. But Dr. John Yudkin, who studied the Tanzanian market, estimated that
the amount which "the companies spend each year on 'educating' doctors about
which drugs to use is more than the annual budget of the Faculty of Medicine,
which is used to educate doctors in every other sphere including how to use drugs
properly". (2( "
The figures suggest that there is a much greater concentration of sales
representatives to doctors in the Third World than in developed countries. Whereas
in Britain there is approximately one for every 18 doctors, in Bangladesh the ratio
is estimated to be 1:7; in Tanzania 1:4; and as high as 1:3 in Nepal, Brazil and
several Central American countries. (2 "
Sales promotion can take up a considerable amount of a doctor's time. A 1975
report gives the example of a Brazilian senator (and doctor) who decided to test
out just how much sales activity was directed at doctors. "For 21 working days
he kept track of salesmen's visits to his clinic. He was visited on 18 of the 21 days
by a total of 69 salesmen. He was given 452 free samples of drugs (after refusing
extra quantities so as not to distort the counting); he received 25 gifts including
coffeepots, notebooks, etc.'" 221 The photograph opposite shows the promotional
handouts and drug samples accumulated by one general practitioner in
Secunderabad, India, over just two weeks.(21'
Promotion is directed at both private and health service doctors. In North Yemen
sales representatives have been banned from visiting government clinics during
the mornings, because they were found to be taking up too much of the doctors'
valua ble time. But the main prices paid for uncontrolled promotion are that it
encourages both overprescribing and a demand for unnecessarily expensive drugs.

BRAND LOYALTY
Promotion is often designed less to point out the merits of a specific drug than
to create 'brand loyalty' to the manufacturer's range of products. The emotionallycharged advertisement "The Priceless Ingredient" reproduced opposite from a
prominent position in the Bangladesh Prescriber's Guide 79aims to impress upon
doctors the superiority of Squibb products and, by implication, the notion that
doctors would be unwise to prescribe anything but drugs marketed by a big name
manufacturer.
The Indian Hathi Committee which reported on the drug industry in 1975 identified
pressurised promotion of brand image as central to the foreign companies'
consolidation of market power: "Attractively got-up medical literature and
international brand names of drugs appearing in advertisements in foreign medical
journals with which top consultants in the medical profession were acquainted,
played their part in popularising the drugs of the foreign companies. Large sums
of money were spent by foreign companies in systematically training their 'medical
detailers' [_ sales representatives ~\ and the general tone of detailing resorted to
was that their products contained 'something plus' over products with identical
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