Bitter Pills:Medicines & The Third World Poor | Page 76

composition marketed by Indian units and that the edge in their quality was the
outcome of their superior expertise and international standing." (24)
This promotion stressing the intrinsic superiority of the big name producers
continues to threaten the viability of small local producers attempting to market
inexpensive generics. It also confirms the prejudices of many medical students
who leave college with a glowing respect for new drugs. This predilection is easily
reinforced by sales promotion to the point that, as a British pharmacist found
in Nigeria, "Doctors are sceptical of mycomments in favour of cheap, wellestablished, unbranded drugs and against new, fancy, inadequately documented
and expensive drugs". i : ' 1

COST IS SECONDARY?
One example of a 'new' product which was promoted to doctors in Sierra Leone
in 1980isSearle's Rehidrat. As the name suggests,Rehidrat isarehydrationsalts
preparation. Rehydration saves lives, particularly when children become severely
dehyrated through diarrhoea. Rehidrat comes in individual sachets and contains
a "special granule" to preserve its "lemon-lime flavour", as explained by the
eye-catching promotional leaflet, with its refreshing-looking lemons and limes.
But this obviously useful new product has its price. The medical volunteer who
sent us the leaflet explains: "This has made the physician specialist here furious
because the cost of a sachet to make up 250 mis of solution is 80 cents. I've found
that by buying sodium bicarbonate, sodium chloride and glucose at the local
supermarket in small quantities, but using potassium chloride from England, the
cost is just under 10 cents. Moreover, the formula which the rep said followed
the WHO recommendation for oral rehydration fluid is in fact quite different,
with more than twice as much glucose, half as much sodium chloride and also
includes citric acid. To make up the same volume of the WHO solution would
in fact cost about 5 cents" (one-sixteenth of the manufacturer's price).1261
Searle's Director of European Clinical Research stresses Rehidrat is quite
deliberately different from the WHO recommended product. Children, he
explains, may be put off by the taste of the WHO solution and some experts argue
that its sodium content is too high. (:7' He comments: "Rehidrat is made in
Norway, packaged in England, and exported and distributed throughout Africa
and Asia. It contains micro-encapsulated flavouring and is stable. When properly
reconstituted, and in contrast to the WHO soluton - it provides a palatable source
of fluid, glucose and electrolytes for the oral treatment of dehydrated infants.
Il is necesarily more expensive. In context, it costs slightly more than a bottle of
Coca Cola in such countries as Kenya, Nigeria and Zambia." 1281 (our emphasis)
But in Sierra Leone the cost of just one sachet to mix a W o f a litre of Rehidrat
is about equal to the daily wage of a poor labourer. A dehydrated child weighing
10 kilos will need about 8 times that amount of fluid in just 24 hours. (29) Cost
is crucial because rehydration saves lives. Poor families could easily improve the
taste of a basic cheaper solution by flavouring it with local fruits.l3(" Advertising
is designed to catch the doctor's interest and imagination. A salesman for Merck
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