Bitter Pills:Medicines & The Third World Poor | Page 78

in rural Bangladesh stressed to us that Iliadin drops, a nasal decongestant, were
taken by Neil Armstrong, the first man to walk on the moon. (31) Similarly a
promotional leaflet for Wellcome's Septrin makes a direct appeal to the doctor's
emotions: "If your child was suffering from a bacterial infection wouldn't you
prescribe Septrin?" This type of advertising is breakfast reading for doctors the
world over. But in the Third World there can be acute social consequences when
doctors are encouraged to overlook the relative cost of treatment between brand
name produ cts and generic equivalents or between patented products and older
medicines .
A doctor who has worked in both rich and poor countries sums up the pressures
against cost-effective treatment: "Therapeutics is largely taught in isolation from
questions of cost. Once a student has graduated he is usually granted freedom
to prescribe any drug he wishes, and the medical establishment in most countries
fight strenuously to protect the right. For the rest of his professional life the doctor
is subjected to advertising pressure to prescribe the latest types of expensive
proprietary preparations. Most of this advertising is aimed primarily at the doctor's
emotions, appealing to his sympathy for patients, his professional self-esteem,
etc. Such advertising is undoubtedly very effective." °2>
The most serious consequence of doctors' fighting for freedom to prescribe any
drug is that many in the Third World actively oppose even the suggestion that
they should be restricted to a limited selection of drugs. But it is precisely this
limited selection which, both WHO and industry agree, now offers the best hope
of catering for the needs of the Third World poor. The International Federation
of Pharmaceutical Manufacturers Associations (IFPM A), for example, has stated
that they "especially appreciate the problems that arise in those countries which
have few physicians, trained para-medical staff, hospitals or diagnostic facilities
and where distribution arrangements, particularly in rural areas, are lacking ...
In these circumstances, there is an obvious necessity to provide health-workers
with a limited number of drugs which they can prescribe with reasonable safety."
"" But here, in contrast to WHO, the IFPMA is not saying that doctors should
be limited in the drugs they prescribe - only health-workers.

"ACCURATE, FAIR AND OBJECTIVE"
According to the 1981 IFPMA voluntary code of marketing practices, one of
industry's obligations is that "Information on pharmaceutical products should
be accurate, fair and objective, and presented in such a way as to conform not
only to legal requirements, but also to ethical standards and to standards of good
taste." l34' But in the Third World, the information imparted both by sales
representatives and promotional literature is not always as "accurate" and
"objective" as it might be. The Director General of WHO has focused attention
on the problem that sales representatives "often have inadequate medical and
scientific training, insufficient knowledge of the actions of the products they
promote and of the comparative safety and efficacy of competitive products" (35'
The evidence suggests that the sales promotion of the big foreign companies
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