Bitter Pills:Medicines & The Third World Poor | Page 79

maintains higher standards than that of some of the smaller local companies. For
instance, in the experience of a pharmacist working at a Nigerian hospital: "The
multinational company reps come 4 to 6 times a year. They bring the usual
gimmicks and loads of samples. They try to persuade me to buy branded products,
not the cheaper, alternative brands and they push new drugs... The multinational
reps tend to be intelligent and well-informed, and are often pharmacists or trained
nurses. The smaller firms often use less intelligent reps who sound like tape
recordings. One even showed me his 'script' to emphasize the point. It read
something like this: 'Doctor I'm sure you'd be interested in a drug even more
effective than
(old, well-established drug like chloroquine)... (wait for doctor
to agree) ... Well
(their new product) has been shown to be
" |36 '
There are also problems with sales promotion by European and US-based
companies. In a small drug store in the Bangladesh town of Rajshahi in September
1980 we encountered a Senior Field Organiser promoting the products of the
West German company E. Merck. As soon as we expressed interest in his work,
the Senior Field Organiser started reeling off the merits of Merck's products:
Neurobion, Encephabol, Iliadin drops and Pasuma Strong. He told us that the
last product (containing hormones, strychnine and other ingredients) for 'male
sexual potency', was not officially available, but added reassuringly that it was
quite easy to get hold of it in Dacca. We interrupted him, to ask what he saw as
his main duties. He replied quite simply: "to convince doctors to prescribe Merck
products". We then asked how important he saw it to inform prescribers of
problems with drug use. Would he, for example, advise them of any products
being withdrawn from the market in West Germany. He answered, with some
surprise, "No, I don't do that.'"" 1
Officials of E. Merck in West Germany advise us that "It is, of course, problematic
to draw conclusions on the activities of a pharmaceutical manufacturer by
interviewing a member of its field force. Regardless of the country in which he
practices his profession, no responsible doctor will prescribe a product without
being thoroughly informed on its indications, properties and side-effects, and
also without being convinced about the benefits of the particular product for his
patients. Your question as to whether he would advise prescribers when a product
was withdrawn in Gemany, which caused surprise to a member of our field force
in Bangladesh, is also surprising to us as none of the products marketed by us
in Bangladesh has been withdrawn in Germany." t3S) They also comment that
Pasuma has never been registered or marketed by Merck in Bangladesh and that
any packs on the market must have been smuggled into the country through
channels outside their control.
Turning now to the "Merck in Bangladesh Marketing Plan 1980(-1982)", there
is decidedly less emphasis on the need to keep doctors "thoroughly informed"
than on other aspects of promotion. For example, a seven point strategy is listed
for increasing sales of one product, Neurobion. These include: " 1 . Promotion
of Neurobion throughout the year. 2. Presentation of attractive literature with
adequate samples. 3. Presentation of prescription pads. 4. Distribution of stickers
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