Bitter Pills:Medicines & The Third World Poor | Page 80

and gift articles. 5. Fair distribution of stocks in rural markets. 6. Motivation
of field force with clinical reports. 7. Promotion to the fresh graduates and quack
doctors in rural markets.'' (39 ' The seven point plan for marketing another Merck
product, Syptobion, includes as point 6: "Promotion to fresh graduates and
potential quacks." (4( " It is only in the strategy for promoting Encephabol that
any specific mention is made of "Providing field force with sufficient scientific
information and clinical support".' 4 "
A British professor of pharmacology comments that "The marketing plan's
'strategy' plumbs the depths when it urges its Sales Force to undertake 'promotion
to the fresh graduates and quack doctors' ". | 4 2 ) E. Merck in West Germany have
expressed surprise at our queries about their marketing strategies and assure us
that "In Bangladesh, all our pharmaceutical products are promoted only to doctors
and we always take care that our field force is provided with full information
on their properties and use". 14 ' 1

PARTIAL INFORMATION
Some manufacturers are not always consistent in the standards they operate from
country to country in the critical area of drug information. In the next chapter
we focus on potentially dangerous double standards in the promotion of drugs
like anabolic steroids and antibiotics in poor countries. First we shall consider
why Third World doctors need to be sceptical about some of the claims made
in promotional literature, particularly when these are not balanced with
precautions on use or warnings of unpleasant and serious side-effects.
A number of studies have documented the widespread problem of substandard
drug information in the Third World. For instance, a report by Dr. Milton
Silverman of the University of California published in 1976, showed that only
2 out of 23 manufacturers were consistent in what they told US and Latin American
customers about their products. In the US most product literature consisted of
a relatively short list of recommended uses for a drug, balanced with an extensive
list of precautions and possible side-effects. But in Latin America identical
products were recommended for many more uses, and warnings were conspicuous
by their absence.l441
The explanations advanced by manufacturers at the time included the fact that
legal requirements are different in different countries so there is nothing 'illegal'
about not disclosing all warnings that must be given on the home market. |451
Some manufacturers explained that they had accumulated "a wealth of convincing
evidence to show that our product is safe and effective for the conditions we claim.
Unfortunately, the evidence is not convincing to the FDA [ US Food and Drugs
Administration ] . What we have ... therefore is a dispute between honest
scientists." (461 And a Latin American "drug promotion expert" saw the
discrepancies as part of normal business practice: "... if your competitor claims
five indications for his product, you claim at least six. And if he discloses three
adverse reactions, you are senseless if you disclose more than two.'" 471

73