Bitter Pills:Medicines & The Third World Poor | Page 82

But blatant discrepancies in drug information are not just past aberrations. Dr.
Silverman concludes from his more recent research that whilst "some companies
have changed their policies in Latin America ... the situation remains bad there
and probably worse in Africa and Asia". | 4 8 ) The offenders include Western
research-based companies, Eastern bloc producers and nationally-owned
companies. l491
Our own research has brought to light many examples of apparent double
standards. Two package inserts for the Roche products, Valium and Mogadon,
forwarded from Thailand in 1980 and reproduced opposite, illustrate the problems.
Like the English versions of these leaflets, the Thai translations include information
on 'composition', 'properties', 'indications', 'dosage' and 'packings'. But the
Thai versions expressly exclude the information given to English readers on
'tolerance' and 'precautions'.
Roche advise us that these leaflets "dated from 1974 and are no longer being
supplied. Subsequently, the Thai regulations have changed." (5(l) The Thai
product information leaflets now contain "warning" boxes. Roche comments:
"We should stress that in general Roche are not in favour of variations in product
information leaflets in different parts of the world." Moreover, "It is a policy
of Roche Basle to review, from time to time, the leaflets being used by Roche
companies in other countries and to examine the differences which exist. Such
a review is currently taking place." l5"
In Bangladesh Glaxo's local subsidiary has distributed promotional leaflets for
corticosteroids omitting warnings on possible side-effects, precautions and 'contraindications' (i.e. information on when not to use the drugs) which Glaxo makes
available to British doctors. The promotional leaflet for Betnovate-N (see
page 76)
stresses that the product is "unequalled in effectiveness" and that
it' 'swiftly suppresses dermatoses''. But it does not warn that prolonged use should
be avoided, particularly in infants, children and pregnant women. Glaxo advise
us that the data sheet currently in use in Bangladesh for Betnovate-N contains
a very full statement of contra- indications, precautions and side-effects, including
4 separate statements warning doctors of possible adverse results of prolonged
treatment. (52)
Similarly, the promotional leaflet for Glaxo's Betnelan oral corticosteroid tablets
specifically draws attention to their effectiveness in rheumatoid arthritis. But it
does not include specific warnings given in Britain that they should use "the lowest
dosage that will produce an acceptable result", or that the dosage should be reduced
in stages. The recommended dose for rheumatoid arthritis given in Britain is 0.5
-2mg daily.The Bangladesh leaflet, reproduced onp 77 gives the recommended
initial dose as 3 mg, reducing to 0.75 mg.l531
A tendency to keep any 'negative' information to a minimum is also evident in
advertising to the general public. The 'rosy' picture given is particularly striking
in advertisements for the high-oestrogen oral contraceptive pill, Maya, that
appeared in Bangladeshi newspapers during 1980. The distribution of Maya is
75