Bitter Pills:Medicines & The Third World Poor | Page 87

subsidised by Population Services International and the local subsidiary of Fisons
has been involved in repackaging and distributing it locally. The advertisement
reproduced on p. 78 ,"From dreams to reality", which appeared in the Bangladesh
Times, fails even to hint at the possibility of side-effects from the use of the highoestrogen pill. But even more disturbing is the fact that a promotional leaflet was
circulated to the medical profession bearing the name of Fisons (Bangladesh)
omitting any warnings of possible side-effects or precautions for use. (541

CURE-ALLS
In Britain each 'indication' (or recommended use) of a drug has to be approved
separately. This is not the case in developing countries, such as Bangladesh.(551
Manufacturers appear on occasion to have taken advantage of these loose controls,
and the fact that few doctors have easy access to independent drug evaluations,
to claim indications for their products that are not accepted on the home market.
For example, in Britain the only uses Glaxo recommends for its vitamin B12
preparation, Cytamen, are "pernicious anaemia" and the "prophylaxis and treatment
of other macrocytic anaemias associated with vitamin B12 deficiency".l561 But the
promotional leaflet from Bangladesh, reproduced opposite, recommends its
use for a wide variety of problems, inducing "poor appetite", "poor growth"
and "sterility''. We understand from Glaxo that the data sheet in use in Bangladesh
since March 1980 does not include any of these indications, which would make
the advertisement out of date.
At the time of going to press we have no comments from Glaxo on why these
extra indications were ever included. But Glaxo did respond to an earlier query
we raised about their promotion of Calci-Ostelin syrup as a general tonic in another
developing country, when not only does Glaxo not do this in Britain, but the British
National Formulary describes this use as having "no justification".' 571 Glaxo's
Senior Medical Adviser responded then by stressing that "different countries"
have very ''different concepts of medical practice''. (58) If people in developing
countries want to use vitamin B12 as a general tonic, why should we stand in their
way? - was the gist of the argument. What it ignored was the manufacturer's role
in creating this demand through its own promotion in the first place.
It may require some effort to sift through all the indications claimed for just one
product. For example, E. Merck's top-selling product in Bangladesh - Neurobion
(containing vitamins Bl, B6and B12) - is promoted for a wide range of uses, as
illustrated by the advertisement on page 82
. A British professor of clinical
pharmacology commenting on this variety of indications points out that the
individual vitamins in Neurobion are certainly useful for some specific nerve
disorders. For example, vitamin Bl is effective for treating the nutritional disorder
beri-beri, which causes peripheral neuritis (nerve inflammation). One specific form
of drug-induced neuropathy, caused by the anti-tuberculous drug isoniazid, does
respond to vitamin B6. But it has no effect on many other types of drug-induced
neuropathy. Vitamin B6 is also taken by women suffering from depression
associated with oral contraceptives and Vitamin B12 is useful for neuropathy
connected with pernicious anaemia. (S9)
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