Bitter Pills:Medicines & The Third World Poor | Page 90

Professor Rawlins concludes that the individual vitamins "are effective in
alleviating certain specific forms of neuropathy but their use in a blunderbuss
fashion for the wide range of indications quoted... would be as inappropriate
in Bangladesh as it would be in the United Kingdom". He also states that "The
indications claimed by the company (including neuralgia, neuritis, diabetic
neuropathy) would be appropriate in patients also suffering from coincidental
malnutrition but in the vast majority of patients with these disorders Neurobion
would be valueless. Moreover, adequate nutrition would be a much more
appropirate method of treating such patients." im
E. Merck argue in defence of their claims that many patients have nerve disorders
resulting from "a sub-optimal supply of vitamins", and that the "first clinical
sign of this [ vitamin deficiency] is often in the peripheral nervous system"." 1 "
Both claims are undoubtedly true in specific cases such as beri-beri, but
neither argument supports the use of Neurobion for the specific indications:
neuralgia, neuritis or diabetic neuropathy. Merck also argue that a deficiency of
a single B vitamin is rare and that "As the diagnosis of a specific vitamin deficiency
is more expensive than a course of Neurobion ... it is again a reasonable therapeutic
decision to cover the patient by administering a combination of B vitamins". <62)
A single vitamin deficiency is indeed rare in Bangladesh where malnourished people
suffer from lack offood, not lack of vitamins. Consequently, it makes more sense
to 'prescribe' food, especially when the cost of daily treatment with Neurobion
adds up to more or less the entire daily income of a family in rural Bangladesh.(6JI

SALES INDUCEMENTS
In both developed and developing countries, manufacturers offer gifts and
inducements to doctors to prescribe their products. In Britain the industry's
voluntary code limits these to gifts that are "inexpensive and relevant to the practice
of medicine or pharmacy". (64) But in most Third World countries, the
parameters of 'normal' promotional practices are very much wider. Not all
countries even have manufacturers' associations to define and monitor ethical
standards - let alone governments that enforce controls.
Promotion in the Philippines is on a noticeably lavish scale. One doctor explains
that some "drug companies, in order to get the physicians' commitment to
prescribe only their products, offer the following incentives - a car (Volkswagen),
a refrigerator or other home appliances. A drug company has been known to get
the bank account number of physicians with a promise that within the week a
4 digit cash deposit will be added to the physician's bank account, if and when
the physician commits himself to prescribing their products." |65)
The sales inducements described by the Filipino doctor are a far cry from the ethical
guidelines laid down by the ABPI code. He also reports that some "drug companies
now employ beautiful women as drug representatives (or drug detail persons) to
advertise their products to doctors".<66) "Doctors in remote areas are encouraged
by the drug companies to sell drugs on a consignment basis. The doctors are given
20-30% discount (meaning prices that are 20-30% lower than the market value).
The doctors are told they can sell them at any price as long as they pay the designated
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