Bitter Pills:Medicines & The Third World Poor | Page 91

prices of the drugs.'' (67) In one specific case a doctor, on the island of Samar, was
offered two Ford cars by a drug company to encourage him to set up a pharmacy
selling exclusively their products. His store would have had a total monopoly on
sales, as he was the town's only doctor and there were no pharmacies. ">S|
From Indonesia a doctor reports that bonuses are paid to doctors and even
government officials receive both impressive discounts and special gifts from drug
companies.'691 In Bangladesh, as elsewhere, the transnational companies support
doctors' travelling expenses to attend seminars and meetings abroad.' 'These are
disguised as neutral scientific gatherings," explains the former Director of Drug
Administration,' 'but are in fact meetings sponsored by big companies to promote
their special products. This makes it possible for them to offer 'paid holidays
abroad' as gifts to doctors who 'matter'." (70) In some cases influential doctors
have a direct stake in a company's profitability. (7I)
The evidence suggests that the big transnational companies are by no means the
worst offenders in using over-zealous sales promotion tactics. An article in :i
Business India magazine quotes a "knowledgeable wholesaler based in Bombay's
Princess Street" as pointing out that "It is mainly the Indian sector companies
that give expensive gifts like cars and refrigerators to class A doctors who have
what is known in the trade as a 'prescription following'. The multinational
companies with their established brand names don't have to be so lavish." (7:'
It is not of course only manufacturers that offer inducements to doctors to boost
drug sales. For example, in North Yemen doctors are known to receive a 10%
commission from drug retailers who dispense their prescriptions.(73) Throughout
the Third World it is not only business interests - manufacturers, wholesalers and
retailers - that profit from sales of prescription medicines. Doctors and sales
assistants often have a direct stake in sales and an obvious incentive to
overprescribe.
An OXFAM Field Director comments on the situation in Brazil: "... pharmacy
salesmen make commissions on over-the-counter sales to boost their meagre
salaries. Hence, they try to push the most expensive drugs onto customers, which
are often inappropriate. Doctors also receive commissions, sometimes from
pharmacies, on the basis of patients and drugs turnover." (74'
At the receiving end, the poor end up paying for unnecessarily expensive
treatments. An anthropologist who investigated the money spent by people buying
medicines over the counter in a town in El Salvador, found that the companies'
promotion and distribution methods were directly responsible for unnecessarily
high spending on medicines. The poor were most dependent on over- the-counter
sales from the drug stores. The most expensive treatments were those recommended
at the town's two pharmacies which depended on travelling sales representatives
for their supplies. Customers who asked for advice in these pharmacies ended
up paying on average 260% more than those who consulted the sales staff in the
town's two other pharmacies, supplied directly by wholesale pharmacies in the
capital.1751
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