Bitter Pills:Medicines & The Third World Poor | Page 92

This grassroots research into the economic consequences of company promotion highlights the fact that when salesmen depend on commissions, poor patients are more likely to end up paying unnecessarily high prices for treatment. The basic monthly pay of the travelling salesmen in El Salvador was very low. But they could earn 6 to 7 times more with sales commission. If pharmacies failed to place big orders for a wide range of products, the salesmen would no longer find it worth their while to include them on their sales trips. With their drug supplies at stake, the pharmacies were under pressure to stock a wide range of expensive products. As a result sales staff "used the opportunity presented by customers seeking advice to unload products which in many cases would not sell quickly because of their higher prices". (761 Compounded with this, when the sales staff behind the counter earn a percentage on sales, it is in their interests to sell higher-priced brands. BY-PASSING THE SYSTEM There are a number of reports of ways in which sales representatives have been able to get their products bought for the health services when these drugs are excluded from the national formulary. For example, Dr. Yudkin observed these pressurised sales tactics in action in Tanzania: "Doctors above a certain rank are allowed to prescribe non-scheduled drugs at their discretion, and representatives offer to help by taking local purchase orders to the Medical Stores to facilitate ordering. These orders are frequently of great cost but little use; one representative for A. H. Robins persuaded a doctor at a district hospital to order 300 bottles of Dimetane (a cough syrup), 300 of Robitussin (another cough mixture), and 120 of Donnagel (a mixture for treating diarrhoea) with the offer to take the local purchase order to the Medical Stores. The cost of this order .... would supply a dispensary with enough drugs for three years." |77' (our emphasis) SAMPLES ABUSE A major element of sales promotion in the Third World is the lavish distribution of free samples. Whereas guidelines in developed countries stress the need to restrict the distribution of samples to a minimum, in poor countries large quantities are offered and snapped up by doctors who can sell them profitably.<78) For example, the Hathi Commission reported that in India, "Unfortunately, this practice of distributing samples has degenerated into a rat race among manufacturers, each trying to excel the other in the quantity of drug samples distributed to doctors. The scale of distribution of samples ... leads to malpractices. Reports have been received of physicians' samples being found on the premises of drug dealers. "(79) There is evidence of the wasteful and dangerous misuse of free samples from many developing countries. A nurse reports from Upper Volta that samples usually contain too little of a drug to provide a complete course of treatment. But this does not prevent them from being used indiscriminately - by people in need of drugs, but not because the free sample is what they actually need. For example, one man suffering from bilharzia was delighted to have been given six different free samples by a friend working in a hospital. He was taking all of them 85