Bitter Pills:Medicines & The Third World Poor | Page 93

concurrently. They included two different forms of injectable penicillin (neither
sufficient for a full course), two eye ointments, a nasal decongestant and a drug
for vertigo. Not one of these free samples was any use for treating bilharzia.(S("
In North Yemen research carried out in the remote mountainous region of Raymah
unearthed 'free samples' stocked on the shelves of local drug sellers.(81) In the
capital, the practice of taking advantage of free samples avilable from drug
manufacturers has been institutionalised. Companies are required by law to hand
over 20% of all samples imported into the country to the Ministry of Health. They
are earmarked'' for the stores of the General Office of Pharmaceuticals and Medical
Supply in the Ministry of Health to support government drug services".(82)
From Tanzania, Dr. Yudkin reported that samples have been used by sales
representatives as a means of creating demand for th eir products within the health
services. In this way they have effectively by-passed centralised controls on drug
purchases. "Along with the donation of a free sample to the doctor usually goes
a box or bottle of the drug to the hospital pharmacy, and a message to the doctor
that the drug is available in the pharmacy. This may happen whether or not the
drug is approved by a Hospital Pharmacy Committee, or even if it is a nonscheduled drug (one which is not included in the Central Medical Stores List).
When the doctor prescribes the drug, the pharmacist dispenses it, and will often
order more when the doctor continues to prescribe and the free sample has been
consumed.'"" 1

SLEDGE-HAMMER THERAPY
Overprescribing by doctors, health workers and drug sellers is a worldwide
epidemic. But it hits the Third World hardest. There are many causes, including
uncertainty over diagnosis, lack of training in alternatives to medicines, patientdemand and, as we have seen, the fact that prescribers often have a direct stake
in selling more drugs. In each case advertising aggravates the underlying problems.
We know of numerous specific cases of overprescribing from many very different
developing countries.
A classic example from North Yemen is that of a patient referred to a doctor in
the town of Hodeidah by a rural clinic with a note recommending that his nasal
arteries should be cauterised to stop his nose bleeds. He needed no medicines.
Two days later he returned to the rural health centre. He was still suffering from
nose-bleeds. The straightforward cautery had not been performed. But, over the
two days he had spent in the town, he was prescribed 12 different drugs by one
qualified doctor. These included a total of 1,000 ml of intravenous fluid (both
sodium chloride and dextrose); antibiotic injections (Pfizer's Terramycin); 3
different brands of vitamin injections and multivitamin tablets (15 of Bayer's
injectable vitamin B-complex, Campovit; vitamins A and C; and Roche's Cal-CVita); two injectables to stimulate blood-clotting (vitamin K and Luitpold-Werk's
Clauden); Otrivin nasal drops, and Hoechst's painkiller, Novalgin, in both tablet
and injectable forms. This prescription was not the end of the story. The man
returned with a bulging carrier bag full of drugs which also contained a further
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