Bitter Pills:Medicines & The Third World Poor | Page 94

four preparations of vitamin and antibiotic preparations, that were not included
on the doctor's prescription, but had been sold to him nonetheless.l8""
The tragic consequences of this overprescribing are easily apparent in poor
countries. In Upper Volta a typical prescription for a simple illness like a cough
or cold will include a cough syrup, a decongestant, vitamin injections in case the
patient is run down and sometimes even penicillin injections. Patients are generally
prescribed medicines for a whole range of symptoms, rather than for the specific
cause of their illness. An OXFAM researcher writes that "One can often see in
the always crowded Ouagadougou pharmacies people forlornly clutching their
prescriptions for a number of drugs. The assistant tells them how much each item
costs, and then the would-be buyer must decide whether he can afford all the drugs.
I f not, he must choose amongst them, and generally unless well-informed, or with
a friendly assistant, he will select the cheapest one or two.'' <85) So the poorest are
most likely to end up with the multi-vitamins, rather than the vital antibiotic.
Meanwhile, manufacturers turn a blind eye to irrational and wasteful drug use.
Some even appear to condone this tragic state of affairs. An example of this
apparent endorseme'nt of overprescribing is the advertisement reproduced
on p. 88 : "Some patients treat prescriptions like menu cards: they pick and choose
the medicines" ... "Give your doctor's prescription the importance it deserves.
Have faith in it," from Roche, "World leaders in Vitamins". The manufacturer
ignores the fact that the poor are forced to "pick and choose".
Roche comment that this advertisement placed in Indian papers during 1980 "was
not aimed at doctors and, therefore, was not expected to have any effect on
prescribing. The audience would be the literate and the better-off members of
the community and the intention was to improve the understanding of, and
confidence in, the practising physician by the patient ... Thus we do not think
it reasonable (nor do doctors) to regard such an advertisement as an appeal either
to over-prescribe or to over-consume."""" Are doctors not "literate and betteroff members" of Indian society? Can patients - above all poor patients - afford
to have 'confidence' in doctors' multi-item prescriptions?
Professor Nurul Islam, head of the Dacca Institute of Post-Graduate Medicine
and Research, stresses that virtually all doctors prescribe drugs unnecessarily and
members of the medical establishment are often responsible for setting a bad
example to medical students. Some routinely prescribe seven, eight or nine drugs.
IS7
' For example one of Bangladesh's leading paediatricians is reported to have
used this sledge-hammer approach in prescribing treatment for a 19- day -old baby,
suffering from diarrhoea. The prescription included an anabolic steroid
(Orabolin), a drug that is "specifically not recommended for children" in Britain.
'lS(i| The infant was also prescribed Flagyl (a powerful antimicrobial drug), and
two antibiotics: Beecham's Ampiclox Drops and a tetracycline preparation (a drug
not to be given to "children under 12" on the recommendation of the British
National Formulary). |(W| The baby's prescription was rounded off with the
inevitable multivitamins and Polyvison, Mead-Johnson's baby vitamin drops. I m
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