Bitter Pills:Medicines & The Third World Poor | Page 97

CHALLENGING DRUG DEPENDENCE
The problems arising from promotional practices underline the need for controls
on drug marketing practices. But these alone cannot succeed unless they are backed
by concerted efforts to change the attitudes of medical students and practising
doctors. This is one of the conclusions reached by the recent Indian Council of
Social Science Research and Indian Medical Council's joint report. "One of the
most distressing aspects of the present health situation in India is the habit of
doctors to over-prescribe or to prescribe glamorous and costly drugs with limited
medical potential. It is also unfortunate that the drug producers always try to
push doctors into using their products by all means - fair or foul. These basic
facts are more responsible for distortions in drug production and consumption
than anything else. Ifthe medical pro]'ession could be made more discriminating
in its prescribing habits, there would be no market for irrational and unnecessary
medicines." W) (our emphasis)
UNCTAD question whether the all-important area of providing doctors with drug
information should be left to drug manufacturers: "It is debatable if the methods
used at present are the correct ones. In fact many of the current malpractices in
drug consumption are connected with this mode of drug promotion and highpressure salesmanship, with their many exaggerated claims of the usefulness of
the particular products and only a vague mention (if any) of possible side effects.
Ideally, this information should be provided only by professional bodies such
as medical associations in collaboration with the drug control administration,
absolutely independently of interested companies."{92) (our emphasis) This is of
course an expensive task for Third World governments to take on.
However, as a doctor in North Yemen explains, commercial pressures from drug
sellers remain a serious obstacle to rational drug use: "It takes a brave-doctor
to stand against the tide. He may refuse to see the sales representatives or be swayed
by promotional literature. But the salesmen still promote their products to the
pharmacies. They in turn put pressure on doctors to prescribe a large number
and wide range of the products they stock. The pharmacies are, after all, in a
position to destroy a private doctor's livelihood. Patients asking in the pharmacy
for the name of a good doctor, could be told: 'Avoid Dr X. She's terrible' (ie
she prescribes very few drugs). 'Dr Y, on the other hand, is excellent' (ie his
prescriptions are usually for six drugs or more)". W)
The attitudes of patients who expect or even demand to be prescribed drugs add
to doctors' difficulties. Professor Nurul Islam in Bangladesh explains that doctors
stake their professional reputation each time they decide not to prescribe any
medicine. But no one doubts the judgement of the doctor who doles out multiitem prescriptions.(94) (Professor Islam himself often writes a prescription "No
Medicine Required", to convince his patient that their condition does not need
drug treatment.)
Next, we shall explore more of the hidden dangers of doctors always reaching
for the prescription pad, and patients rushing to the market to buy medicines.
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