Healthy Skepticism Library item: 19896

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Lasagna L
Book Review: Prescriptions for Death: The Drugging of the Third World
NEJM 1982 Sep 23; 830

Full text:

By Milton Silverman, Philip R Lee, and Mia Lydecker

This book claims to document “drug dumping”. By this is meant the practices of shameless advertising, failure to warn about drug hazards, and “shocking campaigns to induce poor countries to suander their few healthcare rupees or pesos or shillings on uneeded tonics, costly vitamin preparations, and other luxury drugs” – all putative sins of drug manufacturers. In point of fact it becomes primarily an indictment of the miserable economic, medical, and ethical conditions of most Third World countries, with their rampant corruption, poverty, cupidity, and bureaucratic incompetence.

Developing countries spend proportionally more on drugs than do Western countries, but its not clear that they are foolish to do so, given the limited healthcare options available to them. Most developing countries bemoan their inability to get more drugs for their people. If I were a czar of a poor country plagued with malaria, tuberculosis, and a host of bacterial infections, I might well spend my total health budget on mosquito control, food, isoniazid, and chloramphenicol. The latter drug, so often vilified in the West, is cheap and easy to take, has few side effects in adults (except for very rare aplastic anemia), and works well against many bacteria. All this may explain why this antibiotic is so widely used in China; its popularity there is hardly explained by capitalistic advertising!

The many tables in the book indicate that drugs are labeled differently in different countries, but the authors fail to explore adequately the local reasons for this phenomenon. It is also disturbing to catch the authors in error, because it makes you wonder how many other mistakes there might be. For example, Parke-Davis has had a policy of uniform labeling abroad for a decade, and the Philipine insert I have seen on Chloromycetin looks exactly like the one used in the United States. What the data shows is that indigenous, non-innovative companies are much less careful about warnings than are the multinationals. The sections on generic prescribing also fail to describe adequately the appalling quality control of drug manufacture in such countries as Pakistan and India.

At first, most people are shocked to learn that ethical drugs can be bought over the counter in many countries, but it is not clear that requiring a professional intermediary is necessarily better, especially when such professionals are in very short supply. Nor is it clear what a multinational company should do if a country refuses to police such practices.