Healthy Skepticism Library item: 20483
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
MLAM
Round the World: From our Correspondents: Australia: MLAM
Lancet 1984 Oct 13; 861
Abstract:
There is general acceptance that inappropriate marketing of pharmaceuticals by advertising questionable indicators or neglecting adverse effects is a significant problem in the Third World – eg, anabolic steroids to attain “‘normal growth weight gain’ safe even for children and infants”. 1 Transnational corporations may not be aware of the advertising practices of their subsidiaries. The Medical Lobby for Appropriate Marketing (MLAM), based in Adelaide, Australia, now reports its first 6 months’ experience of encouraging companies to take responsibility for higher-quality information about risks and benefits of their products. MLAM believes that companies should provide adequate information about efficacy and adverse effects so that informed local decisions can be made about appropriate use of their products.
MLAM produces a monthly letter summarising a current problem with a drug or pesticide and making positive suggestions for safer marketing. The MLAM editorial board includes professors of pharmacology, microbiology, and paediatrics and spans Australia, Malaysia, Papua-New Guinea, the UK, and the USA. Active MLAM members receive the MLAM letters, sign them personally, and send them to the manufacturers.
MLAM has written about the pyrazolone analgesics (aminopyrine, propyphenazone, and dipyrone), the anti-diarrhoeal ‘Lomotil’ and breast-milk substitutes. All companies have replied. Ciba-Geigy and Winthroph denied any need to improve current practices, Nestle and Wyeth said they had improved, and Searle promised to continue improvements.
Prescott concluded that “there can be no doubt that aminopyrine and dipyrone cause agranulocytosis although it must be conceded that the true incidence is unknown and that different estimates vary widely. Since effective, less dangerous alternative drugs are available there is no case for the continued use of aminopyrine and dipyrone”. 2 Regarding aminopyrine, Ciba-Geigy “decided that the actual hazard was extremely low and hence no recall of packs in the distribution chain was necessary”. In 1976 Ciba-Geigy decided to replace aminopyrine with propyphenazone, which is chemically almost identical. A review of the literature on propyphenazone in 1978 concluded that “Published data in relation to toxicity is sparse… missing is essential data, above all valid for humans, such as metabolic pathways and elimination rates, effects of metabolites and biological half lives. Further, we are unable to obtain data about chronic toxicity, teratogenicity and side effects of therapeutic doses”. 3 Ciba-Geigy promised to answer our concerns about propyphenazone but have been unable to do so for the past 5 months.
Winthrop said, “in 1976, when the US Food and Drug Administration proposed withdrawal of dipyrone products we strongly objected”. Winthrop is “more than convinced that our dipyrone products carry a high benefit/risk ratio”. This conviction is based on an uncompleted retrospective study by Levy et al, 4 which is limited to Europe and Israel.
Jelliffe estimates that 3 million deaths each year are associated with breast-milk substitutes. Wyeth claimed that advertising violating the May, 1981, WHO code had been stopped because “in July 1983 Wyeth adopted the WHO International Code of Marketing of Breast Milk Substitutes in its entirety in developing countries”. However, the International Baby Food Action Network (IBFAN) has documentation that “the same SMA advertisements appeared in South Africa in April 1984”.
Nestle reassured MLAM that they had “always emphasised the superiority of breast feeding”. However, MLAM members who sent their letters after January, 1984, received an adjusted reply. They were told that, “as a result of intensive discussions involving UNICEF, Nestle further clarified its policies”. This is a big victory for IBFAN. MLAM congratulated Nestle on its new policy and will monitor implementation with interest.
As a result of lobbying by social audit, “Searle has revised its product labelling worldwide to indicate that Lomotil is not recommended for use in children under two years of age”. MLAM congratulates Searle for saying “thank you for informing us that ‘A Guide for Prescription’ by Sarma et al in Bangladesh, contains erroneous information on Lomotil. We will attempt to obtain a copy of this guide and request that its publisher correct this information”. However, Searle failed to provide references to support their claim that lomotil is “safe and effective” in children over the age of two.
MLAM is a non-partisan, non-profit organisation financed by membership subscription. MLAM needs more members in the First World and more sources of information about marketing practices in the Third World. Membership is open to doctors, pharmacists, groups, and the general public and costs Aus $25. Inquiries can be addressed to:
MLAM, 22 Renaissance Arcade, Adelaide, 5000 Australia
References:
1. Foo GS, et al. Anabolic steroids. IOCU. Penang, Aug 1983; 22.
2. Prescott LF. In: Dukes MNG, ed. Side effects of drugs annual. Amsterdam: Excerpta Medica, 1980: 63-64.
3. Muhlendah. Propyphenazone – Daten zur Toxizitat. Deutsche Med Wschr 1978; 38: 102-03.
4. Shapiro S. The design of a study of the drug etiology of agranulocytosis and aplastic anaemia. Eur J Clin Pharmacol 1983; 24: 833-36.
