Healthy Skepticism International News
December 2003
Our beginning
Excerpt from a letter from Peter Mansfield to his father Richard Mansfield written during his final year medical students elective in Bangladesh in early 1982:
I’ve been keeping very busy these past weeks with ward rounds, reading up on paramedics, WHO publications, etc, and a little informal research on what the drug multinationals are doing here. They are very immoral! Hope to put pressure on them as part of the current international campaigns. In the meantime it is a very effective way to learn about side effects and contraindications of drugs.
Our first letter for recruiting subscribers, September 1983:
Medical Lobby for Appropriate Marketing Inc.
EDITORS
Dr Ian Gust - Virology, Fairfield Hospital
Dr Ken Harvey - Microbiology, Royal Melbourne Hospital
Professor Gary Kneebone - Paediatrics, Flinders University
Professor Ian Lewis - Paediatrics, University of Tasmania
Professor Peter McDonald - Microbiology, Flinders University
Professor John Shaw - Pharmacology, Sydney University
Dr Victor Lim - Microbiology, Universiti Kebangsaan Malaysia
22 Renaissance Arcade ADELAIDE SA 5000 Australia
1st September, 1983.
Dear
I believe you may share my concern about international marketing of products causing danger to health in the Third World.
The Medical Lobby for Appropriate Marketing offers a practical response to a major problem.
Supporting us will cost you 5 minutes each month.
Please read the pamphlet.
Regards,
Dr Peter Mansfield B.M.B.S.
MLAM AIMS
To inform Doclors, Pharmacists and the public about inappropriate international marketing causing danger to health in the Third World. To create an informed lobby to encourage transnational companies to Improve their marketing practices.
The first MaLAM letter, November 1983:
Medical Lobby for Appropriate Marketing Inc.
EDITORS
Prof. Felix Bochner - Pharmacology, Adelaide University
Dr Ian Gust - Virology, Fairfield Hospital
Dr Ken Harvey - Microbiology, Royal Melbourne Hospital
Dr Basil Hetzel - Human Nutrition, CSIRO
Prof. Garry Kneebone - Paediatrics, Flinders University
Prof. Ian Lewis - Paediatrics, University of Tasmania
Dr Victor Lim - Microbiology, Universiti Kebangsaan Malaysia
Prof. Peter McDonald - Microbiology, Flinders University
Prof. John Shaw - Pharmacology, Sydney University
22 Renaissance Arcade ADELAIDE SA 5000 Australia
Managing Director
Ciba-Geigy Ltd IP2
4002 BASEL
Switzerland
Dear Sir/Madam,
As a member of MLAM I am writing to express concern about Ciba-Geigy products containing amidopyrine:- Cibalgin, Espasma-Cibalgina, Spasmo-Cibalgin.
Amidopyrine, an antipyretic analgesic has been associated with severe, often fatal agranulocytosis [1] [2]. This danger has been known since 1934 and the incidence has been estimated as high as 0.86% [3]. Also “the finding that it can react with nitrate to produce the carcino-genic dimethylnifcrosamine is another cogent reason for prohibition of its use in medicine” [4].
In August 1977, Ciba-Geigy announced “intention to reformulate all products containing amidopyrine before the end of the year” [5]. However, Ciba-Geigy still listed amidopyrine in MIMS Africa, published in March 1980 and in Middle East MIMS published in April 1980 [5]. Continued production by Ciba-Geigy up to October 1979 and wholesaling up to November 1980 has been reported in the Philippines [5].
Ciba-Geigy has replied to criticism with the statement that “recall action has not been requested and was judged unnecessary” [6]. However, cases such as the 27 year old British woman who developed septicaemia, jaundice, uraemia, a lung abscess and gingival and mandibular necrosis after taking Cibalgin in Mozambique [7] suggests that recall of Ciba-Geigy amidopyrine is necessary to prevent further suffering and death. The Third World poor do not have the resources to diagnose let alone treat iatrogenic agranulocytosis.
The onus is clearly on Clba-Geigy to ensure that Ciba-Geigy amidopyrine is no longer available anywhere. I look forward to your reply.
Yours sincerely,
N.B. Amidopyrine is also known as aminophenazone, aminopyrine and pyramidon.
(1) Pavla et a1. “Drug induced agranulocytosis, with special reference to aminophenazone”, Acta. Med. Scand.,187,pp109-115,1970
(2) Gordon-Smith. “Aplastic anaemia”, Med. Aust.,26,ppll95-1198,1983
(3) Discombe. “Agranulocytosis caused by amidopyrine, an avoidable cause of death”, British Medical Journal,ppl271-1273.1952
(4) Boyland et al. “Catalysis of the reaction of Aminopyrine and and Nitrate by Thiocynate”, Arzneim.-Forsch. (Drug Res.),23,8,1974
(5) Yudkin. “Ciba-Geigy, Amidopyrine, and the Third World”, Lancet,2(8255),plll4,1981
(6) Ciba-Geigy.“Ciba-Geigy replies to attack on Third World drug marketing”, Scrip.513,pll,1980
(7) Epstein et a1. “Agranulocytosis in Mozambique due to amidopyrine, a drug withdrawn in the West”, Lancet,2(8188),pp254-5,1980
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