BRITAIN is supporting international moves to ensure that the poor in the third world get the essential medicines they need and to efiminate unethical and dangerous marketing practices. Much more needs to be done in both rich and poor countries before these aims can be fulfilled. Uvedale Tristram reports.
IN MAY the British Government supported a resolution at the World Health Assembly in Geneva calling for urgent reform. Out of total health expenditure, poor countries allocate proportionately more for drugs than many rich nations, but the funds are still far too small to meet actual needs.
In addition, the private drug market in the third world has been rapidly expanded, with a concentration of retail pharmacies in the cities mostly run by nonpharmacists.
Medicines which can only be obtained on a doctor's prescription in developed countries are freely available over the counter or from street traders in poor countries. The type of drugs marketed in the third world often bears no relation to the most pressing disease problems and placebos are available in wasteful abundance.
Early in June, three distinguished doctors together with an Oxfam representative met the Minister of Health, Kenneth Clarke to urge rapid action to back up Britains World Health Organisation vote. The three doctors were Sir John Crofton, Emeritus Professor of Respiratory Diseases at Edinburgh University, Andrew Herxheimer, a lecturer at Charing Cross Hospital Medical School and editor of the Drugs and Therapeutics Bulletin and Martin Schweiger, Senior Registrar in Community Medicine for the Yorkshire Regional Health Authority.
They presented the Minister with a rational health declaration signed by more than 2,400 health professionals and overseas aid campaigners which calls on the Government to work for a code of conduct for pharmaceutical companies selling medicines in the third world.
The WHO assembly has proposed setting up a group of experts to examine drug marketing practices, and the doctors have pressed the Government to provide financial support for WHO's action programme on medicine marketing and distribution and also for developing countries which are adopting essential drugs policies.
These activities have fed to a series of parliamentary questions and an early day motion signed by over 160 MPs.
At a recent meeting in the House of Commons, Dr Ernest Laurisden, the Danish physician who is the manager of the WHO action programme was the key to the success of the organisation's stragegy of "Health for all by the year 2000." He said it was essential for the big drug companies to be closely involved.
"The industry's decision on research and development determine to a large extent whch drugs we shall have in the future," he said. "Its marketing and promotion exert a big influence on drug consumption and its pricing policies govern the degree to which essential drugs and vaccines will become available to ever larger segments of the world's population.
Hundreds of millions in the third world have no access to the most important medicinal drugs. Many poor countries have been spending 20-30 per cent of their national budgets on pharmaceuticals, much of this expenditure largely useless.
In 1977 WHO called together a committee to define which drugs were really necessary to deal with most health problems and the committee concluded that about 200 drugs were essential for good therapy.
The list, which was greeted with surprise, indignation and opposition from some drug companies and some doctors who claimed it interfered with their right of free prescription now contains about 220 essential drugs. More than 80 countries have adapted the list to their own needs.
The, programme is designed to make essential drugs available to all through primary health care.
"Unless a limited number of these drugs can be regularly delivered to rural areas and to the big city slums, WHO's whole ambitious strategy of Health for all by the year 2000 will face partial or even total disaster." said Dr Laurisden.
"I believe history will judge us harshly some ID to 20 years from now if we have such wonderful drugs and vaccines but fail to put our best talents to work on finding new ways of making them available to the many hundreds of millions who desperately need them".