Bad Medicine: The Prescription Drug Industry in the Third World

Bad Medicine: The Prescription Drug Industry in the Third World

Bad Medicine: The Prescription Drug Industry in the Third World

Bad Medicine: The Prescription Drug Industry in the Third World

Synopsis

The pharmaceutical industry has long and vehemently insisted that it has the willingness, the dedication, and the ability to police itself to insure that the public will not be unnecessarily harmed or defrauded. As the record shows with painful clarity, however, virtually no industry or professional group has ever adequately policed itself, and the pharmaceutical industry is no exception. Where the most flagrant abuses have been exposed and corrected, major credit must probably be divided among the media that publicized the situation, consumer groups that applied pressure, government officials who took actions that were often unpopular, and individual members of the pharmaceutical industry who had the courage to face up to their social responsibilities.

In this book, the authors turn their attention to what happened in Third World countries when, because of worldwide pressures, the multinational drug companies largely corrected their notorious abuses. On the basis of painstaking research, much of it conducted in a great many Third World countries, the authors conclude that a plethora of small local firms have filled the dishonest sales channels vacated by the multinationals. The authors show in great detail how local drug firms in the Third World have taken advantage of loose regulatory practices and unscrupulous behavior on the part of regional and national health care professionals to promote the sale of dangerous or worthless drugs as remedies for diseases for which they were never intended. Warnings of bad side effects are omitted from promotional literature, drugs are sold that have not had proper trials, and drug firms have often bribed government officials, doctors, and hospital administrators in order to gain favorable treatment in the importation and sale of their products. Among the many topics treated in this book are the controversy over inexpensive generic drugs (including disclosures of fraud and bribery in the U. S. Food and Drug Administration), the actions of consumer groups, and the key role of government in preventing abuses by drug firms. The authors describe a remarkable attempt in Bangladesh, one of the poorest of all the developing countries, to develop a high-quality local drug industry. They also present as case histories reports on three extremely important drug products or groups- the dipyrones (for control of pain and fever), high-dosage estrogen-progesterone hormone products (for use in pregnancy tests), and clioquinol or Enterovioform (for treatment of diarrhea)- all of which were or still are centers of worldwide, heated controversy.

Excerpt

The pharmaceutical industry has long and vehemently insisted that it had the willingness, the dedication, and the ability to police itself--not necessarily to do a perfect job of policing, but to do an adequate one--to see that the majority of the public would not be unnecessarily harmed or ripped off. This was wishful thinking. Virtually no industry or professional group has ever adequately policed itself--not the Knights of the Round Table, not the medical or the legal profession, not the clergy, neither academicians nor scientists, and certainly not the media.

Where the more flagrant abuses have been exposed and corrected, major credit must probably be divided among the media that broadly publicized the situation, consumerists who applied pressure, governmental workers who took often unpopular therapeutic actions, and members of the industry itself who had the courage to face up to their social responsibilities.

Specifically, a limited number of drug companies, for a variety of reasons, have taken such responsibilities quite seriously. the record will show that a few companies--notably Syntex, Merck Sharp & Dohme, Upjohn, and SmithKline in the United States and, in recent years, Ciba-Geigy in Switzerland--have only rarely been found guilty of making unsubstantiated claims or of glossing over the hazards of their products. the most memorable explanation came from a Syntex official who once confided to us, "We have found that we can tell the truth and still make a decent profit."

As the following pages will reveal, in their promotion of drug products in developing countries, the worst offenders were originally the big multinational companies based in the United States, Europe, and, more recently, Japan. By the end of the 1980s, however, the situation had changed remarkably. More and more, it was the multinationals which had discovered that they could tell the truth and still make money. Instead, it was the local or domestic firms--many with enor-

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