The Multinational Monitor

MAY 15, 1985 - VOLUME 6 - NUMBER 5

S T R A T E G I E S   F O R   T H E   S O U T H

Prescriptions for Health

Drugs and World Health -
An International Perspective

by Charles Medawar
Available for $4.00 from the IOCU Regional
Office for Asia and the Pacific,
P.O. Box 1045, Penang, Malaysia

Drugs and World Health is a concise analysis of why more drugs don't necessarily mean improved health for the world's population. Indeed, Medawar's main thesis is that "health for all depends on fewer drugs being used less often."

Of the tens of thousands of drugs on the market today, Medawar states that approximately 70 percent are "inessential and/or undesirable." In Western countries, medication is used excessively, jeopardizing the health of consumers and wasting millions of dollars annually. In the Third World, drugs maybe used less frequently, but ineffective and harmful drugs are pervasive.

Clearly, there are cases where prescription medicines alleviate severe health problems. Nonetheless, Medawar believes the major problem is not a paucity of medicine but that medicines are used improperly.

In the U.S. alone 1.4 billion prescriptions are filled annually and 40 million people take nonprescription medication daily. This drug addict ion has lessened our willingness to rely on the body's ability to heal itself and increased our exposure, (o hazardous side effects and serious reactions.

In less developed nations, lack of strict goverment standards allows the sale of many drugs that are useless, if not dangerous. In the Philippines, the drug clioquinol remains on the market despite the fact that it has caused more than 1,000 deaths in Japan. The Filipino FDA reportedly said genetic differences between their people and the Japanese people renders the drug harmless, reports Medawar. All over the Third World precious funds are spent on medicines of dubious quality instead of 'on the basic foods and essential medicines that would lead to better health.

Medawar does not call for a moratorium on prescriptions to combat the consumption of useless and harmful drugs, though cutting back-he is convinced-would be a positive first step. Instead, he argues for the implementation of a rational drug policy to limit the number of drugs on the market.

The World Health Organization created a list of "Essential Drugs" in 1977. The list, containing only 250 drugs, includes all the prescription medicines that are needed to safely and effectively treat all but the rarest ailments. Widespread adoption of these WHO guidelines would do much to curb excessive use of medication and to rid the market of harmful and inappropriate drugs, argues Medawar. But pharmaceutical companies, doctors and governments oppose such a policy for fear it would cut profits, limit "clinical freedom," halt innovations, slash exports and unduly interfere with trade.

Medawar convincingly refutes some of these arguments: doctors regularly prescribe from a less comprehensive list; pharmaceutical companies would have to develop new and better drugs instead of variations on the same drug: governments would gain real benefits from having healthier populations and therefore would have to spend less on health care.

The WHO, however, has been hesitant to anger pharmaceutical companies by actively pursuing the essential drugs program. To lessen the influence of the pharmaceutical companies. Medawar prescribes an extra dose of consumer involvement on local, national and international levels. The goal: limiting the number of drugs available for prescribing. Although this is only a first step, it's a step that could profoundly improve health care the world over. It "is the proven answer to shortage of resources; and also provides a useful check on over-medication. It makes less likely the abuse of clinical freedom and/or the excessive promotion of drugs. It encourages people to distinguish clearly between more and less effective drug treatments, and to accept drugs for all (but no more) than they're worth," writes Medawar.

If you are concerned about the influence pharmaceutical companies have on health care policy in both the developing and the developed world. Drugs and World Health is well worth reading.

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