This little book documents the successful efforts of the authors to persuade the U.S.-based multinational drug company, G.D. Searle, to amend its third world marketing policies for the antidiarrheal drug Lomotil (MM, December, 1981).

But this is more than a narrow case study; Medawar and Freese, consumer activists in Britain, use the Searle case to illustrate the woeful failings of the pharmaceutical industry - "an industry unable to face criticism, . . , incapable of facing facts."

Drug Diplomacy deals primarily with the questionable usefulness and potentially dangerous side effects of Lomotil when given to children under the age of two. Adverse reactions to the drug, particularly among infants, include nausea, numbness of the extremities, anorexia, and comas, according to the Physician's Desk Reference.

Since 1973, the U.S. Food and Drug Administration has contraindicated Lomotil for children in the U.S. under the age of two. For other users, it is available only on prescription and must carry a warning regarding dosage.

In developing countries, by contrast, Lomotil was given to infants only three months old with no warnings on dosage hazards and no prescription requirements, the authors report.

When the authors met with Searle officials to discuss the problems associated with Lomotil, the company representatives exhibited a "wholly improper bias in favor of Lomotil" in which they could "perceive only the legitimacy of their own purpose."

Searle did agree, however, on September 28, 1981, to change its labelling policy on Lomotil "to indicate clearly that Lomotil should be used for the adjunctive treatment of diarrhea and is not recommended for use in children under two years old," according to an agreement signed by Searle officials and Medawar and Freese.

If there is one weakness in this book, it is that the authors do not provide any analysis as to why the giant drug company Searle decided to capitulate to two consumer activists. This would have been interesting to readers, and helpful to organizers.

In the final chapter of the study, Medawar and Freese assess the dangers the drug industry as a whole poses for third world countries. Not only do companies aggressively market dangerous drugs, the authors say, the "drug prices they charge are extremely high... this has a very damaging effect in the third world." To combat the hazards the drug companies bring on, the World Health Organization, Medawar and Freese conclude, should adopt a comprehensive code to govern the international drug industry.

Copies may be obtained by mail from:

Social Audit
9 Poland Street
London W1V 3DG
England

- Douglas Stone

This study of the political economy of rural development is likely to become a classic in its field. De Janvry elegantly shows how an export-oriented strategy for agricultural production reinforces the political power of the local, wealthy landowners while impoverishing the mass of rural workers who used to eke out a subsistence living on the land, but who are increasingly thrown off the land to make way for "modern" commercialized production.

This scholarly book uses case studies, but presupposes some knowledge of debates within the academic literature of the dependency and Marxist schools. Although parts of the study are complex and some arguments sophisticated, readers should persevere, for this is a richly rewarding book.

- Reviewed by Guy Gran, who edited Zaire, The Political Economy of Underdevelopment.