Health Activists Seek U.N. Code on Drug Company Marketing Practices

Regulating multinational corporations is never an easy task, but delegates at the May annual meeting of the World Health Assembly in Geneva took a small step toward that goal. With encouragement from the international consumer organization, Health Action International, the delegates stressed the need for developing an international code to curb misleading and dangerous marketing practices by multinational pharmaceutical companies.

The World Health Assembly is the governing body of the World Health Organization (WHO), a specialized agency of the United Nations having its own funding and an independent membership of 157 countries.

Prior to the meeting, Health Action International was concerned that the WHO was backpedalling on a commitment it made in 1978, when it established an Action Programme on Essential Drugs. The mandate of the Programme was "to study how prices of pharmaceutical products are determined and possible strategies for reducing such prices, including the development of a code of marketing practices with special emphasis for the populations of developing countries."

But when the WHO submitted a progress report on the Action Programme to the World Health Assembly, it omitted mention of the code - the only major item neglected. This signalled to Health Action International that the WHO was willing to abandon quietly the development of a pharmaceuticals marketing code, even though the WHO itself acknowledged in its 1982-83 budget proposal that "abuses" in pharmaceutical marketing "are widespread and well-recognised."

To salvage the code idea, Health Action International sent nine representatives to the Assembly, and published a booklet on the code to distribute to delegates.

A number of delegates from diverse countries took up the call for the code: Chile, Cuba, Ghana, Holland, Romania, Samoa and Sudan all stressed the need for controls to protect developing countries from unethical industry practices. The Netherlands representative, for instance, told the Assembly that the "problems such as misinformation, incorrect advertisement, defective products [and] the introduction of inappropriate technologies" that the pharmaceutical industry causes suggest "the need for an international code on the marketing of pharmaceuticals." The Netherlands delegate added that "it would no doubt be very difficult to develop such a code - but the challenge was worth meeting, in order to progress towards the just and honest goal of health for all."

On May 13, the World Health Assembly passed a strongly-worded resolution urging the WHO to implement the Action Programme "in its entirety" - including the study of a

"This call for the full Programme to be implemented opens the door for urgently needed controls on pharmaceutical marketing," Health Action International announced in a press release on May 13, adding that the passage of the resolution relieved pharmaceutical marketing code. "earlier fears that WHO's inconclusive discussions with the drug industry had blunted its resolve for action."

The pharmaceutical industry, for its part, is vehemently opposed to a WHO marketing code. The president of the U.S. Pharmaceutical Manufacturers Association, Lewis Engman, has denounced proponents of the code. "The ultimate concern of at least some of the people behind the campaign for a WHO pharmaceutical marketing code is not the health of Third World consumers," said Engman in a speech last September. "The code movement," he explained, "has as its real goal the redistribution of wealth worldwide and the seizure - by political force if necessary - of economic power by those with no respect for the profit incentive and the rights of private property on which our society is based."

The Reagan Administration backs the pharmaceutical industry position on the code. The U.S. government is "irrevocably opposed" to a WHO marketing code, said the director of the office of international health at the U.S. Department of Health and Human Services, Dr. John Bryant, in an interview with Scrip.

In an apparent effort to defuse the issue, the International Federation of Pharmaceutical Manufacturers' Association issued its own voluntary Code of Pharmaceutical Marketing Practices in September, 1981. Health Action International denounced this industry code in a pamphlet it distributed to the delegates of the World Health Assembly. The industry proposal is "conspicuously unconvincing," Health Action International said, arguing that "it lacks elementary monitoring and enforcement provisions. It is no substitute for a meaningful WHO code on drug marketing practices."

Virginia Beardshaw is a senior researcher for Social Audit, Ltd., a London-based action research organization. Charles Medawar is the director of Social Audit, which is a part of Health Action International.