How the Drug Companies Kill One Million People a Year

People in poor countries - like many in industrialized nations appear to be convinced that there must be a curative pill for every ill, and they will spend their last rupee or peso or quetzal to buy the vitamin, the hormone, or the pain-killer that will restore themselves or their children to health. To help their babies grow, they will sacrifice their limited funds to buy an infant-feeding formula that, without clean water and proper sterilization, can kill their babies.

Much of this irrational and often emotional demand has stemmed from the enormous promotion and advertising campaigns, particularly for over-the-counter products, mounted by the drug industry and the food companies - advertising in newspapers, in magazines, on billboards, and on television and radio. Decent health care may not penetrate to every village, but advertising can.

The promotion of drugs in the Third World by most companies - though certainly not all of them - is marked by puffed-up claims of effectiveness which cannot be supported by substantial scientific evidence. In this promotion, contraindications and potentially serious or lethal adverse reactions are minimized, glossed over, or totally omitted. Essential warnings, sometimes life-and-death warnings, are not consistently given to physicians and pharmacists.

In one way or another, this kind of promotion can lead to irrational drug prescribing and drug use, and to needless injury or death. These points seem evident:

Many products ousted from the market in such industrialized nations as the United States and Great Britain, or never approved for marketing, are readily available and widely promoted in the Third World. Among these are products containing clioquinol, aminopyrine, dipyrone, and an assortment of combinations of vitamins, minerals, amino acids, and such ingredients as ginseng, arsenic, strychnine, and royal bee jelly. It should be borne in mind, however, that some products - notably those needed for certain tropical infections - were never disapproved in the industrialized nations. They were never proposed for approval.

With many important products, the dangers of serious or lethal side effects are minimized, glossed over, or totally ignored. In the case of some drugs that can produce serious injury or death, specific warnings to physicians are included in the labeling in some Third World countries but not in others.

Included here are such effects as the serious or deadly blood damage produced by chloramphenicol, aminopyrine, and dipyrone, the crippling and blindness associated with clioquinol, the growth-stunting in children and the masculinization caused in girls and women by anabolic hormones, and the serious or fatal blood clots caused by oral contraceptives. Even in the case of the identical product marketed by the identical manufacturer, appropriate warnings may be given in one Third World country but not in another.

With many of these drugs, claims of effectiveness are wildly exaggerated. For example, no adequate scientific evidence is available to support the recommended use of anabolic hormones to increase strength or enhance athletic ability, or the application of so-called tonics to increase physical and mental prowess, improve memory, enhance sexual ability, or promote a happy disposition. Perhaps more important, there is no adequate evidence to support the use of potentially damaging or deadly antibiotics for the treatment of trivial infections.

In the developing countries, the reliability of drug-labeling practices is not necessarily related to the size or type of company. Instances of irrational and potentially dangerous promotion have been apparent in the case of products marketed by some brand-name firms and by some generic-name companies, by some multinational companies and by some domestic companies, and by some based in capitalist countries and some in the communist bloc. The offending drug companies seem to demonstrate one characteristic in common, an acute deficiency of social responsibility.

Drugs may be responsible for a minimum of 10 to 15 million cases of injury and a million drug deaths annually among the more than 3 billion people in the Third World.

Because of drug company marketing practices, together with the inability or unwillingness of Third World governments to enact and enforce adequate regulations, the labeling and promotion of many products in those nations often fail to disclose hazards and to include appropriate warnings. Hospital facilities for the treatment of life-threatening reactions are rarely accessible. If these facilities do exist, they can seldom be reached in time.

Excerpted from Prescriptions for Death: The Drugging of the Third World, by Milton Silverman, Philip R. Lee, and Mia Lydecker (1982), Regents of the University of California. Reprinted by permission of the University of California Press.

Drug Promo Techniques It is believed by many, including many physicians, that advertising in medical journals and direct mailings to physicians represent the major forms of promotion used by the drug industry. These are, in fact, of relatively minor importance. The big drug firms have learned to put most of their promotion dollars into drug detailing, or frequent visits to physicians in their offices - and often in their homes. The individuals who do this work are known variously as detail men in the United states, visitadores in Latin America, company representatives or "reps" in Europe and most of the countries in Africa and Asia, and "propas" (the Japanese term for propagandists) in parts of Southeast Asia. The ratio is roughly one detail man for ten or more physicians in the United States, Great Britain, and most of the Northern European countries, one to eight in Ecuador, one to five in Colombia, about one to four in Tanzania, and one to three in Guatemala, Mexico, and Brazil. Drug company officials in Indonesia and the Philippines put the ratio at one detail man for every two or three physicians. In most developing countries, the detail men are often considered to be only salesmen. They have been repeatedly charged with exaggerating the claims and glossing over the dangers of their products, bulwarking their arguments by passing out copies of articles reprinted from journals that are actually owned or controlled by the drug company, and using rumors, innuendoes, or outright lies to run down competitive products. They have induced physicians or purchasing agents, occasionally by offering bribes, kickbacks, or other inducements, to purchase drugs in enormous quantities, with the result that some of these drugs will spoil on the storage shelves long before they can be dispensed.