Worldwide Consumer Campaign on Problem Drugs
Item
- Title
- Worldwide Consumer Campaign on Problem Drugs
- extracted text
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Health Action International
HAI-Europe
Jacob van Lennepkade 331T
1053 NJ Amsterdam
The Netherlands
tel:+31 (0) 20 683 36 84
fax:+ 31 (0) 20 685 50 02
tlx: (+402) 6105915gmalu
E-mail: (GE02:) HAI-Europe
Under strict embargo until 15 September 1993
Worldwide consumer campaign on problem drugs
Today, Health Action International (HAI), an international network of
consumer, development and health organisations, is launching Problem
Drugs, a new information pack on medicines.
Problem Drugs, written by Andrew Chetley, covers 10 categories of
medicines: antibiotics, antidiarrhoeals, analgesics, cough & cold
remedies, growth stimulants, drugs in pregnancy, contraceptives,
hormone replacement therapy and psychotropics. It contains detailed
information on the "problem drugs" currently being marketed,
recommendations for rational drug treatments, and priorities for action
which will be taken up in campaigns by HAI groups in over 70 countries
worldwide.
Overall, this information pack documents an excessive waste of
resources:
</)
*
4 out of every 5 antidiarhoeal products on the market are of no
value in the treatment of acute diarrhoea;
,
more than 4 out of every 5 cough and cold products contain
ineffective ingredients, while more than 1 out of every 2 contains
ingredients liable to cause harmful adverse reactions;
*
1 out of every 3 analgesics is a combination product, and 1 out of
every 5 contains a potentially harmful ingredient;
*
more than 1 out of every. 3 non-steroidal anti-inflammatory drugs
(NSAIDs) should be removed because of a poor safety record,
lack of significant therapeutic advantage over safer preparations,
and, in most cases, much higher cost;
*
more than 4 out of every 5 vitamins cannot be recommended;
nearly 3 out of every 5 are promoted for unproven indications;
more than 2 out of every 5 contain non-essential or ineffective
ingredients; more than 1 out of every 2 is irrationally formulated;
and nearly 1 out of every 2 contains excessive dosages.
Obsolete and dangerous drugs continue to be marketed. The pain killer
dipyrone has been banned or severely restricted in twenty-three countries
because it has caused deaths, yet it is widely promoted in Latin America,
Africa and Eastern Europe for indications like fever and pain.
- over HEALTH ACTION INTERNATION IS AN INFORMAL NETWORK OF SOME 100 CONSUMER. HEALTH, DEVELOPMENT ACTION .AND OTHER PUBLIC INTEREST
CROUPS INVOLVED IN HEALTH AND PHARMACEUTICAL ISSUES IN 60 COUNTRIES AROUND THE WORLD, HAI ACTIVELY PROMOTES A MORE RATIONAL USE OF DRUGS.
ALL DRUGS MARKETED SHOULD MEET REAL MEDICAL NEEDS, HAVE THERAPEUTIC ADVANTAGES, BE ACCEPTABLYSAFE AND OFFER VALUE FOR MONEY.
Other coordinating ILAI offices:
HAI Clearinghousc/Action for Rational Drug for Asia (ARDA). c/o IOCU, PO Box 1015, 10830 Penang, Malaysia tel: + (601) 371396 fax: + (601) 366506 telex: MA 40161 apiocu
AIS Latin America, c/o Action para la Saltid, Avda. Palermo 531, Dpto. 104, Lima 13, Pent, tel: +(5114) 712320 fax: +(5114) 712320
"People may not be aware that the drug they buy at their pharmacy or that doctors
prescribe to them has been banned for safety reasons in another country," says HAIEurope coordinator Catherine Hodgkin. "We want to make this information known and to
clearly recommend the steps needed to protect public health."
The problem, however, is not restricted to a few "bad apples". It is an inevitable result of
the way the pharmaceutical industry puts profits above health. Lack of adequate
regulatory controls and overpromotion exacerbate this situation. "The company with the
best marketing strategy often succeeds, even if its products offer no advantage," says
author Andrew Chetley.
HAI makes clear recommendations for change in Problem Drugs, pointing out the
responsibilities of users, prescribers, government and industry. To list a few:
*
Products which have been withdrawn for safety reasons in one country should be
withdrawn in all countries;
*
Governments should review the drugs on the market and remove products which
are obsolete, ineffective, or harmful;
*
Stronger controls are needed on promotion;
*
Prescribers and consumers should have access to independent drug information;
.
Uniform labelling should be adopted for drugs in pregnancy;
Above all, drugs should only be marketed if they meet a real medical need, are
acceptably safe and effective, and offer satisfactory value for money.
These recommendations, and many more, will form the basis for campaigns for better
national and international drug policy by HAI groups all over the world.
* Review copies available on request *
Chetley A., Problem Drugs, Amsterdam, Health Action International, 1993
208 pages, indexed by subject, company and drug. ISBN 90-74006-X
Problem Drugs was first published in 1986 and has been used by thousands of
health workers, educators, journalists, students and activists around the world. It
has been translated into Spanish, French, Arabic, Bangla and Indonesian. The
revised edition will also be translated into Spanish, French and Russian in 1994.
Price: Dfl 30 + Dfl 5 for postage and handling
Payments in Dutch guilders only by Eurocheque, Postal Order or credit card (VISA,
Mastercard or American Express)
For further information, please contact:
Barbara Mintzes, Press Office, HAI Europe
Jacob van Lennepkade 334 T, 1053 NJ Amsterdam, The Netherlands
Tel: (31 20) 683 36 84; Fax: (31 20) 685 50 02
Andrew Chetley (author)
24 Speedwell Close, Cambridge CB1 4YZ, UK
Tel and Fax: (44 223) 41 36 67
2
Comments on the first edition of Problem Drugs:
I problem
‘Very useful...gives us the information which cannot be ot
from manufacturers." - Tanzanian Bureau of Standards
'The recommendations are generally clear, entirely acci
and obviously necessary." - The Lancet
“Its findings, particularly with respect to the developir
countries, are disquieting.” - British Medical Journal
Health educators love it."- Health educator, Niger!
"Essential and thought provoking reading” - Nurs
A new campaign and information pack
for a more rational use of drugs by
Health Action International
revised and updated in 1993
by Andrew Chetley
Chetley, A. Problem Drugs,
Amsterdam, Health Action
International 1993
208 pages, indexed by
subject, company and drug
ISBN 90 74006 06 X
Problem Drugs was first
published in 1986 and has
been used by thousands of
health workers, educators.
pharmacists, journalists.
students and activists
around the world It has
been translated >nto Spanish.
French. Arabic. Bangla and
Indonesian. This revised
edition will also be translated
into Spanish. French and
Russian in 1994.
problem
• contains well-documented and up-to-date information sheets
on many types of drugs, including antidiarrhoeals, antibiotics,
analgesics, growth stimulants, cough & cold remedies, drugs
in pregnancy, contraceptives, hormone replacement therapy
and psychotropic drugs
• has special sections on drugs and children, women and the
elderly
• highlights examples of unethical marketing, double standards
and failure to meet real health needs
• is international in scope
• gives clear recommendations for action
Return to: Health Action International (HAI-Europe)
Jacob van Lennepkade 334T
1053 NJ Amsterdam, The Netherlands
Name
Organisation
Address
Price: Dfl 30 + Dfl 5 to cover postage and handling costs
Bulk rates: For 10-20 = Dfl 25/copy + 10% postage and handling
20-50 = Dfl 20/copy +■ 10% postage and handling
Reduced rates available for groups in developing countries,
HAI members and larger orders. Please write for details.
Please send me
copies of Problem Drugs
Dfl.
Postage and handling
Dfl.
Total
Dfl.
Please include payment with this order. Payments are to be made in Dutch guilders
(1993 exchange rate: Dfl 1 = about US $0.55), by Eurocheque, Postal Order or credit
card (VISA, Mastercard or American Express).
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problem
drugs
Health Action Internationa!
September 1 5, 1993
Children and drugs: starting the habit of a lifetime
In 1986, the US-based company, Merck Sharp and Dohme (MSD) told a UK
public interest group, Social Audit, that it would no longer promote its antihistamine
drug. Periactin (cyproheptadine), as an appetite stimulant. A year later, the company
began a string of six successive years as the recipient of Fortune magazine's "most
admired corporation" award. Among the attributes that were assessed to make up the
award were community and environmental responsibility. In 1991, MSD's Indian
subsidiary, Merind, was still promoting cyproheptadine as an appetite stimulant for
children. The product was also on the market in Pakistan and throughout Africa —
including in countries where famine conditions existed.
"This is one of the most disturbing examples of pharmaceutical industry
marketing of inappropriate and unnecessary products for children", says Andrew
Chetley, author of Health Action International's latest publication. Problem Drugs. "As
long ago as 1971, independent sources in the USA were telling companies like Merck
Sharp and Dohme that promoting cyproheptadine as an appetite stimulant for children
would do more harm than good. Twenty years later, this company still does not seem
to have heard the message."
The World Health Organization (WHO) has stated that there is no evidence that
the products being promoted as appetite stimulants have any effect on appetite, and
says these preparations "should not be used".
However, they are not the only drugs that children should not use. According to
WHO, two-thirds of all drugs used by children may have little or no value. At least $1
billion is wasted every year on inappropriate antidiarrhoeal drugs and cough and cold
remedies for children. Many of these preparations are useless and some are potentially
dangerous. Ineffective products such as antidiarrhoeals and appetite stimulants can
detract attention from effective therapies or from efforts to identify and treat the real
causes of poor growth and development among children.
The use of "brain tonics" and other substances to improve children's
performance at school is another area where money is wasted and unnecessary
products are consumed. In Peru in 1991, the Belgian company, UCB, advertised that its
piracetam product, Nootropil, would help children with "school difficulties" such as
"memory problems, difficulty learning, lack of concentration, intellectual tiredness, poor
1
Common examples of drug misuse in children
performance, agitation and
•
antibacterials for viral upper respiratory
infections
irritability". There is no evidence
•
decongestants for colds, resulting in
that piracetam can perform any of
unacceptable adverse effects
these miracles. The product was
•
drugs in diarrhoea
•
oral anti-emetics for vomiting
licensed in 1993 in the UK, but
•
antipyretic agents for fever
only for the treatment of a rare
•
tricyclic antidepressants for bed-wetting
condition that results from brain
•
sedatives for sleepless children or those
labelled hyperactive
damage, cortical myoclonus. During
•
spasmolytics in abdominal pain
1992, in the UK, three vitamin
•
appetite stimulants
manufacturers were successfully
prosecuted for claiming that their
vitamin products could increase children's intelligence.
Aside from the waste of resources, the excessive use of drugs by children has
its own health consequences. Adverse reactions to the drugs is one such consequence.
In Mexico, for example, 12% of paediatric hospitalisations were due to adverse effects
of medication. Because infants and children react to drugs in a different way from
adults, they usually need lower dosages. The exact way children respond to a particular
drug can only be determined through research and experience; however, most drugs do
not have established doses for infants and children. About three-quarters of the drugs
on the market in the USA are either contraindicated or contain strong precautions for
use in children, and 9 out of every 10 contain warnings against use by infants and
toddlers.
A long-term consequence of excessive and inappropriate drug use in children is
that they may grow up believing that drugs are the only solution to many of life's
problems. HAI is calling on health workers and governments to take action to ensure
that children do not get started on a lifetime habit of taking unnecessary medicines. It
also is calling for the removal of paediatric medicines that are hazardous or ineffective
and is urging stronger controls over the promotion of medicines for children.
— ends (680 words) —
Note to editors
This feature is based upon the information contained in sections 1B (Drugs and
children), 5A (Cough and cold preparations), 6A (Growth stimulants), 6B (Brain tonics)
and 6C (Vitamins) of Problem Drugs. Publication details are as follows:
Chetley, A., Problem Drugs, Amsterdam, Health Action International, 1993.
208 pages, indexed by subject, company and drug. ISBN 90-74006-06-X
Price: Dfl. 30 + Dfl. 5 postage and handling
Payment can be made in Dutch Guilders by Eurocheque, Postal Order or credit
cards (VISA, Mastercard or American Express).
For further information, please contact:
Barbara Mintzes, Press Office, HA! Europe
J. van Lennepkade 334-T, 1053 NJ Amsterdam, The Netherlands
Tel: (31 20) 683 36 84; Fax: (31 20) 685 50 02
Andrew Chetley (author)
24 Speedwell Close, Cambridge CB1 4YZ, UK
Tel and Fax: (44 223) 41 36 67
2
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problem
September 15,1993
Antidiarrhoeals: dying for lack of a drink
Executives from the US-based Johnson & Johnson company watched a British
television documentary in 1990 in stunned silence as, before their eyes, a child in
Pakistan died. The child died as a result of paralysis of the intestinal muscle, caused by
the world's leading antidiarrhoeal drug. The drug, loperamide (Imodium), manufactured
by Johnson & Johnson's subsidiary, Janssen, should never be used in young children.
Loperamide is only one of the many antidiarrhoeal products that should not be
given to children, says Problem Drugs, the latest publication from Health Action
International (HAD. It found that more than 8 out of every 10 antidiarrhoeal products on
the market in developing countries in Asia, Africa and Latin America were unsafe or
ineffective. As the World Health Organisation (WHO) puts it, "most medicines for
diarrhoea are either useless or harmful".
Yet four million children die each year from diarrhoea. Most of those deaths
could be prevented through better infant and young child feeding practices, better
hygiene and sanitation, and by treating the dehydration caused by diarrhoea.
It is this dehydration that causes most deaths from diarrhoea. The solution is an
inexpensive and easy to prepare drink of water, salt and sugar that helps restore
children's fluid and mineral balance. This oral rehydration therapy (ORT) costs little
more than 50 cents a child.
"The continued production and promotion of antidiarrhoeal products that detract
from effective and affordable therapy is one of today's biggest public health scandals,"
says Problem Drugs author, Andrew Chetley. "It's time action was taken to stop this
waste of resources and this loss of lives."
HAI is calling on governments to review the antidiarrhoeal products on national
markets with a view to removing all those that are ineffective and introducing bans on
products that contain hazardous ingredients.
Drugs that are singled out for removal because of safety risks include a number
of products containing hydroxyquinolines. These first came to public attention in Japan
in 1970 when an epidemic of subacute myelo-optic neuropathy (SMON) — a disease
1
1
that could cause total paralysis and blindness — swept through the country. Clioquinol
was the drug that caused the disease, but similar concerns were raised about the
adverse neurological effects of its close relatives — iodoquinol and broxyquinoline. Lack
of proven efficacy of these products in the treatment of diarrhoea makes their use even
more foolhardy. According to WHO, "there is no rationale for their continued production
and sale".
Loperamide preparations for children and paediatric preparations of a similar
drug, diphenoxylate (sold as Lomotil by G.D. Searle) are also products that are overdue
for a ban, according to Problem Drugs. In both cases, WHO has said "there is no
rationale for the production and sale of liquid and syrup formulations for paediatric
use". Following the international publicity surrounding the child deaths in Pakistan,
Janssen withdrew oral and liquid formulations of Imodium (loperamide) in many
countries; however, not all manufacturers have done the same, and several
governments are now considering bans.
The inclusion of antibiotics in antidiarrhoeal products is another dangerous
practice that Problem Drugs has highlighted. It found that one out of every two
antidiarrhoeal products around the world contained an antibiotic, while in Latin
America, it was two out of every three.
The indiscriminate use of antibiotics encourages the development of resistant
micro-organisms, alters the normal bacterial content of the gut which can lead to
possible fungal infections and the overgrowth of resistant bacteria, can increase the
risk of relapse, prolong the period when the patient with an infection can pass on the
disease, and can also interfere with subsequent bacteriological diagnosis. However, in
India in 1991, G.D. Searle produced a regular magazine, Diarrhoea Update, that told
doctors that the combination of diphenoxylate and an antibiotic was an "advantage" in
fighting diarrhoea.
Products containing neomycin, streptomycin or dihydrostreptomycin,
chloramphenicol, and/or one of the many sulphonamides are of particular concern.
According to WHO, there is no evidence that these antibiotics are effective in the
treatment of any type of diarrhoea. It says that "the production and sale of these
products cannot be justified".
The firm conclusion is that the vast majority of antidiarrhoeal drugs on the
market worldwide are, at best, unnecessary and, at worst, ineffective and sometimes
dangerous.
— ends (700 words) —
See next page for note to editors
2
Note to editors
This feature is based upon the information in the five sections of Problem Drugs dealing
with antidiarrhoeal drugs: 2A (Antidiarrhoeals); 2B (Antidiarrhoeals containing
antibiotics); 2C (Hydroxyquinoiines); 2D (Diphenoxylate); and 2E (Loperamide).
Publication details are as follows:
Chetley, A., Problem Drugs, Amsterdam, Health Action International, 1993.
208 pages, indexed by subject, company and drug. ISBN 90-74006-06-X
Price: Dfl. 30 + Dfl. 5 postage and handling
Payment can be made in Dutch Guilders by Eurocheque, Postal Order or credit
cards (VISA, Mastercard or American Express).
For further information, please contact:
Barbara Mintzes, Press Office, HAI Europe
J. van Lennepkade 334-T, 1053 NJ Amsterdam, The Netherlands
Tel: (31 20) 683 36 84; Fax: (31 20) 685 50 02
Andrew Chetley (author)
24 Speedwell Close, Cambridge CB1 4YZ, UK
Tel. and Fax: (44 223) 41 36 67
3
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Cl J PS
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Health Action international
September 1 5, 1993
Antibiotics: wasting a valuable resource
Australian microbiologist Dr Ken Harvey is worried that the global misuse of
antibiotics in humans and animals may leave us defenseless against severe infections.
"We may look back at the antibiotic era as just a passing phase in the history of
medicine, an era in which a great natural resource was squandered and where the bugs
proved smarter than the scientist," says Dr Harvey.
His concern, and that of many other experts in infectious disease control, is
outlined in Problem Drugs, a new publication from Health Action International. It points
out that the indiscriminate use of antibiotics has led to the development of bacteria that
are resistant to the standard, effective and inexpensive drugs normally used to treat
common diseases. This is described by a Dutch specialist in paediatric infections,
Ronald de Groot, as "a global problem with a major impact on health care in developed
and developing countries".
The inability to treat infections with the usual antibiotic of choice (or any other
drug) can be disastrous. In recent years, resistant strains of bacteria have triggered
severe outbreaks of gonorrhoea, dysentery, pneumonia, meningitis and deadly hospital
infections in many countries. Infections caused by resistant bacteria are more likely to
cause prolonged illness, frequent and prolonged hospitalisation and a higher death rate.
This human suffering is accompanied by financial burdens as well. In the USA alone,
the cost of antibiotic resistance has been estimated at more than $100 million a year.
There is no shortage of evidence about the misuse of antibiotics. Studies from
the USA, the UK, Canada, Italy, Australia, New Zealand, Uruguay, Nigeria, the Middle
East and Brazil confirm the indiscriminate and often unjustified use of antibiotics.
Anywhere from one-third to two-thirds of antibiotics prescribed in settings as diverse
as the USA, New Zealand and Nigeria are inappropriate.
In developing countries, more of the national health budget and personal income
is spent on antibiotics than on any other class of drug. In industrialised countries, too,
sales are high, which all contributes towards a global market of some US$22 billion. By
the turn of the century, the global antibiotic market is expected to top $40 billion.
sales are high, which all contributes towards a global market of some US$22 billion. By
the turn of the century, the global antibiotic market is expected to top $40 billion.
Antibiotics as a percentage of the total pharmaceutical market in selected countries
Country/Region
Year
Sales of
antibiotics as
% of total market
Total sales of
antibiotics
US$ million
Iran
Middle East
Indonesia
Philippines
Mexico
Argentina
1990
1989
1989
1989
1990
1990
31
29
25
23
15
12
71
100
98.9
300
177.5
In some countries, a large percentage of the antibiotics produced are given to
animals. In the USA, for example, about half of all antibiotics produced are used to
prevent or treat animal disease, or as growth promoters in feed stock. One
consequence of this extensive use of antibiotics has been the spread of antibiotic
resistant salmonella infection from animals to humans.
Whether antibiotics are used for human or animal consumption, the
pharmaceutical industry invests heavily in promoting their use. Almost two-thirds of the
antibiotic market is dominated by sales of three types of drugs: penicillins,
cephalosporins and the newer quinolones. Misleading promotion abounds for these
products; much of it encourages doctors to prescribe the latest — and most expensive
— antibiotic as first-line therapy for a broad spectrum of infections. In most cases,
independent advice from bodies such as the American Medical Association, the British
National Formulary, or Australia's Antibiotic Guidelines is that these newer antibiotics
should be used only for well-defined indications or as second or third line therapy when
other drugs have failed due to resistance.
The World Health Organization suggested in 1990 that governments establish
such a "reserve list" of antibiotics that would include many of the newer
cephalosporins and quinolones. It said that although such antibiotics were effective in a
wide range of infections, they were inappropriate for unrestricted use because of the
need to reduce the risk of resistance to them or because of their high cost.
In the same year, UK-based Glaxo was promoting its cephalosporin antibiotic,
Ceporex (cephalexin), in Pakistan with the picture of the hands of a baby and an elderly
person linked together and the headline: "from early days, till autumn years, an
2
indications that read like a who's who of epidemiology — everything from skin, ear and
eye infections to respiratory, intestinal and reproductive tract infections.
"Antibiotics are too valuable a public health tool to waste simply because the
pharmaceutical industry wants to recoup its investments a little faster," says Andrew
Chetley, author of Problem Drugs. If we want to avoid future epidemics of infections
that are difficult or impossible to control, we have to start using antibiotics more
wisely, right now."
Health Action International is calling on governments to develop strict antibiotic
policies as part of their national health and drug policies. Such policies should include
developing a limited list of antibiotics, including the reserve list suggested by WHO;
producing and regularly reviewing a set of therapeutic guidelines for antibiotic use; and
studying the use of antibiotics with a view to introducing education programmes to
encourage more rational use where necessary. HAI also recommends that governments •
introduce stronger controls to prevent misleading promotion of antibiotics.
— ends (880 words) —
Note to editors
This feature is based upon the information in Section 3A (Antibiotics) of Problem Drugs.
Publication details are as follows:
Chetley, A., Problem Drugs, Amsterdam, Health Action International, 1993.
208 pages, indexed by subject, company and drug. ISBN 90-74006-06-X
Price: Dfl. 30 + Dfl. 5 postage and handling
Payment can be made in Dutch Guilders by Eurocheque, Postal Order or credit cards
(VISA, Mastercard or American Express).
For further information, please contact:
Barbara Mintzes, Press Office, HAI Europe
J. van Lennepkade 334-T, 1053 NJ Amsterdam, The Netherlands
Tel: (31 20) 683 36 84; Fax: (31 20) 685 50 02
Andrew Chetley (author)
24 Speedwell Close, Cambridge CB1 4YZ, UK
Tel. and Fax: (44 223) 41 36 67
3
'
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problem
drugs
_ _______ ha!
Health Action International
September 1 5, 1993
Dipyrone: a drug no one needs
In the early 1 980s, 94 people died in Germany after taking a pain killer that
contained dipyrone. As a result, the German drug registration authority (BGA) restricted
the indications for the drug to severe pain after surgery or accident, as a result of
cancer, or because of intestinal colic. Combination products containing dipyrone were
withdrawn from the market. In 1990, the BGA re-emphasised that it considered
dipyrone a drug of last resort, primarily for cancer pain.
The world's leading manufacturer of dipyrone is the German company, Hoechst.
The restrictions on dipyrone in its home country have not stopped Hoechst from
promoting its dipyrone products widely in other countries, says Health Action
International's (HAD latest publication, Problem Drugs. In 1992, Hoechst was
advertising dipyrone's "ample safety margin" in Latin America and recommending the
product for all types of fever and pain.
Promotion such as this ensured high sales. Globally, dipyrone contributes more
than 2% to the company's overall pharmaceutical sales. In countries such as Pakistan
or the Philippines, dipyrone brings in anywhere from one-quarter to one-third of the
company's national turnover.
Besides Hoechst, many local companies manufacture dipyrone-containing
products. At least one out of every seven pain killers in markets in Pakistan, the Middle
East, Africa and the Caribbean during 1990 contained dipyrone.
In 1977, the American Medical Association described dipyrone as "obsolete"
and the US Food and Drug Administration withdrew approval of the drug because of
the availability of safer alternatives. Ten years later; the German Medical Association
said that even a small risk of a life-threatening condition was "an unacceptable price to
pay for pain relief, especially since it cannot be maintained that alternatives are not
available".
Dipyrone can cause two life-threatening conditions: agranulocytosis (severe loss
of white blood cells due to bone marrow damage), and anaphylactic shock (a severe
allergic reaction). In both cases, it is impossible to predict who is likely to be at risk
from these conditions.
1
In the mid-1980s Hoechst
Dipyrone is an analgesic (pain killer) with
helped to pay for an international
anti-inflammatory and antipyretic (fever
study which the company hoped
reducing) properties. It is the sodium sulphonate
would show that dipyrone was not
derivative of amidopyrine or aminopyrine and,
like propyphenazone and phenylbutazone, it is a
a significant factor in causing
member of the pyrazolone group of chemicals.
agranulocytosis. Instead, the study
The drug was first introduced by the German
found that one out of every four
manufacturer, Hoechst, in 1922.
cases of drug-induced
Dipyrone is known by many names: analgin,
agranulocytosis in the participating
analginum, metamizol, aminopyrine-sulphonate
countries occured as a result of
sodium, sodium noramidopyrine
methanesulphonate, sulpyrine, methampyrone,
taking dipyrone. Subsequent
novamidazofen, natrium, novaminsulfonicum,
examination of the data in the
noramidazophenum, and noraminophenazonum.
study suggest that there could be
as many as 7,000 cases of
dipyrone-induced agranulocytosis worldwide each year — up to 2,000 of which could
be fatal.
"The purpose of an analgesic is to kill pain, not people," says Andrew Chetley,
author of Problem Drugs. "Dipyrone is a drug that no one needs. It is a disgrace that
Hoechst and other companies have refused to take it off the market."
HAI is very clear about what needs to be done: ban dipyrone immediately.
— ends (545 words) —
Note to editors
This feature is based upon the information contained in sections 4A (Analgesics) and
4B (Dipyrone) of Problem Drugs. Publication details are as follows:
Chetley, A., Problem Drugs, Amsterdam, Health Action International, 1993.
208 pages, indexed by subject, company and drug. ISBN 90-74006-06-X
Price: DfL 30 + Dfl. 5 postage and handling
Payment can be made in Dutch Guilders by Eurocheque, Postal Order or credit
cards (VISA, Mastercard or American Express).
For further information, please contact:
Barbara Mintzes, Press Office, HAI Europe
J. van Lennepkade 334-T, 1053 NJ Amsterdam, The Netherlands
Tel: (31 20) 683 36 84; Fax: (31 20) 685 50 02
Andrew Chetley (author)
24 Speedwell Close, Cambridge CB1 4YZ, UK
Tel and Fax: (44 223) 41 36 67
2
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III Ll^b
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Health Action International
September 1 5, 1993
Norplant: contraceptive freedom or coercion?
It took 24 years to develop, test and approve the implantable contraceptive
Norplant. It took less than two weeks for Norplant to be billed as a new method of
coercion. Within days of licensing in the USA, a Philadelphia newspaper published a
racist editorial recommending Norplant in the fight against black poverty; a judge in
California included compulsory use of Norplant in the sentence of a woman found guilty
of child abuse; and the state legislature in Kansas held hearings on a bill to encourage
mothers receiving state welfare benefits to get the implant.
This new contraceptive consists of six silicone rods filled with the hormone
levonorgestrel which are inserted under the skin of a woman's upper arm. Norplant has
one of the longest periods of effectiveness for any contraceptive, five years.
Specialised minor surgery is needed for insertion and removal.
A disturbing feature of Norplant's design is that women cannot just stop using it
when they wish, says Health Action International's (HAD latest publication, Problem
Drugs. They need to find a specially trained health worker who agrees to remove the
implants. This is not always easy. "Women are sometimes pressured into continuing to
use the method when they don't want to," says Problem Drugs author Andrew
Chetley.
In Thailand, women are routinely told that Norplant will not be removed for
minor side effects. Reports from the Dominican Republic, Egypt, and Indonesia also
found that "removal on demand" did not occur to the satisfaction of the users.
Norplant has been approved for use in at least 26 countries and more than 1.5
million women have used it. The developers believe that — despite its high cost —
more than 30 million women could be using it by the end of the decade, most of them
in developing countries.
National promotional campaigns are being used to help meet those targets. In
Zimbabwe in 1992, posters proclaimed that Norplant was a "five-year insurance plan"
with "no surprises", a convenient slogan that ignored the lack of knowledge of long
term effects of this contraceptive. Immediate effects are better known: at least twothirds of all women using Norplant experience irregular menstrual bleeding. In one
1
I
Overall, women need to have a greater voice in setting the policies and practices
that will determine not only how contraceptives — but all drugs — are researched,
developed, produced, marketed, used and provided. "Women make up the majority of
health care consumers and health care workers and should have a major voice in
determining health and medical care policy," says Yvonne Bogaarts.
— ends (850 words) —
Note to editors
This feature is based upon the information contained in sections 1C (Women and
drugs), 8A (Contraceptives) and 8E (Implants) of Problem Drugs. Publication details are
as follows:
Chetley, A., Problem Drugs, Amsterdam, Health Action International, 1993.
208 pages, indexed by subject, company and drug. ISBN 90-74006-06-X
Price: Dfl. 30 + Dfl. 5 postage and handling
Payment can be made in Dutch Guilders by Eurocheque, Postal Order or credit
cards (VISA, Mastercard or American Express).
For further information, please contact:
Barbara Mintzes, Press Office, HAI Europe
J. van Lennepkade 334-T, 1053 NJ Amsterdam, The Netherlands
Tel: (31 20) 683 36 84;
Fax: (31 20) 685 50 02
Andrew Chetley (author)
24 Speedwell Close, Cambridge CB1 4YZ, UK
Tel. and Fax: (44 223) 41 36 67
3
study, more than one-third of all users had these problems during the full five-year
period of use.
Another concern is that if pregnancy does occur while the method is used, there
is a 20 to 30% chance that it will be ectopic. Ectopic pregnancies —- when the
fertilised egg begins to develop in the Fallopian tube rather than in the uterus —- can be
fatal for the mother if they are not terminated quickly. At least three to four out of
every hundred Norplant users become pregnant during the five-year period of use.
If a woman keeps the implants for more than five years, the amount of hormone
released gradually diminishes, increasing the likelihood of pregnancy. This may lead to
more ectopic pregnancies and to a higher risk of birth defects in children exposed to the
hormone levonorgestrel before birth.
Five years is a long time to follow women up to notify them to have the
implants removed. "This is expensive and time-consuming," says Yvonne Bogaarts,
coordinator of Women's Health Action Foundation. "Most health services in developing
countries simply aren't equipped for it."
It is clear that removal after five years does not always happen. In Brazil, 14 of
52 women followed up after a trial of Norplant had the implants in place for more than
five years. The clinical trial they were taking part in had been stopped, the doctors had
left, and other doctors did not know how to remove the implants.
Like other long-acting, highly effective contraceptive methods, Norplant has
been developed to be used in family planning programmes in developing countries
which aim to reduce population growth. Indonesia was the first country to use Norplant
on a large scale, with more than 886,000 women having received the implants
between 1987 and 1990. Problems arose when Norplant was included in the so-called
"safari" programme - a programme where health workers visit a village for a day to
recruit as many women as possible to use contraception. Individual counselling and
information about side effects "tended to be minimal". Implants were inserted
improperly by poorly trained health workers, using equipment that was not properly
sterilised, leading to infections and later difficulties with removal. Some women had
Norplant inserted when they were already pregnant, but did not yet know it.
HAI recommends against promoting implants as "first choice" contraceptives
and says that they should only be used where they can be provided safely and
respectfully and with a woman's fully informed consent. HAI is calling for research
efforts to be directed at improving the availability and convenience of existing usercontrolled methods of contraception.
2
J
, 0 FEATURE 0 FEATURE 0 FEATURE 0 FEATURE 0 FEATURE 0 FEATURE 0 FEATURE 0
____ HAI
Health Action International
September 1 5, 1993
Tranquillisers: a tale of dependence
A British woman, Tess Higham, went to her doctor suffering from exhaustion
and anxiety. The doctor prescribed antidepressants and sleeping tablets. This
prescription began a dependency on psychotropic drugs that lasted 21 years. She
described them as "lost years" and said the experience was like a "chemical lobotomy".
Her experience is not unique. According to Health Action International's (HAI)
latest publication. Problem Drugs, the benzodiazepine drugs used to treat anxiety and
sleep disorders follow in a long tradition of drugs that were introduced as being safer
and less likely to cause dependence than their predecessors. But it was to be a false
promise.
Between 15 and 44% of long-term users become dependent on
benzodiazepines. Although they are among the most frequently prescribed drugs
worldwide, benzodiazepines do not cure any anxiety disorders; they suppress
symptoms that may return once the drug is stopped.
World Market for Psychotropic Drugs
Therapeutic type
World Sales 1991
$ Million
Hypnotics
Anti-anxiety drugs
Antidepressants
Antipsychotics*
406
1,200
1,500
1,244
Total
4,350
* includes anti-epileptics and drugs to treat Parkinson's disease
Nonetheless, used wisely and for a limited amount of time, benzodiazepines can
provide valuable breathing space when an emotional crisis becomes intolerable. Expert
advice, such as that given by the UK Committee on Safety of Medicines (CSM), is that
benzodiazepines should only be used for the short-term (two to four weeks) treatment
1
J
of anxiety that is severe, disabling or causes extreme or unacceptable distress. The
CSM says that their use for "mild" anxiety is inappropriate and unsuitable.
Unfortunately, misuse through overprescribing is common. Problem Drugs
reports on studies in the UK, France, Spain, Canada and South Africa that found
widespread overprescribing, often for long periods of time. In one UK study, at least
one out of every three people taking tranquillisers had done so for periods of more than
four months.
One cause of poor prescribing is the promotional effort of the pharmaceutical
industry. In Peru in 1991, Multifarma promoted alprazolam (Alpaz) as a treatment for
virtually every condition of daily life. It promised relief for:
•
the "syndrome of the modern woman" — who suffers from increased worries
about work, and an increased workload, emotional worries and stress;
•
the "syndrome of today's man" — who worries about the future, his increased
responsibilities, frustrations at not reaching his goals, financial problems and
stress;
•
the "syndrome of the housewife" — who worries about the children's
education, having too much work, financial problems, fear of domestic
accidents and a fear of the house being burgled; and
•
the "syndrome of the elderly" — who fear being lonely, worry about their health
and future, have limited finances, and lack affection.
In 1992, also in Peru, Upjohn used a similar theme for its brand of alprazolam
(Xanax), indicating it for "a large variety of patients with anxiety", including a business
executive who is under pressure, a housewife coping with family conflicts, a lonely
elderly woman worried about her health, and a cardiac patient with digestive problems
and fears of another heart attack.
"This medicalisation of life may help the pharmaceutical industry sell more
drugs," says Andrew Chetley, author of Problem Drugs, "but it bears no resemblance
to appropriate health care.”
Women and the elderly are particular targets for benzodiazepines,
antidepressants and other psychotropic drugs. In most industrialised countries women
are two to three times more likely than men to be using tranquillisers or
antidepressants. For example, a study in the Netherlands found that doctors were two
times more likely to prescribe benzodiazepines for women than men when neither the
symptoms nor the diagnosis warranted the drug. In developing countries, too,
promotional materials clearly identify women as needing powerful drugs to cope with
daily life. In India, for example, Sandoz recommends giving women suffering from
anxiety an antipsychotic drug, thioridazine (Melleril-10), usually reserved for the
treatment of severe psychoses such as schizophrenia. The Indian subsidiary of Merck
2
j
Sharp and Dohme suggests that women undergoing the menopause would benefit from
a combined tranquilliser and antidepressant (Libotrop). Menopause is not a valid
indication for either drug; together, they make an irrational combination drug which
should not be used to treat any condition.
In the USA, the elderly, who make up one-sixth of the total population, are
prescribed one-third of all tranquillisers and more than half of all sleeping medications.
Studies from other countries confirm that the elderly receive a disproportionately high
amount of prescriptions for benzodiazepines. The adverse effects of these drugs are
often more severe among the elderly. These include confusion, disorientation and lack
of coordination — symptoms that can be misdiagnosed as signs of dementia. In
addition, the lack of coordination caused by benzodiazepines can lead to falls and
broken bones.
HAI is calling on governments and health workers to take action to limit the use
of benzodiazepines in the elderly in particular, and to generally restrict their use for
severe anxiety or severe sleep disorders. HAI is also calling for better independent
information about the rational use of psychotropic drugs and strict penalties for poor
quality promotional material. The development of national and local formularies and
therapeutic guidelines for the treatment of anxiety, insomnia and depression and the
encouragement of non-drug solutions are seen as ways to improve the current
situation.
In the words of consultant psychiatrist, Brian Ballinger, "More emphasis should
now be placed on managing sleep disorders and anxiety without using drugs."
— ends (840 words) —
Note to editors
This feature is based upon the information in section 10A (Psychotropics) of Problem
Drugs. Publication details are as follows:
Chetley, A., Problem Drugs, Amsterdam, Health Action International, 1993.
208 pages, indexed by subject, company and drug. ISBN 90-74006-06-X
Price: Dfl. 30 + Dfl. 5 postage and handling
Payment can be made in Dutch Guilders by Eurocheque, Postal Order or credit
cards (VISA, Mastercard or American Express).
For further information, please contact:
Barbara Mintzes, Press Office, HAI Europe
J. van Lennepkade 334-T, 1053 NJ Amsterdam, The Netherlands
Tel: (31 20) 683 36 84; Fax: (31 20) 685 50 02
Andrew Chetley (author)
24 Speedwell Close, Cambridge CB1 4YZ, UK
Tel and Fax: (44 223) 41 36 67
3
0 FACTS & FIGURES 0 FACTS & FIGURES 0 FACTS & FIGURES 0 FACTS & FIGURES 0
problem
HA
Health Action
Problem Drugs: Facts and Figures
Size of the world market
The value of the world pharmaceutical market was estimated by the European pharmaceutical
industry (EFPIA) at $164.5 billion in 1989. The 1990 market was estimated at being between
$174 billion and $186 billion. The major market areas were: North America, 33.0%; Western
Europe, 31.9%; Asia, 25.4%; Latin America, 3.9%; Eastern Europe, 3.1%; Africa, 1.8%; and
Australasia, 1.0%. Forecasts for the year 2000 suggest that the global market could reach
$330 billion.
Drug category
Antidiarrhoeals
containing antibiotics
Antibiotics
penicillins
cephalosporins
quinolones
aminoglycosides
Analgesics
NSAIDs
Cough and cold remedies
Cognitive enhancers
Oral contraceptives
Psychotropics
hypnotics
anti-anxiety drugs
antidepressants
antipsychotics
Global sales
US$ millions
600
150
22,000
3,000
6,800
2,250
620
15,000
6,000
7,300
1,500
1,800
4,350
406
1,200
1,500
1,244
Year
1993E
1989E
1993
1988
1988
1990
1988
1995E
1991
1990 (OTC only)
2000E
1989
1991
1991
1991
1991
1991
Notes: E = estimated; OTC only = over-the-ccunter products and does not include
prescription medicines
Increasing demand by misleading promotion
A 1990 survey of doctors in the UK found that 66% of doctors said a pharmaceutical company
sales representative had claimed more indications for a product than were permitted on the
approved data sheet.
Imitative research
Of the 348 new drugs from the 25 largest US drug companies between 1981 and 1988, the
US Food and Drug Administration (FDA) said that at the time of introduction:
3%
(12 drugs) made an "important potential contribution to existing therapies";
13%
made a "modest potential contribution"; and,
84%
made "little or no potential contribution".
Population groups where caution is needed
Women make up about 52% of the world’s population; children under 15 account for about
32%; people over the age of 65 account for about 6%. All together, at least two-thirds of the
world’s population are in "special case" categories where more care needs to be taken in the
use of drugs and where less is known about the effects of the use of drugs. These are also the
groups of people who are most likely to use drugs.
Children: According to the World Health Organization (WHO), two-thirds of all drugs used by children
may have little or no value. At least $1 billion is wasted every year on inappropriate
antidiarrhoeal drugs and cough and cold remedies for children.
Women: Women are more likely to use vitamins than men; two to three times more likely to be
prescribed tranquillisers, sleeping tablets and antidepressants; and three times more likely than
men to use contraceptives.
The elderly: In the USA, 1 out of every 6 people is over 60, but they consume:
1 out of every 3 tranquillisers
1 out of every 2 sleeping pills
1 out of every 3 antidepressants
2 out of every 3 antihypertensives
2 out of every 5 gastrointestinal drugs
Misuse of antibiotics
Studies from around the world show that between one-third and two-thirds of antibiotic use is
inappropriate and unnecessary.
Inappropriate pain killers
Combination pain killers offer no real advantage, are more costly and can be harmful. They are
more likely to produce kidney damage than single ingredient pain killers. Yet one out of every
three pain killers on the market in developing countries in Asia, the Middle East, Africa, and the
Caribbean in 1990 was a combination product.
NSAIDs: a high risk of adverse effects
Non-steroidal anti-inflammatory drugs (NSAIDs) account for 5% of all drugs prescribed in the
UK, but are responsible for 25% of all adverse drug reactions reported to the Committee on
Safety of Medicines.
Consequences of vitamin misuse
Misuse of vitamins can do harm. For example, it can:
• distort national health priorities;
• drain limited national economic resources and foreign exchange;
• waste limited individual and family financial resources;
• encourage harmful beliefs about the nature of health; and
• encourage ineffective and harmful practices.
Drugs in pregnancy
Surveys from more than 20 countries around the world show that 8 out of 10 women take at
least one drug during pregnancy, with an average of three to four drugs.
Prescribing in pregnancy
The editor of a book on drugs in pregnancy, Dr D.F. Hawkins, a consultant obstetrician,
gynaecologist, and pharmacologist suggests four basic rules for prescribers.
1. Review all patients with medical disorders before they conceive, regarding every
woman of reproductive age as a potential antenatal patient, and encouraging them
to attend for counselling before planning a pregnancy.
2. Question the real need for any drug in pregnancy, giving due consideration to
alternative methods of treatment.
3. Review all drug regimens in pregnancy to see how careful therapeutics and good
control can minimise risks.
4. Use medicines that have been widely employed in pregnancy for years in preference
to the latest drugs.
2
I
Contraceptives
The pill: Four out of every 10 oral contraceptives
on the market in Asia, the Middle East,
Africa and the Caribbean during 1990 and
1991 should be avoided because they
contain a high level of the hormone
oestrogen, or the balance between the
oestrogen and progestogen is not
acceptable.
IUDs: A woman who uses an intrauterine device
(IUD) is about twice as likely to suffer
from pelvic inflammatory disease (PID) an infection within the fallopian tubes,
ovaries or uterus. PID develops in an
estimated 1 % of young women annually
and causes more illness in women of 15
to 25 years of age than all other serious
infections combined. PID is a leading
cause of infertility.
Global estimates of the number of people
using different methods of contraception
(1980s)
Method
Sterilisation
male
female
Hormonal contraceptives
oral
injectables
implants
IUD
Condom
Other barrier methods
Natural birth control
Withdrawal
dumber of users
42 million
1 40 million
63 million
6 million
1.5 million
80 million*
40 million
8 million
32 million
32 million
Hormone replacement therapy (HRT)
*nearly 60 million IUD users are in the
In 1988, the most often prescribed drug
People's Republic of China
in the USA was a brand of amoxycillin,
Amoxil, produced by Beecham. By 1992,
the most widely prescribed drug was an
oestrogen product, Premarin, produced by Wyeth-Ayerst and promoted as hormone replacement
therapy for postmenopausal women.
Preliminary findings from one health region in the UK suggest that the use of HRT for 10 years
from the time of menopause would lead to a reduction of hip fractures 20 years in the future of
only some 5 to 10%. Five to 30% of women who receive HRT at a dosage level considered to
be sufficient to prevent bone loss nonetheless still suffer a reduction of bone density. As well,
most deaths in women with low bone mineral density are unrelated to the occurrence of
fractures.
The whole concept of hormone replacement therapy is itself promotional. The hormones are not
missing: they do not need to be replaced.
Psychotropics
In the UK, nearly one out every eight people take tranquillisers for periods of four months or
more. The UK Committee on the Safety of Medicines advises that these drugs should only be
used for the short-term relief (two to four weeks) of anxiety or insomnia that is severe,
disabling or subjects the individual to extreme or unacceptable distress.
3
0 QUOTES 0 QUOTES 0 QUOTES 0 QUOTES 0 QUOTES 0 QUOTES 0 QUOTES 0
A few quotes in Problem Drugs
"There is an inherent conflict of interest between the legitimate business goals of manufacturers
and the social, medical and economic needs of providers and the public to select and use drugs in
the most rational way."
— World Health Organization, 1993
"Prescription drugs are marketed as if they were cosmetics or candy. Claims are made beyond
what the product will do. Demand is inflated beyond the medical need. Uses are promoted that
are neither healthy nor wise."
— David Jones, former executive at Abbott and Ciba-Geigy, 1990
"There are simply not enough sick people around to satisfy the desires of the marketing
managers of drug companies. There are not enough sick people around to absorb all the new
variations on old drugs which are produced."
— Professor Bill Inman, Drug Safety Unit, University of Southamptom, UK, 1991
"The most important objective of the short-term component of public health policy under
conditions of poverty is to set priorities.... Setting priorities, in fact, means preventing avoidable
death. It certainly does not mean treating self-limiting diseases."
— Dr Klaus Leisinger, Head of Third World Relations, Ciba-Geigy, 1989
"Children may tend to grow up believing that drugs are the solution to many of life's problems."
— World Health Organization, 1987
"A major factor in the number of adverse drug reactions among the elderly is their doctors' over
reliance on promotional materials provided by the drug manufacturers."
— US Department of Health and Human Services, 1989
"Antidiarrhoeal drugs generally divert attention from oral rehydration and are also too expensive
for most families."
— Rolf Carriere, UNICEF India, 1987
"There are no drugs available at present that will safely and effectively stop diarrhoea."
— World Health Organization, 1989
"Rather than attempt to overcome or pre-empt resistance by prescribing yet another agent, the
objective should be to prevent resistance by limiting the amount of antibiotic prescriptions."
— T.D. Wyatt and colleagues, British Medical Journal, 1990
"NSAIDs [non-steroidal anti-inflammatory drugs] are overvalued as symptomatic treatments, yet
they continue to be prescribed in high quantities.... Empirical evidence suggests that a high
proportion of long-term NSAID users can be safely switched to simple analgesics without
compromising their therapy.... Not only would there be a real saving of health expenditure
through the use of cheaper drugs, but also there would be a considerable reduction in mortality
and morbidity from NSAID side-effects."
— P.A. Dieppe and colleagues, Lancet, 1993
1
"NSAIDs are one of the most common cause of adverse reactions reported to drug regulatory
authorities.”
— P.M. Brooks, Lancet, 1993
"Although cyproheptadine stimulates appetite in some children, Medical Letter consultants
believe that promotion of the drug as an appetite stimulant will do more harm than good."
— The Medical Letter on Drugs and Therapeutics, 1971
"In general, little or nothing is gained by stimulating appetite by drugs."
— D.R. Laurence and P.N. Bennett, Clinical Pharmacology, 1987
Age-associated memory impairment is "a pseudo-disease. It's having a drug and wanting an
illness for that drug. It's a modern disease, when pharmaceutical chemists can produce hundreds
of molecules and the industry is desperately wanting to get these molecules on the market."
— Prof. Ian Hindmarch, University of Surrey, UK, 1991
"There are few valid indications for vitamin or mineral supplements."
— American Medical Association, 1986
"The routine prescription of multivitamin and mineral supplements for pregnant and lactating
women is common but generally unnecessary. A well balanced diet designed to meet the needs
of pregnant and lactating women minimises the need for supplementation."
— American Medical Association, 1986
"DES [diethylstilboestrol] present risk without benefit."
— R.J. Stillman, American Journal of Obstetrics and Gynecology, 1982
"The burden of ill health associated with reproduction is divided very unequally between the two
sexes, with women bearing the brunt of it.... Contraceptive use worldwide is three times greater
among women than men, and among all available methods, those used by women carry more
potential health hazards."
— World Health Organization, 1992
"In trying to find a method of birth control, the main action is to interfere with a normal body
process and this means taking extra-special care. The method will be used by initially healthy
women or men and should not make them unhealthy; on the other hand, it could be used by
people who are already unhealthy and must not do them additional harm."
- Dr J. Guillebaud, The Pill, 1991
In Thailand, "because of the cost of the method, women are routinely informed when choosing
Norplant that the implants are appropriate for long-term spacing and will not be removed for
minor side-effects."
— M. Zimmerman and colleagues, Studies in Family Planning, 1990
"Menopause is not a disease, but a life-cycle transition."
— Margaret Lock, medical anthropologist, 1991
"Benzodiazepines do not cure any anxiety disorders — they suppress symptoms which may
return when the drug is stopped."
— Prof. Gavin Andrews, Australian Prescriber, 1991
"More emphasis should now be placed on managing sleep disorders and anxiety without using
drugs."
— Dr Brian Ballinger, consultant psychiatrist, 1991
"Since 1958, when imipramine (Tofranil) was first reported to be effective in depression, no
other antidepressant has been widely shown to be any more effective."
— E.H. Rand, American Family Physician, 1991
2
problem
HAI
Health Action International
Merck, Sharpe and Dohme's Indian subsidiary,
Merind, promotes cyproheptadine as an appetite
stimulant in 1991. Cyproheptadine is an
antihistamine used to treat allergic reactions.
“Although cyproheptadine stimulates appetite in
some children... promotion of the drug as an
appetite stimulant will do more harm than good."
Anon, “Cyproheptadine (Periactin)'', The Medical
Letter on Drugs and Therapeutics, Vol 5, No 3,
March 1971
“in general, little or nothing is gained by
stimulating appetite by drugs." Lawrence DR and
Bennett, PN, Clinical Pharmacology, Edinburgh,
Churchill Livingstone, (6th edn), 1987, p365
problem
Health Action International
NOOTROPIL Jarabe i
principle active: Piracetam
|
*=ss» -—
Li
TRATAMIENTO SEGURO
POSOLOGIA SIMPLE
Ooda:
Una o doi cucharadus aJ Ola
A drug which can improve a child's grades? Misleading
promotion for piracetam (Nootropil) by UCB in Peru in 1991
NOOTROPIL
MEJORA LA COMUNICACION NEURONAL
/°(
L A
<
ANO
OOCUM^/'O*
pun
4,vc
)
y ■■■
HAI
Health Action International
Lomotil
Provides fast, antidiarrhoeal action
The desire to defecate diminishes after
approximately one hour ’.
Preferred alternative to_________
The
Imodium (Loperamide)________
Rapid Control
Antidiarrhoeal
prescribed by Economical________________
physicians
in over
Lomotil
70 countries
In a multicentre trial it was found
“that on an average Lomotil treated patients
reached a cure ’nearly six hours before
those receiving Imodium"2.
Available to patients at just 19 paise per tablet.*
For prompt control of diarrhoea
RzHcrmca,
1 Hoc I C W. J Mad Aawc Ga. I«l. W (10).
? JaHa G. J IM Mod Raa 1977. 5.196
• Timo ol t’Ol normal roton when »u rot looowod by srotro' lor atloaal
O-Chl hour, and rot k>K—ad try a reUpw io tr«ueot loom itooH
0 local Tare, c.lr.
Printed and Pubhibed by Mt A S Mandate Mangling Sen -ces Manage/ onoe'iailo'Se.irlo(lndi.i)Limited. 2' 0 S Marti Fori. Bombay-aOOOOt andpnntedal
Cbandan.i Graphics Sbah A Nahar Ind Estate. Lower Pare! Bombay-aOOOIJ and published at SEARLE (INDIA) LIMITED 21. DS Marg, Bombay JMOOl
Editor Or S J Phaterpekar. Director Medical A/tj.rs,
1991 ad in Searle’s Diarrhoea Update in India for
Lomotil (diphenoxylate + atropine), featuring a picture
of the Dutch queen.
Lomotil has been described as "the worst means of
treating" infectuous diarrhoea because it can prolong
the length of time that toxins from the bacteria remain
in the intestinal tract. Lappe, M, When Antibiotics Fail.
Berkeley, North Atlantic Books, 1986, pl54
HAI
Health Action International
...Fiebre,
...Dolor?
Novalffina®
Dipirona
• Maxima eficacia
• Amplio margen de seguridad
• Rapidez de accion
• Facilidad de administracion
.——---- —---- -----
Hoechst advertises dipyrone's "ample safety margin"
in Comahue Medico in 1992 in Latin America. Fever
and pain are listed as indications.
Dipyrone has caused deaths from agranulocytosis
(severe loss of white blood cells due to bone marrow
damage) and anaphylactic schock (a severe allergic
reaction) and has been banned or severely restricted
in many countries.
“Since effective, less dangerous alternative drugs are
available there is no case for the continued use of
aminopyrine and dipyrone." Dukes, MNG, Side
Effects of Drugs Annual 4, Amsterdam, Elsevier,
1980, pp63-4.
HA
Health Action International
We have taken a Five Year
Insurance Plan...
We have left no room for Surprises
\WI//
NORPLANT
TK«5y<arcontrac«pttvepl»n
CtPor
V
''OPnL
*
<i! cL r-'t er Millh ctni rt.
1992 poster promoting the contraceptive Norplant
(levonorgestrel implants) in Zimbabwe.
No room left for surprises? The long-term risks of
this hormonal contraceptive to users - or to babies
exposed during breastfeeding - are unknown.
problem
HAI
Health Action International
OESTROGENEN EN PROGESTAGENEN
ZIJN VOOR HEN NU AL
DE GEWOONSTE ZAAK VAN DE WERELD.
DAT GELDT MET ZUMENON EN DUPHASTON
STRAKS OOK VOOR HUN OVERGANG.
Voor vccl jonge vrouwen van nu behoort
het innemen van hormonen cot de routine
van aJlcdag. Sinks - rond cn na de overgang kan dat wcer aan de orde zijn Danimmcrs
worden behandelingen preventic van emstige
postmcnopauzalc klachtcn acrucel en kan hormoonsuppletie gci'ndiccerd zijn
Zumcnon cn Duphaston voldoen ruimschools aan de eisen voor vennnvoorde hormoontherapie. Het oestradiol van Zumcnon is
identick aan het lichaamscigcn oestrogecn,
tcrwijl Duphaston zorgc voor optimal? progcstagenc bcschcrming. En om het patienten
extra makkelijk te maken zijn zc ook nog in
6cn verpakking vcrkrijgbaar Ondcr de naam
Zumcston.
Tcgcn de tijd dat hormoonsupplene gewenst
is, ligt de keuzc dan ook voor de hand Voor
de jongcrc generaue zijn hormonen immers
nu al de gewoonste zaak van de wcrcld.
ZUMENON EN DUPHASTON
OMDAT FIORMOONTHERAPIE 70 ZUIVER MOGELIJK MOET ZIJN.
Irn K-qi.iU.ing ZnnicMon* bn ji 2H uhlriim Ziinirnon rn 11 l.iblcltcn Dupluunn Zl'MENON* Samcnitrlling. 2 mg estradiol. IndicalicL Svmplonu n v.in
■ trMiogmxirlnirnlir Irn gmdgr ».m dr inrnojuuzr id ihuiilgiwli triixiizj.iklr mcimp.m/r Contradndicalir*. IhxirgcilUdklr <■( ihIhk-gilr k.imiip lruiiilMi>r
• A A Kolrcin, Irvntumlmnxxnn'rn. <x^n<»grm.grMieligr mir.ntfind niaMiip.ilhi.iiil>i<n4i y»lir.i Do»rring.2mgZ.niiicuoii|>ri d.ig llandebvorm.2Hljhl> i
irn in mndr lulrndrnripakking DI PI IA.SK IX* Samenitrlling. In mg (hdiogeslcroi). Indicaliri. Rrgulriing t.m dr <uluv In i umbiii.ilir m< I imingiriiilirr.ipir hi) pm rn p<nliiirii<>p.in/.dr kLi. him rn <nlr<>|xnou* tri iixiikimung van rniJiiiiicInumlnpripliMr hi, vriiuxrn incl ml.ulr (limit Contra-indicalirv.
\agmilr lihirdingrn tan imlwkcinlr ixnz.uk. < ni'iigr Jctrrtuitalirstiximnw-n. ciliMigr pmnlin. <linlr«taliM hr Kimis hripcs grstaliniio. |xnluir <■!
i.i..m l< i..»r Dovering. 1'1 mg DnpliaMim |x i dag grdnirndr 11 dagrn prr rului \an 2« dagrn llandrluvonn. 12 lahlrlicn in k.drndriM ip.ikking
Sttlli-digc piixlukiinh.iiiiaiM- n up a.inviaag viiknigtuai Duphar Nrdrrland IkV, I'oilbut 7133. 1007 JC Anulrrdam. Trlrfoon: 020-SI1) OH 15.
"Oestrogen and progestagen are already the most normal thing
in the world for them. This will also be true for Zumenon
(estradiol) and Duphason (dydrogesteron) during their
menopause.”
Duphar promotes their "as pure as possible” hormone therapy
for women in the Netherlands in Nederlands Tijdschrift voor
Geneeskunde, May 1993
HAi
Health Action International
\ana\
(alprazolam)
para el tratamiento eficaz
de una mayor variedad
de pacientes con ansiedad
El ejecutivo sobrecargado de tfabajo
que eslatenso. irritable ytiencJificuliad
de concentrarse debidoa presiones
financieras o a cambios de
responsabilidades.
El paciente de edad avanzada. solitano.
a menudo triste, que se preocupa por su
mala salud y tiene dificultades para
donriir y aprension con rcspecto al
fuluro.
El ama de casa ansiosa que sc preocupa
por la finanzas de la familia y tambicn
porconflictoscon los hijos. y sc pone a
ilorarfacilmcnte.
El pacientecardiaco asustado que terne
otro ataque de corazon, no puede
rclajarse. sc preocupa por su familia y
con frecuenciaexperimenta rrastornos
digestives ymarcos.
Tranquillisers for the pressures of everyday life
Notepad from Upjohn for doctors in Peru in 1992, promoting a
benzodiazepine (Xanax or alprazolam) for treatment of "a large
variety of patients with anxiety”: the executive who is tense
because of financial pressures and new responsibilities; the
housewife who is preoccupied with family finances and conflicts
with her children; the elderly patient who is lonely and concerned
about her poor health; and the cardiac patient worried about
having another heart attack and experiencing digestive problems.
HAS
Health Action International
Melleril provides significantly greater
improvement than Diazepam
Sandoz promotes an
antipsychotic, thioridazine, in
India in 1990, as a substitute for
diazepam, and suggests
treatment of symptoms such as
“feeling inadequate" and
“indecisiveness”.
The indications for this drug in
the British National Formulary are
“schizophrenia and other
psychoses, mania" and short
term management of psychotic
episodes or severe anxiety,
agitation and restlessness. BMA
and the Royal Pharmaceutical
Society of Great Britain, British
National Formulary, London. BMA
and The Pharmaceutical Press,
No 25, Mar 1993. ppl49, 154
Suicidal wishes
Indecisiveness
Loss of appetite
Put your patients
on Melleril-25 right away....
~
See them respond
WITHIN A WEEK
WHAT IS HEALTH ACTION INTERNATIONAL?
Health Action International (HAI) is an informal
network of some 150 consumer, health, development
action and other public interest groups involved in
health and pharmaceutical issues in 60 countries
around the world. HAI has active participants in
Africa, Asia, Europe, Latin America, North America
and the Pacific region.
HAI believes that all drugs marketed should:
• meet real medical need;
• have therapeutic advantages;
• be acceptably safe;
• offer value for money.
In 1988 the World Health Organisation (WHO)
calculated that of the 5 billion people in the world,
between 1.3 and 2.5 billion have little or no regular
access to essential drugs. At the same time it is
estimated that as many as 70% of the drugs on the
global market are inessential and/or undesirable
products. HAI supports the Essential Drugs Policy of
the WHO which concentrates on the supply and use
of some 250 drugs considered to be the most
essential. HAI also believes that the problem of the
enormous numbers of inappropriate and ineffective
products must be tackled.
HAI recognises that access to appropriate medicines
is only one element of health care and that a
significant improvement in world health will be
achieved only if the problems of poverty, poor
sanitation, and malnutrition are addressed.
HAI works through research, education, action
campaigns and dialogue. HAI publications are used
by health workers, government drug regulatory
agencies and consumers around the world. Research
undertaken by HAI’s participants contributes to better
education about drugs, and is the foundation for
campaigns calling for stronger regulations on the
production, distribution, marketing and use of drugs.
HAI participants organise and participate in
educational and training seminars in many parts of
the world. Special attention is given to the use of
medicines by women and to the development of user
information. HAI participants are active in
monitoring promotion practices, supporting efforts to
establish national drug and health policies, and
encouraging the supply of essential drugs.
In the few years since its foundation, the HAI
network has achieved successes at both international
and national level. HAI’s contribution has been
important in areas such as:
• achieving a gradual improvement in the
advertising standards of many of the major
multinational pharmaceutical companies;
• promoting the essential drugs concept and in
winning both political acceptance and public
understanding of rational drug use;
• establishing an international network which has
become accepted as the group protecting the
interests of users of medicines;
• campaigns leading to regulatory action in various
countries to:
- ban harmful antidiarrhoeals,
- stop the inappropriate use of high dose
hormonal drugs,
- end the use of anabolic steroids as growth
stimulants for children,
...many examples can be given but much work
remains to be done.
HAI works at many different levels: with health
workers in many countries; with academics and
trainers; with government officials and national
health associations; with regional decision making
bodies such as the Commission of the European
Community; with the pharmaceutical industry; and at
the international level. HAI participants have taken
part in many consultations and discussions organised
by the WHO as part of its revised Drug Strategy and
been active in mobilising support for the WHO
Action Programme on Essential Drugs and Vaccines.
If you would like more information or would like to
become involved in HAI, contact one of HAI’s three
regional coordinating offices:
HAI Clearinghouse/Action for Rational Drug Use
for Asia (ARDA)
c/o IOCU, P.O. Box 1045,
10830 Penang, Malaysia
tel: + (604) 371396, fax: (604) 366506
AIS Latin America
c/o Accion para la Salud,
Avda. Palermo 531, Dpto. 104,
Lima, Peru
tel/fax: (5114) 7123202
HAI-Europe
J. van Lennepkade 334-T
1053 NJ Amsterdam, the Netherlands
tel:(31 20) 6833684, fax:(31 20) 6855002
Hai believes that all drugs marketed should meet real medical need, have real therapeutic
advantages, be acceptably safe and offer satisfactory value for money.
Health Action International is an informal cooperating network of some 150
consumer, development action and other public interest groups worldwide. The HAI
network works to further the safe, rational and economic use of pharmaceuticals
worldwide; to promote the full implementation of the World Health Organization’s
Action Programme on Essential Drugs and to look for non-drug solutions to the
problems created by impure water and poor sanitation and nutrition.
- Media
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