Silverman, Lydecker, and Lee - who took upon themselves the
seemingly Sisyphean task of exposing the abuses of the
pharmaceutical industry (Prescriptions for Death: The Drugging of
the Third World, 1982, etc.) - now reexamine the situation in the
Third World and conclude that a worldwide crisis exists. The
present survey, begun in 1987, indicates that most multinational
drug companies, under pressure from within and without, have
improved the way they label and market their products. But
apparently the public hasn't benefited - for, the authors contend,
scores of useless and dangerous drugs are now put out by local or
domestic firms, small in size but large in political clout.
Fraudulent drugs abound, and badly needed ones are unavailable. The
authors cite some small success stories - India's ban on deadly,
high-dosage hormones, and a pilot project in Gambia in which drug
companies and the government cooperated to set up a
drug-distribution system - but they observe that, in most
developing nations, drug-regulation agencies are corrupt, weak, and
underfunded, and their workers poorly trained. Bribery, the authors
note, is a way of life throughout the Third World. They conclude
that what's needed is constant surveillance, as well as continuous
consultation among consumer advocates, the drug industry,
government agencies, and the medical and pharmacy professions, with
the World Health Organization leading the way. The scrutiny is
close, the research impressive, though the presentation is so
detailed that it may overwhelm all but the most concerned reader.
Still, a thorough assessment of a perilous situation. (Kirkus
Reviews)
The pharmaceutical industry has long and vehemently insisted that
it has the willingness, the dedication, and the ability to police
itself to insure that the public will not be unnecessarily harmed
or defrauded. As the record shows with painful clarity, however,
virtually no industry or professional group has ever adequately
policed itself, and the pharmaceutical industry is no exception.
Where the most flagrant abuses have been exposed and corrected,
major credit must probably be divided among the media that
publicized the situation, consumer groups that applied pressure,
government officials who took actions that were often unpopular,
and individual members of the pharmaceutical industry who had the
courage to face up to their social responsibilities.
In this book, the authors turn their attention to what happened in
Third World countries when, because of worldwide pressures, the
multinational drug companies largely corrected their notorious
abuses. On the basis of painstaking research, much of it conducted
in a great many Third World countries, the authors conclude that a
plethora of small local firms have filled the dishonest sales
channels vacated by the multinationals. The authors show in great
detail how local drug firms in the Third World have taken advantage
of loose regulatory practices and unscrupulous behavior on the part
of regional and national health care professionals to promote the
sale of dangerous or worthless drugs as remedies for diseases for
which they were never intended. Warnings of bad side effects are
omitted from promotional literature, drugs are sold that have not
had proper trials, and drug firms have often bribed government
officials, doctors, and hospital administrators in order to gain
favorable treatment in the importation and sale of their products.
Among the many topics treated in this book are the controversy over
inexpensive generic drugs (including disclosures of fraud and
bribery in the U.S. Food and Drug Administration), the actions of
consumer groups, and the key role of government in preventing
abuses by drug firms. The authors describe a remarkable attempt in
Bangladesh, one of the poorest of all the developing countries, to
develop a high-quality local drug industry. They also present as
case histories reports on three extremely important drug products
or groups--the dipyrones (for control of pain and fever),
high-dosage estrogen-progesterone hormone products (for use in
pregnancy tests), and clioquinol or Enterovioform (for treatment of
diarrhea)--all of which were or still are centers of worldwide,
heated controversy.
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