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E-DRUG: Editorian Health Horizons

Dear e-drug friends,

The editorial of the latest issue (No.20, Autumn 1996) of Health
Horizons, the journal of the International Federation of Pharmaceutical
Manufacturers Associations is quoted below. It calls into question the
whole essential drugs concept. Since the IFPMA is a powerful
representative of a major stakeholder in the pharmaceutical sector (the
research based industry), its views have both political and economic



      A new scourge - the resurgence of infectious diseases - is
      making itself felt, which is worrying public health professionals
      and putting into question the famous Essential Drugs List - the
      brainchild of a former director-general of the WHO.

      In 1975, when it was first brought out, the List was supposed to
      help member states of the organization choose and purchase
      essential drugs of established quality and reasonable price,
      which would correspond to national health needs. Essential
      drugs were held to be those that correspond to the healthcare
      needs of the majority of the population.

      Since then, the List has raised many questions and aroused
      much criticism. So it is not surprising that, 20 years after it
      came into being, some of the experts mandated to revise it on a
      biennial basis have felt the need not only to up-date it but also
      to rethink the principles on which it is based and how well
      adapted it is to its goals. Thanks to some extra-budgetary
      funding, the experts were able to get together to examine these

      The resulting report (see page 14) is objective. They think that
      the List is a useful reference for developing countries but
      underline that there is no epidemiological or statistical research
      to back it up. They recall that, faced with growing antibiotic
      resistance, those revising the List have, for the last few years,
      had to add so-called reserve antibiotics, recommended for
      situations where the old drugs no longer work.

      In order to counter this modern-day plague of resistant bacteria,
      the authors of the report claim that the only real solution lies in
      pharmaceutical innovation and state that industry must be
      encouraged along those lines - but they do not say how. They
      also note that favoring low-priced products has resulted in
      increasing the sales of counterfeit goods and other sub-standard
      products. The experts know of some 500 incidents triggered by
      such products: and that, it must be feared, is only the tip of a
      very large iceberg.

      What the experts do not say is that the List does not exert its
      influence by means of its content alone but also through
      restrictive rules applied by the World Bank - which donates
      drugs and vaccines of an annual estimated value of $400 million
      - and also by Unicef, the PAHO and WHO.

      For example, even though the List is not supposed to be
      restrictive, the World Bank specifies that the products provided
      through its funding must be  essential drugs. Another example
      - even though a WHO certification scheme does exist, Unicef
      stipulates a pre-selection of suppliers limited to those inspected
      and approved by the Danish national health commission.

      How can we improve the situation?  By being increasingly
      vigilant in the struggle against poor quality, low-priced
      products, without, however, harboring any false illusions. as for
      resistance, that will only be crushed through research focusing
      on the mechanisms involved. It is an enormous challenge, and
      one which researchers from universities and industry have
      already taken up and are working on - without waiting for the
      results of the various expert reports. It remains to be seen how
      to be rid of the Malthusian religion of so-called essential
      drugs and of all the prohibitions that have grown up around it.
      No easy task!"


E-druggers are reminded that the IFPMA is sponsoring a fellowship to
the World Bank. Concerns regarding the implications of this fellowship
and potential conflict of interest (known opposition of IFPMA to
essential drugs concept) were circulated a few months ago on the
network. The tone and perspective of the Health Horizons editorial
would seem to justify these concerns and the objectivity in selection
of any eventual incumbent. 

E-druggers might like specifically to consider whether the editorial:

-     offers a balanced review of the report it discusses;
-     provides an objective explanation of the development, rationale
      and aims of the ED concept; and its contribution to public
      health, drug accessibility and rational use; 

-     in its tone and language e.g. "brainchild of", "supposed to help",
      essential drugs were "held to be", "malthusian religion of
      so-called essential drugs" etc. contributes
-     to a measured debate;

-     suggests spurious links between essential drugs and poor

It seems clear that the essential drugs concept is under attack. The
concept - with its focus on prioritization and rational use of resources
- finds application not only in developing countries but in an
expanded form also in developed countries (i.e. insurance reimburse-
ment purposes, hospital drug committee guidelines, etc.). If you
consider the ed concept to be a major public health tool, what action
could be taken in its support? 

Hilbrand Haak
e-mail: 102347.1567@compuserve.com 


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