IFPMA attack on the essential drugs programme: Much ado about nothing
or just inflicting damage without concern for the consequences?
The recently published Editorial in the IFPMA Newsletter upset many
colleagues. But is it really worthwhile to make such a fuss about?
When carefully comparing the report of the meeting and the IFPMA text
it very much looks like a deliberate misinterpretation of the facts.
In retrospect it was not such a good idea of Dr. Reidenberg to
organize that meeting. The expert committee members were not informed
about it, and the people who were invited were so as individuals.
Reidenberg also insists that his report had no official status,
though in my eyes he misused his prerogative as editor of CPT to have
it published under his name as Editorial.
Who were the experts? Besides himself and his fellow member of the
EDL committee Dr.vSalako (a malariologist from the richest and most
corrupt country in Africa), John Dunne and Margarethe Helling-Borda
(both now retired), Mary Couper who was taken along by John, those
present were: Two representatives from American industries (one
retired), one elderly Spanish professor of pharmacology, two
oncologists, a South-American sexuologist, and the medical director
of one of the sponsoring organisations, the Fondacion Esteve, a
Spanish pharmaceutical company. The other sponsor, Kellogg, has a
good reputation, and I know of no links between corn flakes and
essential drugs (except that breakfast cereals are not essential).
With the exception of a few Spaniards, all probably linked in some
way to the sponsoring industry, no reputable experts from European
academia were there. Apparently none of them has had any long-term
in-depth experience in a developing country. Certainly Reidenberg has
But what did they say? That the essential drugs programme was
excellent, that it should stay, that it is good educational exercise
and not a national formulary but an example of how things could be
done. All this we know, respect and use.
BUT: They also said a few damaging things, such as criticizing the
absence of any drugs for rare diseases, recommending extending the
already very long list of cytostatics, wanting to abolish the
category of "complementary" drugs because it "no longer satisfies
contemporary needs", i.e. mainly stressing increased availability of
antibiotics and the need for developing a new generation of
antibiotics to overcome the resistance problem.
Then they implied that substandard and counterfeit drugs were
undermining the programme, but they did not mention the possibility
of improving quality control in the receiving country. That most
reputable essential drugs wholesalers like IDA, Unipac, MissionPharma
etc. have excellent means of quality control was not mentioned either.
Then mentioning that "pharmaceutical innovation holds the only
tangible solution to... ....these problems (e.g. bacterial
resistance) is simply untrue and runs counter to all available
epidemiological data, because misuse and inappropriate dosing of
available antibiotics are at the root of this evil. And industry has
never fulfilled that promise, because vancomycin's patent dates back
to 1962 (!!). Now up to 50% of Holland's 1.4 million dogs excrete
vancomycin-resistant enterococci. Non-believers should read Laurie
Garrett's recent book "The Coming Plague" (Penguin Books 1995, highly
recommended to all E-druggers). Even industry itself confesses to
have no immediate answer (see the IFPMA Editorial).
Reidenberg looked at the future of the Essential Drugs List and
recommended that the reasons for inclusion of a particular drug
should be stated - look for the next Encyclopedia of Essential Drugs.
Then that the EDL ignored patients with uncommon diseases (untrue).
The colleagues who work with essential drugs at country level should
not be disturbed and angered too much by this publication; on the
other hand the political damage could be great.
There is more than enough data to defend the principle and halt the
slow erosion of the programme which such attacks may cause. Let's do
With best regards,
NL-1077 GL Amsterdam
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