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E-DRUG: Editorial Health Horizons

IFPMA attack on the essential drugs programme: Much ado about nothing 
or just inflicting damage without concern for the consequences?

Dear friends,

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,

Leo Offerhaus 
Chopinstraat 9
NL-1077 GL Amsterdam
Tel.0031 20 676 24 34 Fax 0031 20 675 65 90
E-mail: lo@euronet.nl; 71530.15@Compuserve.COM
EJCP only: POB 75552, 1070 AN Amsterdam Netherlands 

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