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E-DRUG: WHO Resolution - Action taken

E-drug: WHO Resolution - Action taken
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Dear e-druggers,

Greetings from CUTS!

I have the pleasure to introduce myself, Rajat Chaudhuri, as the
Coordinator of Consumer Unity and Trust Society (CUTS),
Calcutta, India. 

Consumer Unity & Trust Society (CUTS) is a leading social
action group in India, and an active member of Consumers
International (CI), working at the grassroot, national, regional
and international levels by pursuing social justice and economic
equity within and across borders. 

Presently our Calcutta office is working on health and related
areas of TRIPS (Agreement on Trade Related Aspects of
Intellectual Property Rights) and pharmaceuticals etc. 

This mail is with reference to the new WHO resolution (available
on WHO web page http://www.who.ch/gb/pdfangl/angr24.pdf)
that is to be tabled at its regular Assembly to be held in May. The
new resolution makes some important points in relation to the
TRIPS agreement and its probable implications for the health
sector. 
The new WHO resolution urges Member states primarily to
ensure that "public health rather than commercial interests have
primacy in health policies and to review their options under the
Agreement on Trade related Aspects of Intellectual Property
Rights (TRIPS) to safeguard access to essential drugs." 
 
In this context it may be noted that India which is a signatory to
the TRIPS agreement needs to change its patent laws (Indian
Patent Act, 1970) by 31st December, 1999, to bring it in line with
the international laws on patenting of pharmaceutical products.
Being a developing nation India has been given a grace period of
ten years for technologies previously unprotected in its market.
During this interim period of ten years all patent applications will
be put in a `black box'. However pharmaceutical corporations can
apply for an `exclusive marketing right' (EMR) for their products
for five years only even before India has phased into the new
patent protection system. In the pharmaceuticals sector India
presently allows process patents only. 

The implications of the above and related rules are:

*  the introduction of product patents may imply significant social
costs due to the higher prices charged for medicaments;
*  the access to local firms of protected technology will become
more difficult because of the enforcement of the patent-holder's
bargaining position through investments in R&D; and
*   there is the possibility that the most dynamic segments of the
pharmaceutical market, where the prospects of growth are
highest, will be excluded from domestic firms. 

Side by side with the above some facts revealed by a recent
study by Consumers International are poignant in this respect:

A critical analysis of the retail prices of 22 dosage forms of
common essential drugs in over 30 countries around the world
revealed -

* The average retail price of 18 out of 20 dosage forms are very
much higher in developing countries of South and Central
America than in developed countries

* Many consumers in developing countries with low per capita
GDP are paying much higher retail prices than some consumers
in the affluent and developed countries.

The situation being such it can be well imagined what will be the
consequences when transnational pharmaceutical giants get
most of the patent rights for pharmaceutical products.

It is expected that the United States will seek to exclude point no.
2 from the WHO resolution. We feel that the US opposition to
point no 2. of the WHO resolution needs to be countered with
cogent logic and facts. 

The WHO resolution among other things also urges member
nations to promote rational use of drugs through independent
up-to-date and comparative drug information. It further requests
the Director-General of the WHO to continue the development
and dissemination of information on rational prescribing.

In this context we can mention an India-wide prescription audit 9
also see appendix) study done by our organisation in 1995 which
brought to light alarming facts like:

*   Propensity to prescribe drugs carrying brand names when
generic names were also available.
*   Affinity to prescribe drugs manufactured by MNCs. 
*  Tendency to prescribe comapratively costlier and higher
generations of medicines. 
*   Rampant polypharmacy
*   A large number of unnecessary prescriptions
*   A large number of incomplete prescriptions
*   A large number of irrational, semi-rational and alarming
prescriptions

Studies done by others have come to similar conclusions. 

Our organisation is seeking funds for launching a nation-wide
advocacy campaign with various state governments and other
decision-making bodies to install a standing prescription audit in
various states of the country and to get a list of safe essential
drugs adopted by the governments. 

We take this opportunity to ask all readers to help us in getting
funds to implement this project which in the long run would
translate to improved health for the people of one of the world's
most populous countries. Please find appended below an 
executive summary of this project. We will feel obliged if you can
guide us to funders who may be interested in financing this
project. A detailed project proposal for this advocacy project is
available on request. 

We have especially asked our governments to take note of point
2. of the Resolution which deals with TRIPS and pharmaceuticals
and act on it keeping in mind the cosequences of its removal
from the document.

We also take this opportunity to urge all readers of e-drug to
voice their considered opinion about the new WHO resolution
and support it in its entirety or parts, as per your priorities. 

With regards

Rajat Chaudhuri, Coordinator
Consumer Unity & Trust Society (CUTS),
3-B Camac Street, Calcutta 700016, India
Ph: 91.33.29 7391/2786
Fax: 91.33.29 7665/249 6231
Email: <CUTSCAL@CAL.VSNL.NET.IN> 
Website: http://www.cuts.org
(Kindly always quote the reference number/date in your
response)

APPENDIX: 1) EXECUTIVE SUMMARY OF THE HEALTH
ADVOCACY PROJECT 

EXECUTIVE SUMMARY OF HEALTH ADVOCACY PROJECT

CUTS                       Consumer Unity and Trust Society
                                 3-B, Camac Street, 
                                 Calcutta 700 016 
                                 India                                 
                                 Ph: 91.33.29 7391/2786 
                                 Fx: 91.33.249 6231/29 7665
                                 Email: cutscal@cal.vsnl.net.in
                                 Website: http://www.cuts.org


STANDING PRESCRIPTION AUDIT AND A LIST OF SAFE
ESSENTIAL DRUGS

Funding Proposal: EXECUTIVE SUMMARY

BACKGROUND

Consumer Unity & Trust Society (CUTS) is a leading social
action 
group in India, and an active member of Consumers International 
(CI), working at the grassroot, national, regional and 
international levels by pursuing social justice and economic 
equity within and across borders. 

In a four series workshop for training of young consumer leaders 
organised by CUTS the Voluntary Consumer Action
Network(V-CAN 
i.e. We can!) was launched which adopted the vision statement: 
"Affordable and sustainable health care for all", with the 
mission: "Equipping activists to empower people to achieve their 
right to health."

In a nationwide survey done in 1995 by V-CAN, data of about
2000 prescriptions from Rajasthan, West Bengal, Gujarat,
Maharashtra, Tamil Nadu and Andhra Pradesh were assessed and the data
was analysed using World Health Organisation's (WHO) guidelines.
The analysis showed alarming trends of misprescription, irrational 
prescription, unnecessary prescription of costlier drugs, 
predeliction for brand names, incomplete prescriptions and other 
such serious lacks. 

THE PROPOSAL

The dismal scenario prevalent in this country as brought out by 
the report of the prescription audit, coupled with a more 
liberalised drug policy and reduced controls on pharmaceutical 
industry necessitates follow up. Health being a state subject it 
has been decided to pursue state level advocacy for having a 
standing prescription audit. Under similar situations elsewhere 
in the world standing prescription audits have shown good 
results. It is also proposed to use advocacy to make the state 
governments adopt a list of safe essential drugs. (It may be 
appreciated that this proposal can smartly dovetail with and 
dynamise many of the proposals made in the new WHO
resolution to 
be tabled in May 1998)

GOALS

To undertake advocacy and communicate with the legislatures, 
executive, judiciary and the medical profession for installing a 
standing prescription audit system and get a list of safe 
essential drugs adopted by state governments. The object is to 
improve the quality of health delivery systems available to the 
common man.

METHODOLOGY

1. VCAN will organise four advocacy workshops in four different 
states. The aim will be to get standing prescription audits and 
a list of essential drugs declared in these four states.

2. The advocacy workshops will involve representatives from the 
legislatures, the executive, the judiciary, media persons and the 
medical profession and representatives from civil society groups 
(NGOs and other voluntary organisations). So both the decision 
making strata and civil society-where opinion is built, will be 
represented. 

3. The workshops will discuss in detail the results of the 
previous prescription audit done by VCAN and other such audits 
done elsewhere in this country. Placing these results against the 
broader perspective of the prevalent health scenario and 
liberalised drug policy as also reduced controls on the 
pharmaceutical industry the interactions will be tailored to 
impress upon the decision makers the importance of the avowed 
aims.

4. These workshops will review plans for further advocacy and 
campaign, identify media strategies for national and zonal level 
advocacy and campaigns. It is also proposed to publish a 
quarterly newsletter highlighting various facets of health issues 
in the country as well as editorialising upon the need for a 
standing prescription audit, a list of safe essential drugs 
declaration. 

ANTICIPATED OUTCOME

The advocacy workshops and newsletter will serve to increase
the 
awareness of decision makers about the importance of improving 
prescribing practices. Public opinion coupled with a sense of 
belongingness and motivation that will be imbibed in decision 
makers as well as the medical fraternity to lead to adoption of a 
standing prescription audit and a list of essential drugs. 

Publication of newsletter as well as transactional analysis 
techniques(used in the advocacy workshops) will help to
generate 
increased awareness and responsibility on part of prescribers. 
These would serve as self-regulatory devices and further help to 
improve the quality of health delivery systems available in the 
country. 

DURATION - One year from the date of approval.

FUNDS SOUGHT FOR THE PROJECT - Including four regional
workshops, 
one national workshop and health newsletter - Rs 500,000 = US$ 
12,820 (US$ 1.00 = Rs 39) 
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