E-drug: 11th Model List of Essential Drugs (cont'd)
---------------------------------------------
Dear Pierre,
Thank you for your restrained response. I think this is an issue that
needs debate and discussion. The crux of my point is that the anti
AIDS drugs are not good enough. If they were made available for free
could they be used effectively? We may want to think so but so far
we do not have any evidence that they could. The Cote d'Ivoire
results I have been told are very disappointing.
If the drugs were curative and not life long and could be easily used, I
would make them "essential" but at present I doubt if many countries
could use them effectively in their public sector health systems.
I wonder if MSF should not try to organize a clinical trial of an
empirical regimen without monitoring in a poor country such as
Tanzania. The message on E-Drug from Dr Gabriel Mwaluko suggests
an interest in undertaking such activities.
If we had evidence that these drugs could be used effectively, I would
change my position. I would like to be wrong but my assessment is
that these drugs could not, at this time, be used effectively in most of
the countries where the disease is devastating such as Zimbabwe.
Price to me is a secondary consideration.
There may be a case for splitting the WHO Model list into two lists: A
vital list which would include curative life saving drugs and an
essential drug list that would depend on a county's infrastructure.
That way the vital list would be a must "have list" and the essential
would be a "may have" list.
I expect that there will be a number of comments on our two
messages. I hope that they will all be as constructive as yours.
Regards,
Richard Laing
Associate Professor of International Health
Boston University School of Public Health
715 Albany St, T4W, Boston MA 02118 USA
Tel 617 414-1444 Fax 617 638-4476
E-mail richardl@bu.edu
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.