E-drug: Article in BMJ on 'appropriate donations'
---------------------------------------------
As e-drugs' current co-moderator correctly states the BMJ-article
entitled "Study finds that most drug donations to developing
countries are appropriate" needs to be read before deciding how
much improvement there has been concerning drug donations. I
think it would even be more advisable to read the mentioned
study's results since the 'news' article in the BMJ is an example
of not accurate journalism.
In the BMJ the same study was reported that was posted in the
middle of august in this e-drug mailing list (Harvard's study of
US pharmaceutical donations). I have written a letter to the
author of the news article in the BMJ - URL:
Here is my letter.
What about the inappropriate donations?
Dear James Ciment,
Reading your article one could ask him/herself is the bottle half
empty or half full? Looking more closely at the results of
Harvard Professor Reich's study(1) these reveal substantial
different data than the news you publish in your contribution to
the BMJ of 9 October.
You state for example that "58-90 % of drugs donated were on the
researched countries' essential drugs list or the WHO's model
list". Interesting however are some precise data: 289 of 494 (59
%) of the different pharmaceutical products arriving in the three
researched countries were not on the country's essential drugs
list. Furthermore between 10 % and 42 % of the unique drug
products shipped to these three countries were not on the
countries' essential drugs list, neither were they therapeutic
alternatives or on the WHO model list. The study was unable to
determine whether these products were requested. This seriously
raises doubts on the relevance of these donations.
You further state that "data from 129 countries show that the
median time to expiry date on the day of shipment was well within
the one year buffer period recommended by the WHO". The WHO,
however, as can be read in inter-agency guideline number six(2)
says "after arrival in the recipient country all donated drugs
should have a shelf life of at least one year". The Harvard study
shows that, at the time of shipment, about 30 % of the shipment
items had a year or less of shelf life remaining. For one of the
two researched donor organisations, however, the median interval
between the receipt of product and shipment to recipient
countries was another 113 days.
Also I read in your article that part of the study's results come
from "examining data from 129 countries". The study however only
examined three recipient countries but got data on
pharmaceuticals that were going to be shipped to in total 129
different countries. It was not the countries that were researched but the
drugs that were donated to these 129 countries.
The Harvard study only considered two aspects of the twelve
guidelines. No data is presented on dosage forms, presentation
forms, language, presence of the generic name, package form. All
contribute considerably to the quality of the donation.
An American consortium of pharmaceutical companies and private
voluntary associations sponsored the Harvard study. One could
seriously question this. Especially since other studies also
quoted in your news contribution reveal huge quantities of
unwanted and thus inappropriate donations, especially in
emergency situations.
I appreciate your lines about the need for considering the
problems of disposing inappropriately donated drugs, by quoting
Reich, "No donation should be allowed without disposal
insurance". What about not donating these drugs at all?
Mark Raijmakers
Coordinator programme on pharmaceuticals, Wemos Foundation
Wemos coordinates the committee on drug donations in the
Netherlands as well as the European NGO-consortium on
'appropriate drug donations'. Please access
http://www.drugdonations.org for more information.
(1) Also published in WHO's Bulletin of the World Health
Organisation, 1999, 77 (8): 675-680.
(2) Guidelines for drug donations, Revised 1999, WHO (also
accessible at http://www.drugdonations.org
NEW - Web-site on drug donations in seven languages:
http://www.drugdonations.org
http://cgi.drugdonations.org/mailinglist_form.cgi
(mailing list for this web-site)
Mark Raijmakers
Wemos Foundation
P.O. Box 1693
1000 BR Amsterdam - The Netherlands
Tel.+31-20-4.688.388 / fax 4.686.008
http://www.wemos.nl
"Mark Raijmakers, Wemos" <mark.raijmakers@wemos.nl>
[Thank Mark, for your detailed and helpful response. BS co-moderator]
--
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'.