E-DRUG: donated drugs
---------------------
I have just returned from a medical mission in Honduras where we again had
to
destroy many thousands of recently outdated medicines due to national
requirements. There is a continuous waste of essential medicines for decades
in most if not all countries. I believe the basis of this in large part is
due
to the WHO recommendations. The predominant illnesses we focus on at this
clinic are diabetes and hypertension which is prevelant and untreated
locally
but is controlled fairly well by monitoring and donated medicines. Both
conditions if even partially controlled markedly decrease morbidity and
mortality. In addition all serious infections require antibiotics. We could
be
more effective if we could use the recently outdated medicines.
I have inquired of the WHO in the past about this and received an
explanation
and literature that essentially stated that a "double standard" of the use
of
medicines is not tolerated and the basis of outdating is the decrease in
stability/potency. The results of the all or none principle applied to the
"double standard" is that millions of people who would benefit are denied
these free essential medicines. Scientifically it has been shown that the
use
of outdated medicines (with the exception of Tetracycline) has no toxic
effects. The potency/stability is only mildly decreased (Medical Letter Vol
44
8/28/02) especially in the first 1 or 2 years when in solid form (tablets
and
capsules).Most of these preparations (except warfarin and thyroid) are made
in
2 or 3 multiples of the basic dose (eg. 25,50 and 100mg) Doctors usually
control the various medical conditions by increasing the doseage 2,3 or 4X
the
base dose up to the maximum allowable amount. The minor variance in potency
(generally <10%) in recently outdated medicines is small compared to the
differences in doses available and to my knowledge do not endanger the
patient.
Millions of dollars of good medicines are destroyed frequently because of
these regulations and free clinics/missions are threatened or shut down if
they use outdated medicines. Is it possible to get some recognized
pharmacologic or medical authorities to recommend permitting the use of
recently outdated solid medications when distibuted free of charge to needy
patients in third world countries? Are there any more definitive studies on
this problem? I would appreciate any input.
David Perlmutter MD
Email: cperlma@msn.com
[Dear David, maybe the drugs are still OK, but would you guarantee that as a
health professional? Can you really be sure? It is indeed a waste that drugs
expire, but why are they expiring? Is the drug supply management system so
poor? And how can one rely on a continuous flow of donated "free" drugs? The
WHO had some valid reasons to be "tough", I think. Anyway, the floor is open
for debate! WB]
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