E-DRUG: Global drug sales through the Internet and unregulated markets?(2)
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dear E-druggers,
1. Re sales through street markets -- although this is probably not a large VALUE, it might be a substantial volume -- of cheaper drugs, and a lot of counterfeit probably goes through these channels. Also what is the precise definition of "street markets" -- would that include the small shops which sell other things e.g. candles, soap, as well, in other words fixed shops other than drug shops /licensed shops? Didier Fassin wrote an interesting article about this a long time ago -- Fassin, Didier. 1988. Illicit sale of pharmaceuticals in Africa: Sellers and clients in the suburbs of Dakar. Tropical and Geographical Medicine 40: 166-70.
2. Re % of prescription only without a prescription. Here there's another wrinkle -- my colleague Dr Anibal Sosa reports that many licensed drug shops return prescriptions to the client when filled -- which they can then use over and over -- the "family prescription" for antibiotics, for example. Is that type of dispensing "with" or "without" a prescription?? In any case the % of prescription-only W/O a prescription must be quite substantial -- half? especially if prescriptions are "re-used".
3. Re quantifiable data -- Fassin's article points out that part of these informal market drugs come from fixed pharmacies, and they are the end of the chain -- pharmacies are glad not to have these lower income clients coming directly into their pharmacies and they sell drugs to intermediaries who take them out and sell them on the market (the part which is not pilfered from health facilities, that is.) Probably most pharmacies have an idea of which of their clients are selling drugs on in this way (as opposed to buying for personal use). This fraction plus the amount of pilfered drugs, much of which probably ends up on the informal markets, would give us some idea of how much actually goes to the informal market. It's a large amount, any way you cut it.
Interesting questions -- anyone want to fund me to do the study?!
regards
Susie Foster
Director of Public Policy and Education
Alliance for the Prudent Use of Antibiotics
75 Kneeland Street, Boston MA 02111 USA
susan.foster@tufts.edu
and
Professor of International Health
Boston University School of Public Health
715 Albany St, Boston MA 02118 USA