E-drug: Pharmaceutical companies and the third world
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[Copied as fair use. HH]
Pharmaceutical companies and the third world
Lancet Volume 361, 29 March 2003.
Sir--Much has been written about ethics and the pharmaceutical
companies--be it on spurious drugs, freebies and other gifts, or the
ethics of sponsored clinical trials and continuing medical education
programmes.1-3 However, there seems to have been little
discussion on an equally important policy that drug companies adopt:
that of selling certain drugs in the developing world while withdrawing
them from the western markets on grounds of safety.
Cisapride, for instance, was withdrawn from US markets in May,
2000, after reports of cardiac dysrhythmias. However, it continues to
be manufactured and sold freely in India.4 Needless to say, no drug
company representative ever informs Indian physicians about the
side-effects or non-availability of the drug in the USA. Just some of
the other drugs that have been banned in the west, but not in India,
are dipyrone (metamizole), phenylbutazone, phenylpropanolamine,
nimesulide, astemizole, and terfenadine.
The regional equivalents of the US Food and Drug Administration and
governments in developing countries have an important role to play,
but have failed in their duties so far. Currently, however, a committee
is studying the Indian data on nimesulide with a view to determining
whether the drug is equally unsafe in Indians. However, this does not
absolve the pharmaceutical industry of their social responsibility to all
people, be it in the richer, litigation-conscious western world, or in the
poorer, developing nations.
We are deeply concerned about these selective withdrawals of drugs
and believe it is racially and socioeconomically discriminatory. It
makes the term "pharmaceutical ethics" an oxymoron and brings to
mind Peter Latham's statement "Poisons and medicines are
oftentimes the same substance given with different intents".5
Sanjay A Pai, P K Lakshmi, B C Rao, Peush Sahni
Manipal Hospital, Bangalore 560017, India (SAP); Drug Information
Center, Karnataka State Pharmacy Council, Bangalore, India (PKL);
Indiranagar, Bangalore, India (BCR); and AIIMS, New Delhi, India
(PS) (e-mail:s_pai@vsnl.com)
1 Newton PN, White NJ, Rozendaal JA, Green MD. Murder by fake
drugs. BMJ 2002; 324: 800-01. [PubMed]
2 Komesaroff PA, Kerridge IH. Ethical issues concerning the
relationships between medical practitioners and the pharmaceutical
industry. Med J Aust 2002; 176: 118-21. [PubMed]
3 Lexchin J. Interactions between physicians and the pharmaceutical
industry: what does the literature say? Can Med Assoc J 1993; 149:
1401-07. [PubMed]
4 Rao BC. Withdrawing drugs: need for global uniformity. Natl Med J
India 2000; 13: 165.
5 Latham PM. General remarks on the practice of medicine, chapter
4. In: Strauss MB, ed. Familiar medical quotations. Boston: Little,
Brown and Company, 1968: 124.
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