E-drug: Re: description/definition of essential drugs by WHO
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The essential medicines definition is a kind of concentrate of the
1977 definition, but falls down through a lack of precision when it
refers to "priority" health care needs. This notion of "priority"
remains vague and is not defined, selection criteria refering only to
prevalence, what is far from being enough to set up any priority,
particularly when we know the lack of public health considerations
and background when governments draw up their own national
medicine policies.
Are priority diseases the only diseases with a prevalence for
example higher than 7 or 10 per thousand? This could mean in this
specific case that no "orphan drug" policy could have emerged.
This could mean as well that few diseases dubbed neglected (see:
http://www.neglecteddiseases.org) are not a priority because their
prevalence in a region or a country may be inferior to the most
prevalent diseases.
Probably other epidemiological criteria have to be better considered
and took into account for any selection (eg, DALYs - see: Murray
CJL, Lopez AD. Alternative projections of mortality and disability by
cause 1990-2020: Global Burden of Disease Study. Lancet 1997;
349:1498-1504), as well as the fact that medicines are only tools
and instruments among many others. Lets keep in mind that some
communicable diseases such as tuberculosis have been under
control before the discovery of "TB drugs", sanitation and social
improvements having been the very landmark events.
Are we sure that a specific medicine can be considered as essential
because it strictly fulfills the three selection criteria (prevalence,
efficacy/safety ratio, cost-effectiveness)? Is-it not a too narrow and
caricatural approach, treating other health interventions with
disdain? Maybe it will be a good medicine (safe, effective), but are
we sure that it will be the essential and right health intervention?
Patrice Trouiller, PharmD, MB
University Hospital of Grenoble, France
MSF, Drugs for Neglected Diseases Working Group
Tel : +334 76 76 54 97
Fax : +334 76 76 51 09
Email: PTrouiller@chu-grenoble.fr
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