E-drug: Re: Wall Street Journal on expired drug (cont'd)
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I do not know Bonnie Fundafunda of ECHO, but I welcome her well-reasoned
contribution to the discussion of expired drugs.
It's become, as Alice said, curiouser and curiouser. Richard Laing, whose
credentials are impeccable, suggests that I am too hasty in hesitating to
foist spot-checked expired drugs on the poor and earthquaked. I, an
unreconstructed Kennedy man representing firms and charities whose
conservatism is assumedly Reaganesque, am forced to take what can only be
described as a position on Richard's left.
I found Laurie Cohen's article fascinating, but I remain convinced that
expired drugs have no role in product donations. None. We should be
working
for stronger adherence to the WHO Guidelines, not their dilution. We
should
be arguing about why our European colleagues are silent on giving the
Guidelines the force of law. We should be arguing about the need for more
pharmaceutical firms to make more generous contributions. We should be
pushing for more of the targeted, collaborative programs against specific
diseases, like Merck's and SmithKline Beecham's and Pfizer's. We should be
demanding more "produce to give" programs where drug firms make what relief
agencies need.
Instead, we're kicking around an idea that encourages donation and use of
expired drugs. This is not terribly progressive.
Of course anything is possible. It is remotely conceivable that a large
inventory of an essential, scarce but expired medication could become
available, whereupon it might be rational to officially re-evaluate its
stability. But let's cross that pharmacokinetic bridge when we come to it.
In the meantime, let's stick with the Guidelines.
I hope Richard Laing would agree.
Jim
James B. Russo
Executive Director
The Partnership for Quality Medical Donations
146 Koenig Road
Bernville, PA 19506
USA
610 488 8303
610 488 7036 (fax)
JBRusso@aol.com
[This is what the guidelines say about shelf-life: ''After arrival in the
recipient country all donated drugs should have a remaining shelflife of at
least one year. An exception may be made for direct donations to specific
health facilities, provided the responsible professional at the receiving
end acknowledges that (s)he is aware of the shelf-life and that the
quantity and remaining shelf-life allow for proper administration prior to
expiration. In all cases it is important that the date of arrival and the
expiry dates of the drugs be communicated to the recipient well in advance.
Justification and explanation: In many recipient countries, and especially
under emergency situations, there are logistical problems. Very often the
regular drug distributiom system has limited possibilities for immediate
distribution. Regular distribution through different storage levels may
take 6 to 9 months. This provision especially prevents the donation of
drugs just before their expiry, as in most cases such drugs would only
reach the patient after expiry. It is important that the recipient official
responsible for acceptance of the donation is fully aware of the quantities
of drugs being donated, as overstocking may lead to wastage. The argument
that short dated products can be donated in the case of acute emergencies,
because they will be used rapidly, is incorrect. In emergency situations
the systems for reception, storage and distribution of drugs are very often
disrupted and overloaded, and many donated drugs tend to accumulate.'' KM,
moderator ]
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