E-drug: Reply from Dr Attaran to Dr Srinivas (cont'd)
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Dear colleagues,
The underlying question raised by Amir Attaran would seem to be
quite sensible. Why can't well trained and competent physicians (or
other prescribers), discern the scientific facts behind the efficacy of a
particular medication and make a purely rational prescribing decision
based on those facts?
Unfortunately, Dr. Attaran's rush to judgment misses the most
important issues that surround this subject.
Firstly, good quality scientific information is not readily available to the
majority of clinical practitioners in the developing world. Certainly the
latest pharmacology reviews and journals are unlikely to ever be
accessed by the majority of prescribers. I make these statements with
absolute confidence as SATELLIFE is dedicated to making this very
information available to those practitioners who live and work in
remote areas with few resources and poor communications
infrastructure and we wrestle daily with the lack of resources to do
this. A minority of doctors can access journals in university libraries,
or via the Internet in capital cities, but even these resources are
inadequate. It is very unfortunate that few donors or organizations are
willing to invest in proving the meager resources necessary to provide
the required information to those in more remote settings.
Secondly, the drug companies are willing to invest significantly in
providing information that promotes the use of their products. Without
questioning the integrity or honesty of drug companies, I do think it is
fair to say that any information that they present as part of their
marketing will be biased towards influencing practitioners to use their
products.
Thirdly, without any means of being able to measure the information
being presented by the drug company against reliable scientific
information, the practitioner is left with having to use proxy measures
to determine whether the new drug is of particular value and should
be prescribed over and above previously available preparations. One
of those measures is whether the new drug has been patented or not.
Historically, the value of a patent is that it enables one to assume that
one is dealing with a new, active and valuable substance. Now, the
value of a patent is meaningless. It may mean that this is a new and
effective improvement on past drugs, but it may just as easily mean
that it is a manipulation by the drug company.
I think it is unnecessarily harsh to suggest that physicians in
developing countries are "dupes" because they have insufficient
access to scientific data, are provided with biased information, and
now no-longer have a sound reference point to make decisions. I am
not willing to go as far to suggest that we restrict the ability of drug
companies to market their wares, but I do think that we should hold
them accountable to provide unbiased information, and as an
international community we should invest appropriately in making the
scientific data available that is necessary to make good clinical
decisions.
Malcolm Bryant MD. MPH
Medical Director
SATELLIFE
30 California Street
Watertown MA 02742
617-926-9400
www.healthnet.org
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