E-drug: What Motivates Drug Donations? (cont'd)
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Dear e-druggers:
I welcome Mark Raijmakers' questions on my critique of the Scott
Hillstrom allegations against US donations. Below, I've paraphrased
his questions and responded to each. Let me say that Mr. Raijmakers'
tone reflects the long-standing suspicion between us, which I want to
do all I can to dispel.
In his preamble, Mr. Raijmakers says he doesn't want to get into
whether US tax laws stimulate bad donations. I understand and
accept WEMOS' desire not to discuss taxes. But in turn I ask WEMOS
to understand that for PQMD, since the tax issue was one of Mr.
Hillstrom's central charges, PQMD could not ignore it. He called the
US tax policy "perverse" and claimed it allows deductions on drugs
the companies "cannot sell." That perception, though untrue, is
commonly held and must be corrected. I feel sure WEMOS
understands.
Now to Mr. Raijmakers' questions.
1. Will PQMD members release their drug donation and tax records?
Plainly, the more openness the better, and many if not all PQMD
members publish data on the value of drug donations and on taxes
paid, in their annual reports to shareholders and donors.
I'd like more data to be released. An informal survey showed that
US-based firms and relief agencies donated well over $550 million in
medicines last year alone. However, I doubt that total disclosure
would help the cause of discouraging poor donations or encouraging
good ones.
I suggest a more direct remedy: sunlight. Let all who encounter bad
donations report them, just as physicians, pharmacists and nurses
report adverse drug experiences to regulatory authorities. Provide as
much specificity as possible to WHO, PQMD and IFPMA. Let those
organizations give the people involved in a questionable donation a
chance to explain or correct the problem. If no adequate response is
forthcoming, release the charges to the media, to e-druggers, to the
tax authorities and to the apparent perpetrator's competitors.
In short, a more targeted, name-naming approach than has been used
in the past. WHO is already working on it.
2. Why are Mr. Hillstrom and PQMD fighting each other, instead of
collaborating to integrate the Guidelines into US tax law?
PQMD isn't fighting anybody. Mr. Hillstrom sent incorrect information
and mean-spirited charges around the world. He did so ten months
AFTER we'd endorsed the Guidelines and three months AFTER we'd
worked with Congressman Doggett and endorsed his bill. He portrayed
us as opposed to them. He said that the US tax code causes bad
donations and that donated drugs sometimes kill, but he provided no
facts to back his allegations. In short, Mr. Hillstrom's contribution has
been, to say the least, inconducive to progress.
When WEMOS put Mr. Hillstrom's inaccurate charges on its website, I
asked for "equal time" to give our point of view. So far, our faith in
WEMOS' interest in the facts has not been confirmed.
The odd thing is, WEMOS and PQMD both want every drug donation
to be appropriate and needed. PQMD has taken initiatives on these
points. I would have thought WEMOS would support what we've
done in the US and would want the Guidelines to have the force of
law in Europe as well. Am I wrong?
3. Why is it that the donations community has to 'defend' itself from
'allegations' as you phrase it?
Mark, come now. A wiseguy pees on my shoe and tells me it's
raining, and you expect me to be a monk? I'm not that charitable.
Incorrect statements and snide attacks should not go unanswered,
because silence gives them credence and encourages more. Do you
not agree?
4 and 5. Lots of sub-questions. You ask if PQMD would have
endorsed the Guidelines if the suggestions we made at the March 9,
1999 signatories' meeting had been rejected. You say Americans
obstructed the Guidelines before 1999, so that the essential drugs
community's skepticism is justified. Finally, you object to PQMD's
claim that we were "partly responsible" for re-drafting the Guidelines,
noting that 155 people and 15 sponsoring organizations were
involved, none from "industry."
First, your skepticism is accepted. I only ask that you look at what has
occurred in the last year or so and keep an open mind. If things are
changing for the better, it isn't simply that PQMD "saw the light." It's
also that WHO staff decided to give us a chance by letting PQMD
attend that 1999 meeting of signatories.
Letting us attend was an ingenious strategy. It made the donations
community "put-up or shut-up." Until then, we could complain that
we weren't substantively involved in framing the Guidelines -- and that
the people holding seats at the Guidelines table, despite their great
stature, had little direct experience with drug donations. We could
send written comments, and we did. But a seat at the table? No. We
felt excluded from the writing of Guidelines we'd have to live under.
WHO disturbed our pleasant little sulk when it let us come to that
meeting. They invited attendees to send suggestions prior to the
meeting, and so we did. At the meeting, our suggestions were
discussed, and most were accepted. (If you are curious, I'll send you
what we suggested.)
Would we have declined to endorse if we not been granted a seat at
that table, or if none of our changes had been accepted? I don't
know, and I don't care to speculate. We came, they listened, and at
the end of the day most of what we suggested was accepted.
That left no option but to come home and recommend that PQMD
endorse the revised Guidelines. We voted, and with unconcealed
pleasure I then E-mailed PQMD's endorsement to WHO staff. I suspect
they were surprised, even incredulous. They asked for something in
writing, on paper!
I'm sorry if, in describing all this, I came across as a braggart. I think
our contribution was significant, but as you rightly say, it was one of
many. Still, I am proud that PQMD was the first NGO/Industry group
to endorse the Guidelines. I keep a copy of WHO's October 9 press
release announcing it on my desk.
Let me also comment on Mr. Rainmakers' observation that the
Interagency group responsible for the Guidelines does not include a
representative of the donations community. He is correct of course,
but I think there should be such a representative -- because it's far
more difficult to oppose Guidelines if one has had a real role in their
making.
In his postscript, Mr. Raijmakers discounts my assertion that
"surprisingly little has been done to actually pinpoint" sources of bad
donations. He says, "...in Western Europe for some years now there is
active campaigning on improving the quality of drug donations. In the
US however there is still a long way to go." Well, I know WEMOS
does a fine job, but too little monitoring goes on to justify
complacency. For example, a 1999 WHO Euro Office survey of drug
donations in Albania listed examples of "unhelpful donations" from the
US, but it also found several from European governments, firms and
relief agencies. Rather than squabbling, let's name names, report
them, and educate them, wherever they are. Would WEMOS agree to
that?
Finally, I suggest we do more to acknowledge and praise good
donations. The need far exceeds the supply, and drug companies and
relief agencies, like activist organizations and governments, strive
harder when justly praised.
Most of all, let's stop bickering.
Kind regards,
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)
e-mail: JBRusso@aol.com
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