E-drug: What Motivates Drug Donations? (cont'd)
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I am an outsider when it comes to the drug donations issue but I do
want to comment on one of James Russo�s suggestions that
anybody who encounters bad donations report them. I make my living
as a doctor and see lots of instances of patients being badly treated
by other health care professionals or if not mistreated then their food
is cold or it takes a nurse 15 minutes to come when they call. But you
know what, most of the time those patients who are mistreated or
ignored don�t complain. Now sometimes they just don�t care, but
even if they do they tend not to complain. Why? Well, if they
complain then maybe the next time they�re sick then they�ll be
treated even worse or they won�t get treatment at all. These
projections are not necessarily accurate but in the patients� minds
the possibility is real enough. It�s easy enough for people from NGOs
or aid agencies to complain but not for the recipients, they have to
live with the possibility of the next time they need aid�they don�t
want to seem ungrateful now for fear of what might happen in the
future. They may even discourage people from NGOs from
complaining the same way that women who have been raped
sometimes don�t want police to press charges because when their
partners find out they (the women) think they will suffer even more.
Being willing to report bad donations is easy when there is no power
imbalance; it is a lot harder when you are the weaker party. What
percentage of rapes are reported? What percentage of instances of
racial, sexual, etc. discrimination are reported? I don�t have exact
figures but it�s only a small minority. (Incidentally, using Mr.
Russo�s analogy about the reporting of adverse drug reactions,
probably only about 1-5% of those are reported to the regulatory
authorities.) Reporting is a passive surveillance system and passive
surveillance systems tend not to work very well. I would press for an
active surveillance system whereby an organization (maybe PQMD
with observers from some other NGOs) randomly inspects a number of
drug donations (to pull a figure out of the hat, say 1-2% per year) to
see if the donation complied with the guidelines. This sort of system
could supplement what Mr. Russo calls for.
Joel Lexchin MD
Townhouse #2--40 Cedar Crescent
Glenside, S.A. 5065
Australia
Tel: +61 8 8338 0151
e mail: joel.lexchin@utoronto.ca
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