# \[e-drug\] What Motivates Drug Donations? (cont'd)

**URL:** <https://talk.edrugplus.org/t/e-drug-what-motivates-drug-donations-contd/7464>\
**Category:** e-drug\
**Created:** [February 28, 2000, 2:14pm UTC](https://talk.edrugplus.org/t/e-drug-what-motivates-drug-donations-contd/7464 "2000-02-28T14:14:33Z")\
**Posts on this page:** 1\
**Page:** 1

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**Author:** ![joel.lexchin](https://avatars.discourse-cdn.com/v4/letter/j/e9c0ed/32.png) [@joel.lexchin](https://talk.edrugplus.org/u/joel.lexchin)\
**Post date:** [February 28, 2000, 2:14pm UTC](https://talk.edrugplus.org/t/e-drug-what-motivates-drug-donations-contd/7464/1 "2000-02-28T14:14:33Z")

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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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