E-MED: R�vision de la liste mod�le des m�dicaments essentiels de l'Oms
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[Mod�rateur : Pour tous ceux qui s'int�resse au processus de r�vision de la
liste mod�le des m�dicaments essentiels de l'Oms, je vous signale ce message
de Richard Laing du forum de discussion e-drug ci-dessous.CB]
E-drug: Comments on the process to revise the WHO Model EDL
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WHO is asking for comments on their proposed new method of
revising the WHO Model List of Essential Drugs.
http://www.who.int/medicines/organization/par/edl/orgedl.shtml
As some of you may know, I have criticized the way the list was
revised in the past. More recently, I was asked to comment on the
process and I participated in a meeting in March to suggest ways in
which what is essentially a technical process could be improved.
The improvements which were proposed related to improving and
making available the evidence base of the model essential drug list,
including information on efficacy, cost and cost effectiveness,
improving transparency and making the document more useful and
accessible to countries developing their own EDLs.
A document detailing the new proposed process was produced and
circulated for comments from member countries.
http://www.who.int/medicines/organization/par/edl/documents/who
edlprocess15May31_eng.doc These comments have now been
received and have been posted and a new version of the proposal
with specific questions has been posted at:
http://www.who.int/medicines/organization/par/edl/documents/who
edlprocess19-4-revised.doc
I read the original document and was pleased with it and was
planning to make a few minor comments about sections that might
need clarification. However in August, I was astonished to hear that
the US government had sent in a very critical series of comments
on this draft. This has been posted at:
http://www.who.int/medicines/organization/par/edl/comments/edl_1
5.doc
Among the more amazing of their comments was a rejection of the
definition of essential drugs which has been used since 1977. They
reject the practice which has been in existence since 1977 of
having a core and complementary list of drugs and suggest that
there should only be one list. In the eleven revisions of the list there
have been two lists (core and complementary) and I have never
heard suggestions that there was anything wrong with this
approach. They also suggest that "Consumers and industry must
play an expanded role in the Expert committee meetings..." When
we allowed industry to participate in national EDL meetings in
Zimbabwe, we ended up with a very long EDL. I recall one industry
representative saying "If you don't include hexaprenaline inhalant
for asthma, we will leave the country!" This despite the fact that
salbutamol was already on the list. Clearly neither consumers nor
industry should participate in the decision making process. They
should be invited to comment and provide information but to attend
the Expert Committee meetings and argue with panel members
seems to me to be ridiculous.
On providing comparative cost information the US states "While
information on cost may be helpful at national and local levels, it is
not viable at the global level unless the prices are listed in a specific
way that makes them exactly comparable." What surprises me
about this statement is that for some years, the US supported MSH
production of the Drug Price Indicator Guide which provides exactly
this comparative cost information. In commenting on the value of
evidence based selection of drugs which in the WHO document
refers to the Cochrane Network and the Cochrane Collaboration
they as the question "What is the Cochrane Network?" My
response to them is that if they don't know the answer to that
question they should not be writing an official document for the US
government! There are many other comments designed to raise
blood pressure!
In one way, I am appalled that the US government could respond in
the way that it has. In many ways, it has gone back to the disputes
which occurred before the Nairobi conference of 1985. That
meeting resolved all of the issues raised and led to the Revised
Drug Strategy. It is as though there have been no developments
since then. On the other hand, I hope that these comments will
encourage member countries and others to seriously examine the
WHO proposal and the country responses. E-Druggers should realize
that the Essential Drugs Concept is under serious attack and that
there is an attempt to turn history back! I was pleased to see that
comments from other countries supported the WHO approach. The
comments from Malta, Netherlands, Iran and Norway are, I think,
constructive and useful and reflect support for the process.
In January this year, I went to Eritrea to work with their Ministry of
Health to revise their national EDL. It was a very rewarding
experience as the many dozens of people who participated
struggled to make the best choices for their country. The WHO
Model list was referred to but not used much because the reasons
for a drug being included or excluded was not available. In practice,
the most frequently used reference book was the British National
Pharmacopoeia because it included modern information on
therapeutic efficacy and comparative cost information. This is what
countries need to make these difficult decisions and this is what
WHO is trying to provide to their member countries.
Please read these documents carefully and send your comments to
WHO. But please send them to your Ministers of Health as well.
Brief your Ministers and permanent secretaries and especially those
who will be attending the World Health Assembly or Executive
Board in 2002. Based on past experiences, there will be a fight over
this proposal and it is clearly in countries interests to have this new
and better process which will provide them with the information
needed to make their own decisions.
If anyone cannot download these documents please e-mail me and I
will send them to you as attached files.
Richard Laing
Associate Professor of International Health
Boston University School of Public Health
715 Albany St, T4W, Boston MA 02118 USA
Tel 617 414-1444 Fax 617 638-4476
E-mail: richardl@bu.edu
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