The Pharmaceutical Journal
Vol 270 No 7250 p720
24 May 2003

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Letters to the Editor

The Industry

A disappointing, one-sided debate

From Mrs S. I. Leverett, MRPharmS

Lack of access to affordable drugs in the so called developing countries is a complex issue. It is neither simply due to the greed of pharmaceutical companies (as the Channel 4 documentary "Dying for drugs" indicated), nor to the corrupt and indebted regimes of developing countries (as suggested in your leading article of 3 May, p602).

It is true that access to clean water, better housing, etc, are fundamental to better health. However, it is also a fact that many people suffer through being denied access to affordable drugs.

I have recently returned from southern Africa where I worked in a large acute hospital as a volunteer pharmacist. Patients were given paracetamol for herpes infections because aciclovir was not available. Terminally ill patients requiring opioid analgesics received morphine liquid. Controlled release morphine tablets are not an option, unless you can afford private health care. When there was a supply problem with the morphine powder used to prepare the solution (for several months), patients in many districts went without.There were no alternatives. As for antiretroviral drugs, these are not a treatment option. However, this is not to say that the drug companies do not assist occasionally.

Many developing countries do lack infrastructure within their health care systems (or else people such as myself would not be required there) and tasks such as monitoring compliance and adverse effects require trained staff to carry them out. So there is a need for managed entry of drugs into the health service.

Your leading article also mentioned bad debts and corruption. The latter is not a phenomenon peculiar to developing countries and the former is something which has been exacerbated by the policies of the World Bank.

The upshot is that pharmaceutical companies do have a significant role to play in the access to drugs and the sooner people face up to this, the better. It is disappointing that all too often, this debate is one-sided, with the blame apportioned to a single party.

Sharon Leverett
Norwich

Such ill-informed blanket criticism is resented

From Mr R. B. A. Johns, MRPharmS

I did not see the Channel 4 programme referred to by Patricia Armstrong (PJ, 17 May, p680) but I have read your comments (PJ, 3 May, p602) which she says she found even more appalling than the programme's content. I intend no disparagement of the editorial in saying that if that was a defence of the pharmaceutical industry, as she claims, then a vastly more vigorous one could have been mounted, and having spent a considerable time in the industry I would like to do so. However, may I say first that Mrs Armstrong exhibits a certain naivety in believing everything that the media put before us; surely most of us realise that bad news and provocative journalism make good copy, or in this instance, good television.

One may reasonably wonder whether Mrs Armstrong offers anything other than her own prejudices in support of her several generalisations, the most glaring of which is to group all pharmaceutical manufacturers under the implied heading, "rapacious and cynical exploiters of the sick". I assume she is aware that there are companies, the true "me-too-ers", which undertake no original research at all but simply await the expiry of patent on a successful drug before producing a cheaper version. The profits of such companies may be huge in relation to their turnover, but do "we all know" it? I certainly do not.

Then there are those whose research is confined to molecular manipulation in the hope of producing a more effective variant or one with fewer side effects than the original. Again, the scale of their profits can only be guessed at but is presumably reduced by their failures.

Finally there are the truly innovative companies with research budgets which can indeed be described as "huge" but which often result in the "breakthrough" which Mrs Armstrong derides. Would she prefer that such research, financed out of profits, should cease? The company with which I was associated for 24 years was responsible for a number of genuine advances in therapy and hygiene — primidone, chlorhexidine, halothane, propranolol and tamoxifen are a few, and the number continues to grow — and incidentally retained on its list at least one unprofitable product to meet a small continuing demand from developing countries. I was proud to be associated with that company and cannot do other than resent the ill-informed blanket criticism of Mrs Armstrong and others of like mind.

Richard Johns
Boston, Lincolnshire

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