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Global issues on the agenda at the World Health Assembly. Discussion of HIV / AIDS, leprosy, access to drugs.
JAMA. 2001 Jul 4; 286(1):29-30.During the World Health Assembly in May 2001, some of the high-priority issues are discussed including HIV/AIDS, the WHO policy on medicines, leprosy, and recommendations for infant and young child feeding. In particular, the worldwide HIV/AIDS pandemic and the Global Fund to fight specific diseases in developing countries were subjects of particular interest. In terms of policy on drugs, the main point under discussion was to ensure that public health issues are taken into account as countries develop patent legislation. The secondary issue was the revised drug strategy. A special briefing was also conducted, pointing to great progress in controlling leprosy. Moreover, the main issue in infant and young feeding tackled during the meeting is the promotion and support of breast-feeding.
ECONOMIST. 1999 Aug 14; 352(8132):11-2.The rising health problems in developing countries present a challenge to both aid agencies and developing-country governments. One major aspect of poor health among poor nations is their lack of access to medicines. The World Bank, WHO, and other agencies have formed alliances with pharmaceutical companies in order to promote research on affordable drugs for neglected tropical ailments. This is not enough: the main solution lies in the contribution that local governments can make toward the promotion of good health through strategies that improve nutrition and through improvements they can make in public health utilities such as drinking water and sewage systems. It is local governments responsibility to promote health education through encouraging changes in habits, providing primary care, and making medicines more accessible to their poor citizens.
BMJ. British Medical Journal. 1992 May 30; 304(6839):1398.A disregard for public health, cry the consumers. "Everything's under control," says industry. "Let's sit down and talk it over," says the WHO. The problem--the ethics of drug promotion--was being debated in Geneva at the world health assembly, which ended its 45th, 2 week session last week. The 3 leading actors in this decade long imbroglio remained true to form, with the usual jostling for media attention. 10 days before the assembly Health Action International (HAI), a public interest group represented in 60 countries, held a meeting in Geneva at which it launched a 50 page booklet attacking "misleading, wasteful and dangerous drug marketing." The book gave examples of products promoted for unapproved indications and of hospitality, prizes, and other inducements offered by drug firms to doctors to influence their prescribing habits. It also described poor postmarketing surveillance by drug firms. The problem, says HAI, is not confined to a few "bad apples" but "is a global phenomenon." Undaunted, on the opening day of the assembly the International Federation of Pharmaceutical Manufacturers Associations (IFPMA) briefed journalists on the code of pharmaceutical marketing practices it had established in 1981. Since that year the IFPMA has dealt with 72 complaints citing 926 alleged breaches of the code--92% of them in developing countries. All were investigated, said the IFPMA, and 527--over half--confirmed. "All these violations were rectified or avoided in future promotional campaigns," said the IFPMA's spokesman Mr. Jean-Francois Gaulis, "The code works." HAI disagrees. The IFPMA's code, said Dr. Wilbert Bannenberg, a Dutch public health physician and trustee of the organization, was "far too weak." "Just waiting for complaints to come in is not enough : there must be an active monitoring system and a way of enforcing respect for the code. National authorities in developing countries often don't have the facilities to do this." HAI also criticized WHO for its failure to prevail on national governments to abide by its ethical code for drug promotion, drawn up in 1988. "That code is also too weak," said Dr. Bannenberg. The debate during the world health assembly was prompted by concern among WHO member states over a lack of evidence of "progress in controlling medicinal drug promotion," since WHO's code was established. In the end the assembly passed a resolution calling for a meeting to be held on neutral territory where "interested parties"--notably HAI and the IFPMA--can thrash out their differences. (full text)
CONTRACEPTIVE TECHNOLOGY UPDATE. 1989 Jun; 10(6):77-81.Although generic oral contraceptives (OCs) are bioequivalent to brand-name formulations, many family planning professionals do not prescribe the significantly lower-priced generics. The Planned Parenthood Federation of America, for example, has refused to approve generic OCs for use in the organization's clinics, presumably because of concerns about their equivalent efficacy and safety. However, much of this skepticism may be fueled by misleading marketing by brand-name OC manufacturers. Sales representatives have reportedly told clinicians that generic OCs can be as much as 20% different from brand-name formulations, despite evidence collected by the US Food and Drug Administration confirming that there is virtually no difference except in terms of inert ingredients. In the case of many formulations, the variability between the generic and brand-name products is no different than the variability found between different lots of the same brand-name drug. Another obstacle to wider use of generic OCs is that discounts for large volume purchases make brand-name OCs the best buy for family planning clinics. Clinicians also note that clients complain of minor side effects whenever OC brands are changed, even if the compounds are the same. As the price of medication continues to rise, the more widespread availability of generic OCs will be especially important for teenagers and other low-income clients.
DEVELOPMENT DIALOGUE. 1985; (2):15-37.This paper discusses the principles involved in formulating international standards to regulate the appropriate use of drugs. It focuses particular attention on the role of the World Health Organization (WHO) in organizing this. The following questions are addressed: What is meant by the appropriate use of drugs? What are the main determinants of appropriate drug use that all the main actors agree on? How appropriately are drugs used today? To what extent are the standards agreed on in principle actually observed in practice? Is regulation called for? What kind of regulation is appropriate? What standards would meet the needs of all countries? Appropriate drug use is the provision of drugs to people who really need them and restiction of the supply of drugs to those who don't need them. Primary health care requires a continuous supply of essential drugs. As many as 70% of the pharmaceuticals on the market today are inessential and/or undesirable products, and many pharmaceutical products are marketed today with little concern for the differing health needs and priorities of individual countries. Few countries systematically monitor drug prescribing standards and consumption patterns. There is chronic and serious under-reporting of adverse reactions to drugs. Regulation implies control over the activities of the main drug producers. This requires international initiatives, since an essentially transnational industry is involved. Transnational corporations dominate the world market for drugs. All pharmaceutical products must be approved and registered for use by the competent government authority. All pharmaceutical products shall have full regard to the needs of public health.
Oxford, United Kingdom, OXFAM, 1982. 277 p.Third World countries face foreign domination of their drug markets, a glut of overpriced and unnecessary medicines, a short supply of essential drugs, technical obstacles to local production, unethical promotion techniques, and inadequate warnings about the side effects of certain drugs that may be banned in the developed world. However, a number of small-scale grass roots projects are attempting to redress this situation. For example, Gonoshasthaya Kendra (People's Health Center) in rural Bangladesh operates a pharmaceutical factory which manufactures inexpensive, essential generic drugs. Profit margins are set lowest on drugs considered most useful, and research and development are tailored to local needs. In addition, countries such as Sri Lanka and Mozambique have adopted comprehensive national drug policies that give priority to essential drugs for primary health care. To make the benefits of modern medicine more available to the poor, Third World governments must prioritize preventive and primary health care services and reallocate resources to the poor majority. National drug policies should include identification of essential drugs, compulsory use of generic names, balanced drug information sheets for prescribers and patients, establishment of an efficient public sector drug distribution system, controls on private distribution, and strict curbs on promotion. Medical training should be rooted in social and economic realities so health workers become oriented toward prevention. Also, the schools, mass media, and community organizations should be used to challenge people's dependence on drugs. The success of new drug policies requires the support of the major drug producing nations. These nations should increase their financial support to UN programs aimed at the needs of developing countries and should not obstruct the World Health Organization in its work on an international code of drug marketing practices. Nongovernmental agencies should publicize examples of constructive policy initiatives and continue to fund community health projects that avoid high technology options. The major transnational drug companies should be consistent in the standards they apply, regardless of loose controls in developing countries, and should demonstrate social responsibility by not creating a demand for nonessential preparations.