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BMJ (CLINICAL RESEARCH ED.). 1996 Oct 26; 313(7064):1085.Jacqui Wise reports that artemether, the active ingredient of a traditional Chinese remedy for fever, has been found to be as effective as quinine in severe malaria. She states that most deaths from malaria occur in Africa and then quotes Dr. Peter Trigg, a scientist with the World Health Organization's malaria unit, as saying that the WHO appreciates the operational advantages of the new drug in the field but will not "recommend its introduction into Africa because of fears that ... resistance would spread." This decision by the WHO is unethical and unprofessional. The organization is condemning African patients with malaria to the possibility of death even while it is announcing that a new drug has shown better outcomes than occur with quinine. It is incredible that an organization that is part of the United Nations and that is charged with implementing health for all in the world by 2000 should decide to abandon patients to possible death from malaria on the basis of the lame excuse that resistant strains might develop if a new drug was introduced. Would this kind of trial be approved by an ethics committee? Rather than deprive African patients of the benefits of a new drug, the WHO should use its influence and resources to educate the governments and people in Africa about the dangers of misuse of drugs and the emergence of resistant strains of malaria. (full text)
Social Science and Medicine. 1996 Apr; 42(7):1011-9.Inappropriate drug use is a major problem in the control of diarrheal diseases. Addressing the problem, the World Health Organization's (WHO) Program for the Control of Diarrheal Diseases reviewed the literature on the most commonly used antidiarrheal agents, and distributed the resulting document widely in 1990. Individual and group campaigns against the registration and use of antidiarrheal drugs also brought considerable attention to the issue in the popular media. This article evaluates the actions taken against antidiarrheal drugs by national drug regulators during and after these events, January 1989 through December 1993. Information on regulatory actions was requested from countries and extracted from published and unpublished sources. 16 countries reported regulatory actions on 21 occasions during the period of study, with the majority of actions taken against antimotility drugs. Few were against adsorbents, antidiarrheal drugs containing antimicrobials, or adult formulae. Six countries took action against large and heterogenous groups of antidiarrheal drugs, with most actions occurring within two years of the distribution of the WHO review and the attention in the media. Many more antidiarrheal drugs may lose their register in the future through a passive deregistration process. The deregistration of inappropriate drugs, however, will probably take quite a while, with widespread deregistrations unlikely. Moreover, regulatory actions alone are probably not enough to achieve a more appropriate use of drugs. Greater effect can be expected from simultaneous regulatory, managerial, and educational interventions directed at providers, combined with communication to the general public.