As a long term critic of big pharma I full support Massimo's position on the disgrace of drug over-use. FInding the right solution to the exploitative marketing isn't easy and of course there are similarities with marketing of infant formula, but without even an International Code to keep the companies in line.
Looking back to my days as a junior doctor when drug lunches were the norm and gifts from the companies were ubiquitous, I see huge changes in the culture in UK in hospital medicine and general practice. How has this come about and can it be replicated in LICs? My thoughts are that the following have made a difference:
1. Regulation of sales. Prescription drugs can't be obtained over the counter and pharmacists stick rigorously to the rules
2. Education of doctors. There is far more education from medical school onwards on the risks of overprescribing and the need to keep company representatives at arms length. Medical associations also know the risks of product advertising.
3. Control of companies. There is much less sponsorship of educational activities by pharma as a result of pressure from GMC etc.
4. Most patients appreciate that they can't expect to be prescribed an antibiotic for every fever or sore throat.
Has this eradicated the problem? no - there is still over-prescribing, but I would say worse in the field of mental health - depression and anxiety - than in relation to antibiotics. But there is much awareness of the problems.
I would have thought that the two first measures mentioned above should be applied whenever possible. I am doubtful if we can expect a solution from WHO, we have to find it within our own practice and change our system ourselves, hard though it may be.
Tony
CHIFA profile: Tony Waterston is a retired consultant paediatrician who worked mainly in the community in Newcastle upon Tyne, UK. He spent 6 years working in Zambia and Zimbabwe and directed the Royal College of Paediatrics and Child Health Diploma in Palestinian Child Health teaching programme in the occupied Palestinian territories. He was an Editor of the Journal of Tropical Pediatrics and is on the Executive Committee of the International Society for Social Pediatrics. His academic interests are child poverty, advocacy for child health and children's rights. He is currently the lead moderator of CHIFA www.chifa.org He is also a member of the HIFA Steering Group.
www.hifa.org/people/steering-group www.hifa.org/support/members/tony
Tony.Waterston AT newcastle.ac.uk
