- Email: [email protected]
BANGLADESHI DRUG POLICY
683 Mr Cox, I would be against increased statutory control; I ask merely y for proper enforcement of existing regulations. Mr Cox’s challenging remarks about the numbering of clauses in the new edition of the code led me to discover that the Code of Practice does not, and never did, contain a requirement of "legibility" in advertisements. Either by accident or design the code does not use the wording approved by Parliament. Whereas the Medicines (Advertising for Medical and Dental Practitioners) Regulation 1978 requires that statements made in advertisements about side-effects should be "printed in a clear and legible manner", the code requires that it should be given "clearly and concisely". I do not accept Mr Cox’s view that these phrases are synonymous. Moreover if the Code of Practice Committee considers them synonymous why does it allow the publication of illegible advertisements (Feb 11, p 341)? Mr Cox’s letter has served to strengthen my view that matters of the law should be taken out of the hands of his committee. However, it seems that the Department of Health is unwilling to accept its mandatory responsibility. The Medicines Act (section 180, 1) states that "it shall be the duty of the appropriate Minister to enforce in England and Wales, or to secure the enforcement in England and Wales, of the provisions of this act and any regulation and order made under it". It appears that the Government is prepared to let the Minister of Health abrogate his statutory duty to the ABPI, a body whose interests are not necessarily shared by the sick. Such privatisation of the law must be resisted. Department of Pharmacology, St George’s Hospital Medical School,
ANTIBIOTIC KILLING OF LEGIONELLA
SIR,-In a combined microbiological and electron microscopical study (Feb 11, p 348), Dr Miller and colleagues described the killing of legionella organisms within vacuoles in human polymorphonuclear leucocytes (PMNs) by erythromycin. In previous reports it has been shown that Legionella pneumophila replicated within human monocytesl,2 and not in PMNs but were only taken up into cytoplasmic vacuoles.2,3 The data in Miller’s fig 1, in the absence of drug, are consistent with active uptake and little or no subsequent replication. Our studies on the action of antibiotics on legionella in suspension showed that 10 g/ml erythromycin induced loss of viability only after prolonged treatment.4The action of this macrolide was fundamentally bacteriostatic rather than bactericidal, ampicillin being bactericidal (fig 1). Similar results have been observed for intracellular L pneumophila in monocytes 5
exposed to
1.
JOE COLLIER
London SW17 ORE
2.
3.
BANGLADESHI DRUG POLICY
Horwitz MA, Silverstein SC. Legionnaires’ disease bacterium (Legionella pneumophila) multiplies intracellularly in human monocytes. J Clin Invest 1980; 66: 441-50. Anøn. Clin Immunol Newsl 1983; 4 (July): 83-97. Horwitz MA, Silverstein SC. Interaction of the legionnaires’ disease bacterium (Legionella pneumophila) with human phagocytes I: L pneumophila resists killing by polymorphonuclear leukocytes, antibody and complement. J Exp Med 1981; 153: 386-97.
Bangladesh (Jan 14, p 97), entitled Government’s Drug Policy Assailed Again, is likely to create an impression that our drug policy has not been successful. I
4.
think your readers should know about its achievements. After promulgation of the policy the value of imported drugs fell by 4%, from T24 -35 crores in 1981 to 23 -38 in 1982 and then by 15% to 19 - 91 in 1983. This reduction was due to a ban on harmful and useless items of medicine and increased home production of essential and useful drugs. Before the drug ordinance multinationals manufactured twelve essential drugs worth Tl 1 -6crores for village level health workers while the figure for the national companies was T22’8crores. (The Bangladeshi unit of currency is the taka; 1 crore = 10 million.) After the ordinance, during 1983, these figures were Tl 1 -3and 36’9crores, respectively. The multinationals used to produce an additional thirty-three essential drugs worth T12.l1 crores, while the corresponding figure for the national companies was 5 - 9. During 1983 the value rose to 17 - 4 for multinationals and 511for the nationals. The percentage shares, in value terms, of the forty-five essential drugs to be used at the primary health care level used to be 45% multinational and 55% national. During 1983 they were 25% and 75%, respectively. The multinationals were more involved than the nationals in the production of useless or even harmful drugs before the ordinance because they were responsible for manufacture of 75% of total products whereas only 25% were produced by the national companies (Islam Committee report 1982,
5.
SIR,-Your
Round the World item
erythromycin.
The intracellular action of the antibiotic may be to affect the release of bacterial products which would otherwise block the lytic sequelae of phagocytosis.2,6 A more likely interpretation of the decrease in viable counts presented by Miller et al would be bacterial degradation due to phagolysosomal function rather than the direct action of erythromycin on the bacteria. In support of this, we have also found that L pneumophila survived protracted treatment with erythromycin and recovered viability, albeit slowly, on removal of the drug, followed by prolonged cultivation on solid media (fig 2).
on
6.
Rodgers FG,
Elliott TS. Action of ampicillin and erythromycin on the growth and morphology of Legionella pneumophila. In: Proceedings of the 2nd International symposium on Legionella (Atlanta, Georgia). Washington, DC: American Society of Microbiology (in press). Horwitz MA, Silverstein CS. Intracellular multiplication of legionnaires’ disease bacteria (Legionella pneumophila) in human monocytes is reversibly inhibited by erythromycin and rifampicin. J Clin Invest 1983; 71: 15-26. Friedman RL, Lochner JE, Bigley RH, Iglewski BH. The effects of Legionella pneumophila toxin on oxidative processes and bacteria killing of human polymorphonuclear leukocytes. J Infect Dis 1982; 146: 328-34.
p 92). A dispassionate look at these figures will confirm the success of Bangladeshi drug policy and encourage other countries to follow suit. Some newspapers and individuals will criticise any health
policy, for their own interests, but we can find no statistical basis for these criticisms. Admittedly, as your RTW correspondent points banned items are still available "under the counter, often prices". This applies to all consumer goods, and drugs are no exception. The fact that they are no longer available over the counter and that the prices are prohibitive indicates that these drugs are too ineffective or harmful to be openly available. There is no moral or legal support for them, and they will not fool people for out, at
some
inflated
ever.
Institute of Postgraduate Medicine and
Research,
Dhaka-2, Bangladesh
N. ISLAM, Chairman, Drug Control
Committee
Fig I-Growth of L pneumophila in broth (0) and action of 10 Jig/ml erythromycin (8) and ampicillin (A) added in mid-logarithmic growth.
ANTIBIOTIC KILLING OF LEGIONELLA
SIR,-In a combined microbiological and electron microscopical study (Feb 11, p 348), Dr Miller and colleagues described the killing of legionella organisms within vacuoles in human polymorphonuclear leucocytes (PMNs) by erythromycin. In previous reports it has been shown that Legionella pneumophila replicated within human monocytesl,2 and not in PMNs but were only taken up into cytoplasmic vacuoles.2,3 The data in Miller’s fig 1, in the absence of drug, are consistent with active uptake and little or no subsequent replication. Our studies on the action of antibiotics on legionella in suspension showed that 10 g/ml erythromycin induced loss of viability only after prolonged treatment.4The action of this macrolide was fundamentally bacteriostatic rather than bactericidal, ampicillin being bactericidal (fig 1). Similar results have been observed for intracellular L pneumophila in monocytes 5
exposed to
1.
JOE COLLIER
London SW17 ORE
2.
3.
BANGLADESHI DRUG POLICY
Horwitz MA, Silverstein SC. Legionnaires’ disease bacterium (Legionella pneumophila) multiplies intracellularly in human monocytes. J Clin Invest 1980; 66: 441-50. Anøn. Clin Immunol Newsl 1983; 4 (July): 83-97. Horwitz MA, Silverstein SC. Interaction of the legionnaires’ disease bacterium (Legionella pneumophila) with human phagocytes I: L pneumophila resists killing by polymorphonuclear leukocytes, antibody and complement. J Exp Med 1981; 153: 386-97.
Bangladesh (Jan 14, p 97), entitled Government’s Drug Policy Assailed Again, is likely to create an impression that our drug policy has not been successful. I
4.
think your readers should know about its achievements. After promulgation of the policy the value of imported drugs fell by 4%, from T24 -35 crores in 1981 to 23 -38 in 1982 and then by 15% to 19 - 91 in 1983. This reduction was due to a ban on harmful and useless items of medicine and increased home production of essential and useful drugs. Before the drug ordinance multinationals manufactured twelve essential drugs worth Tl 1 -6crores for village level health workers while the figure for the national companies was T22’8crores. (The Bangladeshi unit of currency is the taka; 1 crore = 10 million.) After the ordinance, during 1983, these figures were Tl 1 -3and 36’9crores, respectively. The multinationals used to produce an additional thirty-three essential drugs worth T12.l1 crores, while the corresponding figure for the national companies was 5 - 9. During 1983 the value rose to 17 - 4 for multinationals and 511for the nationals. The percentage shares, in value terms, of the forty-five essential drugs to be used at the primary health care level used to be 45% multinational and 55% national. During 1983 they were 25% and 75%, respectively. The multinationals were more involved than the nationals in the production of useless or even harmful drugs before the ordinance because they were responsible for manufacture of 75% of total products whereas only 25% were produced by the national companies (Islam Committee report 1982,
5.
SIR,-Your
Round the World item
erythromycin.
The intracellular action of the antibiotic may be to affect the release of bacterial products which would otherwise block the lytic sequelae of phagocytosis.2,6 A more likely interpretation of the decrease in viable counts presented by Miller et al would be bacterial degradation due to phagolysosomal function rather than the direct action of erythromycin on the bacteria. In support of this, we have also found that L pneumophila survived protracted treatment with erythromycin and recovered viability, albeit slowly, on removal of the drug, followed by prolonged cultivation on solid media (fig 2).
on
6.
Rodgers FG,
Elliott TS. Action of ampicillin and erythromycin on the growth and morphology of Legionella pneumophila. In: Proceedings of the 2nd International symposium on Legionella (Atlanta, Georgia). Washington, DC: American Society of Microbiology (in press). Horwitz MA, Silverstein CS. Intracellular multiplication of legionnaires’ disease bacteria (Legionella pneumophila) in human monocytes is reversibly inhibited by erythromycin and rifampicin. J Clin Invest 1983; 71: 15-26. Friedman RL, Lochner JE, Bigley RH, Iglewski BH. The effects of Legionella pneumophila toxin on oxidative processes and bacteria killing of human polymorphonuclear leukocytes. J Infect Dis 1982; 146: 328-34.
p 92). A dispassionate look at these figures will confirm the success of Bangladeshi drug policy and encourage other countries to follow suit. Some newspapers and individuals will criticise any health
policy, for their own interests, but we can find no statistical basis for these criticisms. Admittedly, as your RTW correspondent points banned items are still available "under the counter, often prices". This applies to all consumer goods, and drugs are no exception. The fact that they are no longer available over the counter and that the prices are prohibitive indicates that these drugs are too ineffective or harmful to be openly available. There is no moral or legal support for them, and they will not fool people for out, at
some
inflated
ever.
Institute of Postgraduate Medicine and
Research,
Dhaka-2, Bangladesh
N. ISLAM, Chairman, Drug Control
Committee
Fig I-Growth of L pneumophila in broth (0) and action of 10 Jig/ml erythromycin (8) and ampicillin (A) added in mid-logarithmic growth.