- Email: [email protected]
DESTITUTION AT THE FESTIVE SEASON
220 DRUG ADVERTISEMENTS IN DEVELOPING COUNTRIES
SIR,-At a recent meeting in Pakistan, I was told that the urban
suffering from diseases associated with overcrowding and polluted water, spend much of their small incomes on useless or inappropriate medicines. Not all of these are "quack medicines" provided by native healers. Some of the worst examples of quackery
poor,
can
be
found
in
advertisements
by ethical multinational
pharmaceutical companies, taking advantage of the fact that drugs can be easily bought from pharmacists and that local drug-control legislation is weak or ineffective. For example, many advertisements for benzodiazepines are untempered by western experience. Sandoz assures that "with Restoril (temazepam) patients do not experience drug dependence". Parke Davis states that "Verstan (prazepam) may provide an advantage in certain patients prone by history to drug misuse". Searle announces that "Tranxene extends a helping hand to your worried patients", while Roche claims that ’Lexotanil’ (bromazepam) "resolves anxiety and relieves the strain on the heart... Clinical reports [none of which are listed] confirm that very good results are obtained in angina pectoris, cardiac arrhythmias, palpitations and precordial pain mimicking angina pectoris". These are misleading statements. There are also claims for other drugs which are not part of the UK pharmacopoeia. If these claims are correct, then British doctors and their patients are missing out on a therapeutic revolution. ’Loftyl’ (buflomedil), according to Abbott Laboratories, "alleviates symptoms of intellectual deterioration, change of personality, and loss of memory". ’Sermion’ (nicergoline) "revitalises cerebral circuitry", and is indicated for "intellectual, affective, behavioural and somatic symptoms associated with cerebral decay (including Parkinson’s disease and senile and presenile dementia) as well as for memory disorders, reduced concentration, mood depression, unsociability, loss of self-care, asthenia, anorexia and dizziness". This drug is marketed by Farmitalia Carlo Erba, who state that there is only one to nicergoline. I was told that advertisements of these and similar drugs were to be translated into Urdu and aimed at parents who might be anxious about their children’s performance at school. Not all companies behave in this way. I saw several advertisements providing the sort of information that would be required in the UK. The companies concerned included Wyeth, Glaxo, Reckitt and Colman, and Ciba-Geigy. What can be done? Proposals for a limited WHO list seem doomed to fail in the open market and the bazaar. Drug companies will weep a few crocodile tears and carry on until effective local legislation arrives to control them.
MIANSERIN
SIR,-Last year The Lancet’s correspondence columns hosted a debate on the antidepressant drug mianserin, prompted by Inman’s survey.! In an unreported series of hearings held in the High Court on Dec 202 to Jan 3, Organon Laboratories Ltd obtained injunctions, the effect of one of which was to prevent the Committee on Safety of Medicines (CSM) from publishing the issue of its newsletter Current Pro6/e?M which was to have been sent to prescribers late last year. Mianserin is marketed in the UK by the originating company (Organon) as ’Bolvidon’ and under licence as ’Norval’, by Bencard, a division of Beecham plc. We understand that Bencard did not itself seek to restrict the CSM. Around one million prescriptions a year are written for mianserin in the UK, and it is also widely available abroad, though not in the USA. We believe this case has important implications, some of which may not be resolved at the High Court hearing of this case, scheduled for Feb 13. One relates to the Medicines Act: section 107 allows a manufacturer who has failed in an appeal to the Medicines Commission to then initiate a series of legal appeals which could, in theory, delay the issue of statements about drugs for months and possibly years. Another concerns the involvement of the courts in the decision-making which determines whether, how, and when medical experts may make public statements on drugs. Social Audit Ltd, Box 111, London NW1 8XG
CHARLES MEDAWAR ELAINE RASSABY
Charing Cross Hospital, London W6
ANDREW HERXHEIMER
1. Inman WHW. Blood disorders and suicide in patients taking mianserin or amitriptyline. Lancet 1988, ii: 90-92 2. Queen’s Bench Division of the High Court of Justice. Applications for stay of execution before Bingham LJ and Leggatt J [CO/1738 and 1739], Dec 20, 1988
contraindication-hypersensitivity
Maudsley Hospital,
J. L. T. BIRLEY
London SE5 8AZ
REVISING RAWP
SIR,-Ur Milner and Mr Nicholl (Nov 19, p 1195) state that 1 used (Oct 8, p 850) "available beds" as a measure of use. But I said that available beds was considered as a measure of availability of services (the supply factor). "Occupied beds" was used as one of the measures of hospital activity-the dependent variable in the regression analyses. The supply factors, including available beds, were used as independent variables. In the study which we did at the district health authority level (paragraph 4.10 of the report’), we used 10 different measures of hospital supply (including beds available, beds occupied, beds unoccupied, medical staff available) and eventually decided on a factor based on beds available as the optimum measure of the supply of hospital services. We used this measure in those final models that were based on regression.
DESTITUTION AT THE FESTIVE SEASON
SIR,-On Christmas Eve we interviewed 58 people living at Arlington House, a long-stay hostel for people in housing need, in Camden, north London, and the St Mungo Community Hostel in Endell Street. Early on New Year’s day in conjunction with the Simon Community tea run we interviewed 43 men who had slept the previous night on the street. On Christmas Eve 17 men were actively psychotic when we interviewed them and a further 11 had a history of psychosis, having received inpatient psychiatric care. Despite the fact that these were men who were in stable accommodation and paying rent, 7 were not receiving benefits of any kind. On New Year’s day 19 of the men were actively psychotic when we interviewed them and a further 7 had had previous hospital care for psychosis. 31 % of the entire sample were not receiving any benefits of any kind and 72% were not registered with a general practitioner, although 52% had conditions requiring medical treatment. There was a significant association between present and previous psychosis and imprisonment, as found in earlier surveys.’2 We hope to publish a fuller analysis of our data, but felt that the above figures were sufficiently pungent to warrant bringing them to Lancet readers’ attention since they cast doubt on the success of community care programmes. Friem
Hospital,
London N1 1 3BP Lisson Grov e Health Centre, London NW8 8EG
MALCOLM P. I. WELLEI ROBERT TOBIANSKY DORIS HOLLANDER
BRIAN JARMAN
1. Department of geography, Queen Mary College, department of general practice, St Mary’s Hospital Medical School, and Cooper and Lybrand. Integrated analysis for the review of RAWP London Coopers and Ly brand, 1988
1. Weller BGA, Weller MPI Health care in a destitute population Christmas 1985. Bull R Coll Psychiatr 1986, 10: 233-35. 2 Weller BGA, Weller MPI, Cocker E, Mahomed S Crisis at Christmas, 1986 Lancet 1987, 553-54.
SIR,-At a recent meeting in Pakistan, I was told that the urban
suffering from diseases associated with overcrowding and polluted water, spend much of their small incomes on useless or inappropriate medicines. Not all of these are "quack medicines" provided by native healers. Some of the worst examples of quackery
poor,
can
be
found
in
advertisements
by ethical multinational
pharmaceutical companies, taking advantage of the fact that drugs can be easily bought from pharmacists and that local drug-control legislation is weak or ineffective. For example, many advertisements for benzodiazepines are untempered by western experience. Sandoz assures that "with Restoril (temazepam) patients do not experience drug dependence". Parke Davis states that "Verstan (prazepam) may provide an advantage in certain patients prone by history to drug misuse". Searle announces that "Tranxene extends a helping hand to your worried patients", while Roche claims that ’Lexotanil’ (bromazepam) "resolves anxiety and relieves the strain on the heart... Clinical reports [none of which are listed] confirm that very good results are obtained in angina pectoris, cardiac arrhythmias, palpitations and precordial pain mimicking angina pectoris". These are misleading statements. There are also claims for other drugs which are not part of the UK pharmacopoeia. If these claims are correct, then British doctors and their patients are missing out on a therapeutic revolution. ’Loftyl’ (buflomedil), according to Abbott Laboratories, "alleviates symptoms of intellectual deterioration, change of personality, and loss of memory". ’Sermion’ (nicergoline) "revitalises cerebral circuitry", and is indicated for "intellectual, affective, behavioural and somatic symptoms associated with cerebral decay (including Parkinson’s disease and senile and presenile dementia) as well as for memory disorders, reduced concentration, mood depression, unsociability, loss of self-care, asthenia, anorexia and dizziness". This drug is marketed by Farmitalia Carlo Erba, who state that there is only one to nicergoline. I was told that advertisements of these and similar drugs were to be translated into Urdu and aimed at parents who might be anxious about their children’s performance at school. Not all companies behave in this way. I saw several advertisements providing the sort of information that would be required in the UK. The companies concerned included Wyeth, Glaxo, Reckitt and Colman, and Ciba-Geigy. What can be done? Proposals for a limited WHO list seem doomed to fail in the open market and the bazaar. Drug companies will weep a few crocodile tears and carry on until effective local legislation arrives to control them.
MIANSERIN
SIR,-Last year The Lancet’s correspondence columns hosted a debate on the antidepressant drug mianserin, prompted by Inman’s survey.! In an unreported series of hearings held in the High Court on Dec 202 to Jan 3, Organon Laboratories Ltd obtained injunctions, the effect of one of which was to prevent the Committee on Safety of Medicines (CSM) from publishing the issue of its newsletter Current Pro6/e?M which was to have been sent to prescribers late last year. Mianserin is marketed in the UK by the originating company (Organon) as ’Bolvidon’ and under licence as ’Norval’, by Bencard, a division of Beecham plc. We understand that Bencard did not itself seek to restrict the CSM. Around one million prescriptions a year are written for mianserin in the UK, and it is also widely available abroad, though not in the USA. We believe this case has important implications, some of which may not be resolved at the High Court hearing of this case, scheduled for Feb 13. One relates to the Medicines Act: section 107 allows a manufacturer who has failed in an appeal to the Medicines Commission to then initiate a series of legal appeals which could, in theory, delay the issue of statements about drugs for months and possibly years. Another concerns the involvement of the courts in the decision-making which determines whether, how, and when medical experts may make public statements on drugs. Social Audit Ltd, Box 111, London NW1 8XG
CHARLES MEDAWAR ELAINE RASSABY
Charing Cross Hospital, London W6
ANDREW HERXHEIMER
1. Inman WHW. Blood disorders and suicide in patients taking mianserin or amitriptyline. Lancet 1988, ii: 90-92 2. Queen’s Bench Division of the High Court of Justice. Applications for stay of execution before Bingham LJ and Leggatt J [CO/1738 and 1739], Dec 20, 1988
contraindication-hypersensitivity
Maudsley Hospital,
J. L. T. BIRLEY
London SE5 8AZ
REVISING RAWP
SIR,-Ur Milner and Mr Nicholl (Nov 19, p 1195) state that 1 used (Oct 8, p 850) "available beds" as a measure of use. But I said that available beds was considered as a measure of availability of services (the supply factor). "Occupied beds" was used as one of the measures of hospital activity-the dependent variable in the regression analyses. The supply factors, including available beds, were used as independent variables. In the study which we did at the district health authority level (paragraph 4.10 of the report’), we used 10 different measures of hospital supply (including beds available, beds occupied, beds unoccupied, medical staff available) and eventually decided on a factor based on beds available as the optimum measure of the supply of hospital services. We used this measure in those final models that were based on regression.
DESTITUTION AT THE FESTIVE SEASON
SIR,-On Christmas Eve we interviewed 58 people living at Arlington House, a long-stay hostel for people in housing need, in Camden, north London, and the St Mungo Community Hostel in Endell Street. Early on New Year’s day in conjunction with the Simon Community tea run we interviewed 43 men who had slept the previous night on the street. On Christmas Eve 17 men were actively psychotic when we interviewed them and a further 11 had a history of psychosis, having received inpatient psychiatric care. Despite the fact that these were men who were in stable accommodation and paying rent, 7 were not receiving benefits of any kind. On New Year’s day 19 of the men were actively psychotic when we interviewed them and a further 7 had had previous hospital care for psychosis. 31 % of the entire sample were not receiving any benefits of any kind and 72% were not registered with a general practitioner, although 52% had conditions requiring medical treatment. There was a significant association between present and previous psychosis and imprisonment, as found in earlier surveys.’2 We hope to publish a fuller analysis of our data, but felt that the above figures were sufficiently pungent to warrant bringing them to Lancet readers’ attention since they cast doubt on the success of community care programmes. Friem
Hospital,
London N1 1 3BP Lisson Grov e Health Centre, London NW8 8EG
MALCOLM P. I. WELLEI ROBERT TOBIANSKY DORIS HOLLANDER
BRIAN JARMAN
1. Department of geography, Queen Mary College, department of general practice, St Mary’s Hospital Medical School, and Cooper and Lybrand. Integrated analysis for the review of RAWP London Coopers and Ly brand, 1988
1. Weller BGA, Weller MPI Health care in a destitute population Christmas 1985. Bull R Coll Psychiatr 1986, 10: 233-35. 2 Weller BGA, Weller MPI, Cocker E, Mahomed S Crisis at Christmas, 1986 Lancet 1987, 553-54.