A pill for every ill
Dexter Tiranti offers a radically different remedy from that presently on offer for the world's health.

Who killed Rosario?
Michael Tan on the free-for-all pharmaceuticals market and community health in the Philippines.

Brazil - Where the President is a hypochondriac

Three times daily
Prescription habits in India, by Trisha Greenhalgh.

When women outlive their ovaries
Advertising slogans like these are hard to ignore. Anne Rochan Ford investigates.

Why we pop pills
Our search for perfect health, analysed by Judy Gahagan.

PHARMACEUTICALS - THE FACTS

Too much of a good thing
David Gilbert discovers antibiotics going down the drain.

The corrupt industry
Saints and sinners incorporated. By John Braithwaithe.

Testing, testing, testing
Francesca Lyman puts drug research under the microscope.

No Kidding
Alternative ways of dealing with ill health.

Health Action International
The network which holds industry accountable.

THE SCENE is a family doctor's consulting room. A down-in-the-mouth editor enters shaking a bit.

DOCTOR: Hello there. How's the family? What's your problem?

EDITOR: .temperature ... hot and cold ... joints aching ... weak and floppy... (mumble, mumble)

DOCTOR: (Probing questions about background, what patient has been doing recently, possible contact points for infection) Have you been...

EDITOR: I was in Bangladesh recently, researching a booklet on essential drugs...

DOCTOR: Ha! That's rich. (Fishes out medical tome, skims through it) It's probably giardia; yes, quite common.

EDITOR: Look, I don't care if it's common or not. I feel like death. Can you do anything about it?

DOCTOR: (Browsing in reference book with increasing interest). Here, have a dekko yourself. (Passes tome). "A parasitic, water-borne disease prevalent in tropical areas." Now I'm sure I have read about a new drug for this recently. Hmmm. What's its name? (Intercom to colleague) What's it called? What's that? Can you spell it? T-I-N-I-D-A-Z-O-L-E (To patient) Shall we give it a try? You can come back if it doesn't work.

EDITOR: Please, anything to get rid of this awful feeling.

No points for guessing who was the patient. And I am much more perky now.

Then, the pharmaceutical industry representatives would say, how can I be helping the campaign for fewer, more essential drugs? When I am unwell I want the best.

But was it the best? Because tinidazole is new and significantly more expensive than the alternative metronidazole, both the doctor and I assumed that it must be better. What I didn't realise was that I was a guinea pig. With any new drug, the side-effects are never completely established from the pre-launch testing. It takes years of prescribing to the general public and reports back from physicians, before all the drug's effects are known. Did I want to be part of the test when there was a cheaper well-known medicine available? I wasn't given the option.

It was obvious too that in Britain the £5000 a year per family doctor that the pharmaceutical industry spends on advertising had had an effect. Somewhere in the back of my doctor's mind an image had stuck. No matter that the Government health system, ultimately the taxpayer, will have to be paying for all this heavy promotion through a more inflated drug bill.

Further down the chain there is a trade off. More money on the national drugs bill means less, for example, on school health or factory inspectors. Cutbacks here have meant that headlice are now a regular plague with my children. They were much less common in schools ten years ago. Less close to home it has meant that industrial accidents and diseases have proliferated.

Cutbacks in factory inspectors, for instance, have harmed working people. Whilst there are 10 per cent fewer inspectors now than in 1981, serious accidents and fatalities in construction have gone up 40 per cent.

Now, if I had been offered the choice between a new more expensive drug by my family physician and an older cheaper medicine where the side-effects were better known, and the savings made would have gone towards helping the health of our children and factory workers, I think I know which I would have chosen. But life is not as clear as that. And in the fudge and mudge of my private everyday life, practice can be different from principle. I guess that's the uncomfortable in-between world which we all experience - NI staff and readers more than most.

Letters
Letter from Mawere
Update
Briefly
Endpiece: by Father John Medcalf
Reviews: including the NI Classic
Country profile: Tunisia

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