[e-drug] USA Today on donations

[Kirsten Myhr <myhr@online.no>]

E-drug: USA Today on donations
---------------------------------------------
Dear friends,

Shocking story for those of us who believe medicines should have the 
same quality regardless of your income - and that we do not have to 
send our leftovers to the poor, but can afford to send quality 
donations. Obviously we still have a job to do - also towards media! 
This article appeared on the front page of USA Today 13 March. I hope 
I am right in assuming that such a story would have the been given 
the same attention in NY Times, if printed at all - does it say 
something about the quality of that newspaper?

http://www.usatoday.com/life/dcovtue.htm

03/13/2001 - Updated 01:37 AM ET
Unused drugs: Legacy or liability?
By Greg Barrett, Gannett News Service  OLYMPIA, Wash. -
Blending with the clutter of a two-car garage in this capital city is a
pile of plain-looking plastic bags. Recycling, it appears, but not the
usual kind. To sick people in poor countries, where a month's supply of
medicine can exceed a year's wages, the bags hold precious leftovers of
America's disposable culture. For more than a decade, Olympia family
physician Diane Dakin has accepted throwaway drugs like these dropped at
her office door, often donated by grieving caregivers as a final legacy of
the deceased patient. Hers is one of several quiet networks of compassion
that span the country, routing drugs to poor medical clinics abroad.
Depending on the type of medicine and who transports it, Dakin could be
breaking state laws. She has never known for sure and doesn't appear 
overly concerned. Common sense should prevail, she says, and as a 
physician for an HMO and a volunteer for Third World medical 
missions, she knows firsthand the cruelty of medicine's supply and 
demand. And America's waste. That's why, when a banana box with 
$5,468 worth of leftover cancer medication was dropped in her lap 
last March by Dave Palmer, she began excitedly sifting through the 
bottles. Procrit, Prilosec, Zofran, thalidomide, Dilantin, Toprol. 
Weapons of choice in medicine's offensive against cancer. Valuable 
drugs made priceless for people with little or no access to them. 
"When I get big batches of things," Dakin says, "it is usually from 
someone who has just had a long bout with cancer."

Had Palmer followed standard advice, he would have done what most of 
us are told to do when a loved one dies: Flush the medicine. It's a 
directive driven in large part by the fear of litigation. A recipient 
of tainted medicine might sue the giver. But even in Palmer's numb 
grief, the thought of trashing valuable medicine struck a nerve. It 
felt wrong. So he kept phoning pharmacies and hospitals and the 
United Way and the Red Cross, two dozen phone calls in all before a 
nurse mentioned Dakin's name. "I just wanted to take care of things 
in an honorable way," Palmer says. "It's what Ellen would've done." 
Palmer, 63, is a denim-wearing horseman retired from IBM and living 
in farm country 30 miles outside Olympia. He and his wife of 20 
years, Ellen Luttrell-Palmer,
had respected doctors' orders through four years of this tug of war 
lost by half a million cancer patients nationwide every year. When 
doctors ordered combinations of chemotherapy and steroids that sapped 
Ellen's vigor and left her feeling dopey for 10 days at a stretch, 
they followed
instructions. When doctors prescribed drugs to combat the side effects of
other drugs, they did as they were told, meticulously. The most 
expensive treatment for the multiple myeloma that ravaged her body 
was thalidomide, which Palmer says held "the beast at bay" for a 
year. It had cost his health insurer $7.50 a pill, $120 a day, 
$43,200 for the year. When doctors  told Palmer to dispose of all the 
medicines after Ellen died last winter, he ignored them. "For me," 
Palmer says, "to put these medicines to use was part of the grieving 
process. Hopefully, it would help someone in Africa, India or 
wherever the stuff ended up." In the United States this year, chronic 
disease is expected to kill 1.7 million people. If the leftover 
medications from these deaths were usable and worth even one-tenth of 
the value of what Palmer gave away, that would be$930 million worth 
of medicine down the drain. Because of the threat of tampering and 
contamination, no state pharmacy board allows pharmacists to reuse 
medicine. "Probably 99.9% of the time the drugs are fine, but it only 
takes one acid (LSD) head to decide that he wants to get everybody 
happy," says Grant Chester, operations manager for the Washington 
State Board of Pharmacy. However, there are no Washington state or 
federal laws that prevent Dakin from accepting leftover medications 
and hand-delivering them to other physicians, as long as the drugs 
are unadulterated and are not controlled substances. Even so, this is 
discouraged by all state boards of pharmacy as well as the FDA, which 
defers to state law.

"I grant you, medicine is
expensive, but I don't think this is the answer to prescription drugs for
poor people who can't afford it," says Don Williams, executive director of
the Washington state pharmacy board. "I think it is a very poor and
possibly dangerous practice." Dakin trusts that people who go to the 
effort to donate medicines aren't the types to spike it, she says. 
About
two-thirds of the medicine donated to Dakin will be used. The rest is
discarded because of expiration dates or fear of misuse. Palmer's $3,360
triple-sealed bottle of thalidomide, a controversial sedative that can
cause fetal deformities, was disposed of because Dakin could not find a
doctor with an immediate need. "I don't donate anything that I wouldn't be
comfortable using myself or giving to my own children," says the
46-year-old mother of two. "I open every bottle. I check every label. I
know exactly where the medicine is going and who the doctors are who 
will use it and what it is they need. Other than that, you'd have to 
test each and every pill."

Too much charity can be bad
When the World Health Organization issued strict guidelines in 1996, and
updated them in 1999, it was mostly in response to wholesale 
shipments by pharmaceutical companies to global hot spots, not 
medical missions such as Dakin's. Researchers for the European 
Institute of Oncology and the European Association of Health and 
Development had tracked drugs donated during the war in Bosnia from 
1992 to 1996. They reported in The New England Journal of Medicine 
that half the charity drugs were useless.

Medicines frequently arrived expired or spoiled or with illegible labels,
or there just was no use for the particular drug. Researchers suspected
that some companies had unloaded outdated medications for the tax 
deduction and to avoid the cost of disposal. More than 17,000 tons 
had to be incinerated at a cost of $34 million to the World Health 
Organization. It's the reason charity relief agencies such as 
Seattle-based World Concern have stopped accepting leftover 
medicines. "There have definitely been abuses in the sense of poor 
donations sent abroad that are not usable," says Kelly Miller of 
World Concern.

The International Committee of the Red Cross, the United Nations 
Children's Fund, the United Nations AIDS program (UNAIDS), among 
others, co-sponsored the WHO guidelines. Today, apparently, none of
the large humanitarian agencies accepts leftover drugs. The task falls to
individual medical personnel, church groups and a charity in 
Massachusetts called Cambridge Cares About AIDS, which funnels its 
medicine to Haiti.

Dakin has read these WHO guidelines. She has worked in medical clinics in
Nicaragua, the Dominican Republic and Costa Rica. She knows the 
importance of quality control, drug relevance and sending only 
complete cycles of antibiotics. Most of all, she realizes that a 
planeload of the best
intentions can overwhelm a clinic or, worse, be thoughtlessly disposed of
in a trash bin where children play. "That's why I want it stressed that I
am already receiving all the donations I can handle," she says. "You have
to be careful not to think you can just accept everything, send it
somewhere and it will be used. That's not how it works."

 From tragedy to compassion
Soon after the ashes of Ellen Luttrell-Palmer - outgoing wife, mother,
grandmother, equestrian, seamstress and master gardener - were 
tearfully scattered in stormy waters off the Oregon coast, most of 
her medications ended up in Santo Tomas, Nicaragua. There, doctors 
gave them away in a clinic crowded with walk-ins, in an uninsured 
population where the monthly income is about $50. "I just hope the 
medicine did somebody some good," Palmer says. The gleanings from 
Dakin's current pile of plastic bags will be carried to Santo Tomas 
this month. Weeding the outdated, she stacks bottles and studies the 
inventory: This one is good for herpes, this one for pain, this one 
for depression, for gout, for high blood pressure, for underactive 
thyroid. Each label carries the name of the original owner.

None are known to Dakin. The stories, however, are probably all familiar.
Someone dies or someone recovers. Someone in a poor clinic gets 
medicine. Or someone doesn't.

Regards

Kirsten

Kirsten Myhr, MScPharm, MPH
Bygdoy alle 58B
0265 Oslo, Norway
Tel.: +47 22 56 05 85
myhr@online.no
[Indeed we do still have work to do.  The guidelines for appropriate 
donations can be found at http://www.drugdonations.org  BS]
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