[e-drug] Returned medicines and drug donations (8)

["Kirsten Myhr" <myhr@online.no>]

E-DRUG: Returned medicines and drug donations (8)
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Jim,

It is not very clear for me whether you in principle support sending
unused returned medicines as donations, but accept the guidelines as
they are. Or whether you support the US legislation which forbids
reusing medicines.

Donations take many forms:

- bits and pieces collected from pharmacies as returned medicines and
consisting of many different medicines in quantities from almost 0 pills
to a few hundred. Most industrialised countries will not allow returned
medicines to be resold or donated to citizens. Why should there be
another standard for developing countries? From international generic
suppliers essential medicines can be purchased very cheap. Why not buy
there after finding out what the recipient is in need of? We can afford
that. E.g. you can buy 150 000 hydrochlorothiazide tablets for around
150 USD. That can treat hypertension in 400 people for one year!
- donations from NGOs, e.g. national Red Cross societies, of medicines
purchased in their own countries and sometimes consisting of
non-essential and even banned medicines and with unreadable labels
because they are in a national language.
- donations from pharmaceutical companies of nearly outdated medicines
and even medicines which showed in clinical trials to have such a bad
risk/benefit profile that they never got registered in rich countries.
Or companies donate non-essential medicines for which there is no need.
I have documented donations in several countries and been fed up seeing
box after box of Tylenol in all sorts of fashions. Tylenol contains
paracetamol + different sorts of cough and cold substances which now FDA
is warning against (pseudoephedrine, ephedrine etc.). If you manage to
find the list of ingredients on the box you will find a substance called
acetaminophen. This is the US name for paracetamol and known by hardly
anyone outside the US. This is just one  example, there are plenty. A
substance such as ephedrine is in some countries on a restricted list
and supply of such unauthorised donations can cause meny problems.
- donations come to countries which have a viable pharmaceutical
industry and no need. Sometimes this causes problem for the local
country. E.g. Why do Lilly donate insulin to countries with own
production of insulin if it were not to introduce its own product?
- donations to special programmes to eradicate tropical diseases.

In the US, instead of having a good healthcare coverage, doctors of
patients who cannot afford the medicines, can apply for company
donations. It is then up to a pharmaceutical company to accept or reject
and to decide for how long the patient can be treated. Novartis tried to
introduce the same in India instead of reducing the price of their
cancer medicine, Glivec (imatinib) or allow copies. I think this is a
system most of us will not want to see in our own countries or spread
around the world. In the e-drug archive, there is a message from me on
that:
http://www.essentialdrugs.org/edrug/archive/199812/msg00041.php

If there were no unused, returned medicines, this discussion would not
take place. Also high-income countries should be concerned that so many
medicines are not used and take measures to improve prescribing.

Kirsten

Ms Kirsten Myhr, MScPharm, MPH
RELIS Drug Info and Pharmacovigilance Centre
Ulleval University Hospital
0407 OSLO, Norway
Tel: +47 23 01 64 11   Fax: +47 23 01 64 10
myhr@online.no