[e-med] Révision de la liste des médicaments essentiels de l'Oms (2]

["Charles Rambert" <crambert@free.fr>]

E-MED: Révision de la liste des médicaments essentiels de l'Oms (2]
-------------------------------------------------------------------------

[Modérateur: on attend avec impatience la version française de ce débat...
merci Charles!CB]


Just a short contribution by myself base on grass root experience and field
activities.

I just want to add my support to Richard Laing's words.

As I am of the opinion that the concept of ED should not change since many
population are still lacking these drugs. I do believe that there is a great
difference between "essential" in Alma Aty views, and necessary. And the
exemple of bringing consumer and industry representatives in the loop is
illustrative of this ambiguity.  I also do agree with the fact that they
should be consulted, but they should not play as decision makers.

Accordingly, I mean in case we can keep moving with the concept developped
20+ years ago, I also agree that there should be a basic (core) list,
complemented by a supplementary list. As evidence of this strong need, I can
mention many countries were the Central Medical Stores are spending a great
deal of their budget at procuring necesssary drugs, no doubt they are needed
but yet for few cases, to the expenses of "essential" ones that could
benefit the whole population. And because of multiple interests, spanning
from purely science-based ones to politics, the CMS are struggling to find
out what is best for the population although they receive strong inputs to
procure what can please influential people instead. It is very sad to have
to say it, but that is what life is.

It is also surprising to see people calling for one unique list, when very
often these people are coming from countries were some drugs are not for use
by GP, but restricted to specialists. Is it not the same concept of
differentiating what is "essential" from the rest that is paving the road
for it? Should the answer be Yes, why not having this concept adapted to the
developing world? Furthermore, in many developing countries, there are
formularies addressing primary, secondary and tertiary health car levels.
The need to split according to health care levels have been obvious to most
of the people, stakeholders, etc. But the complication raises from the fact
that EDL WHO list  very often is seen as intending to address all levels at
once, instead of focusing on primary care. When it comes to developing a
local EDL, very often it goes to the making of a local compendium, kind of
Mims (UK) or Vidal (F) when the goal is not it.

Conclusion: the more the focus on primary care, the more the need of a core
list.

Charles Rambert
Public procurement expert
crambert@free.fr


----- Message d'origine -----
De : <remed@remed.org>
À : <e-med@usa.healthnet.org>
Envoyé : mardi 18 septembre 2001 11:38
Objet : [e-med] Révision de la liste modèle des médicaments essentiels de
l'Oms


> E-MED: Révision de la liste modèle des médicaments essentiels de l'Oms
> -------------------------------------------------------------------------
>
>
> [Modérateur : Pour tous ceux qui s'intéresse au processus de révision de
la
> liste modèle des médicaments essentiels de l'Oms, je vous signale ce
message
> de Richard Laing du forum de discussion e-drug ci-dessous.CB]
>
> E-drug: Comments on the process to revise the WHO Model EDL
> -------------------------------------------------------------------------
>
> [Several of the url's below are too long for one line and wrap to the
> next. Please repair them before you paste them into the address line
> of your browser. HH]
>
>
> WHO is asking for comments on their proposed new method of
> revising the WHO Model List of Essential Drugs.
> http://www.who.int/medicines/organization/par/edl/orgedl.shtml
>
> As some of you may know, I have criticized the way the list was
> revised in the past. More recently, I was asked to comment on the
> process and I participated in a meeting in March to suggest ways in
> which what is essentially a technical process could be improved.
> The improvements which were proposed related to improving and
> making available the evidence base of the model essential drug list,
> including information on efficacy, cost and cost effectiveness,
> improving transparency and making the document more useful and
> accessible to countries developing their own EDLs.
>
> A document detailing the new proposed process was produced and
> circulated for comments from member countries.
> http://www.who.int/medicines/organization/par/edl/documents/who
> edlprocess15May31_eng.doc    These comments have now been
> received and have been posted and a new version of the proposal
> with specific questions has been posted at:
> http://www.who.int/medicines/organization/par/edl/documents/who
> edlprocess19-4-revised.doc
>
> I read the original document and was pleased with it and was
> planning to make a few minor comments about sections that might
> need clarification. However in August, I was astonished to hear that
> the US government had sent in a very critical series of comments
> on this draft. This has been posted at:
> http://www.who.int/medicines/organization/par/edl/comments/edl_1
> 5.doc
>
> Among the more amazing of their comments was a rejection of the
> definition of essential drugs which has been used since 1977. They
> reject the practice which has been in existence since 1977 of
> having a core and complementary list of drugs and suggest that
> there should only be one list. In the eleven revisions of the list there
> have been two lists (core and complementary) and I have never
> heard suggestions that there was anything wrong with this
> approach. They also suggest that "Consumers and industry must
> play an expanded role in the Expert committee meetings..." When
> we allowed industry to participate in national EDL meetings in
> Zimbabwe, we ended up with a very long EDL. I recall one industry
> representative saying "If you don't include hexaprenaline inhalant
> for asthma, we will leave the country!" This despite the fact that
> salbutamol was already on the list. Clearly neither consumers nor
> industry should participate in the decision making process. They
> should be invited to comment and provide information but to attend
> the Expert Committee meetings and argue with panel members
> seems to me to be ridiculous.
>
> On providing comparative cost information the US states "While
> information on cost may be helpful at national and local levels, it is
> not viable at the global level unless the prices are listed in a specific
> way that makes them exactly comparable." What surprises me
> about this statement is that for some years, the US supported MSH
> production of the Drug Price Indicator Guide which provides exactly
> this comparative cost information. In commenting on the value of
> evidence based selection of drugs which in the WHO document
> refers to the Cochrane Network and the Cochrane Collaboration
> they as the question "What is the Cochrane Network?" My
> response to them is that if they don't know the answer to that
> question they should not be writing an official document for the US
> government! There are many other comments designed to raise
> blood pressure!
>
> In one way, I am appalled that the US government could respond in
> the way that it has. In many ways, it has gone back to the disputes
> which occurred before the Nairobi conference of 1985. That
> meeting resolved all of the issues raised and led to the Revised
> Drug Strategy. It is as though there have been no developments
> since then. On the other hand, I hope that these comments will
> encourage member countries and others to seriously examine the
> WHO proposal and the country responses. E-Druggers should realize
> that the Essential Drugs Concept is under serious attack and that
> there is an attempt to turn history back! I was pleased to see that
> comments from other countries supported the WHO approach. The
> comments from Malta, Netherlands, Iran and Norway are, I think,
> constructive and useful and reflect support for the process.
>
> In January this year, I went to Eritrea to work with their Ministry of
> Health to revise their national EDL. It was a very rewarding
> experience as the many dozens of people who participated
> struggled to make the best choices for their country. The WHO
> Model list was referred to but not used much because the reasons
> for a drug being included or excluded was not available. In practice,
> the most frequently used reference book was the British National
> Pharmacopoeia because it included modern information on
> therapeutic efficacy and comparative cost information. This is what
> countries need to make these difficult decisions and this is what
> WHO is trying to provide to their member countries.
>
> Please read these documents carefully and send your comments to
> WHO. But please send them to your Ministers of Health as well.
> Brief your Ministers and permanent secretaries and especially those
> who will be attending the World Health Assembly or Executive
> Board in 2002. Based on past experiences, there will be a fight over
> this proposal and it is clearly in countries interests to have this new
> and better process which will provide them with the information
> needed to make their own decisions.
>
> If anyone cannot download these documents please e-mail me and I
> will send them to you as attached files.
>
> Richard Laing
> Associate Professor of International Health
> Boston University School of Public Health
> 715 Albany St, T4W, Boston MA 02118 USA
> Tel 617 414-1444 Fax 617 638-4476
> E-mail: richardl@bu.edu

--
Adresse pour les messages destinés au forum E-MED:
<e-med@usa.healthnet.org>
Pour répondre à un message envoyer la réponse au forum
ou directement à l'auteur.
Pour toutes autres questions addresser vos messages à :
<owner-e-med@usa.healthnet.org>