INDICES> Clinical Drug Use Studies in Developing Countries (cont)

[DID <did.jms@imul.com>]

INDICES> Clinical Drug Use Studies in Developing Countries (cont)
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Dear Indices Users,

I am concerned.  About the depth and value of some drug use studies in
developing countries.

There are facts, which are well documented about drugs.  Take for
example, that insulin, methylergometrine and oxytocin must be kept at a
low temperature.  Some body will design a study to prove that you can
keep those substances at room temperature.  Wasting resources.  Of course
they can be stable at room temperature for a short while, but that can
not justify, in my own view, spending money on such a study.  I would
look at spending scarce resources on buying storage equipment for those
medicines.  Since people who develop medicines would have already done
research on the subject of storage.

Secondly, drug regimens are often changed after certain studies.  And a
few years later, rapid development of resistance to antimicrobials
occurs.  

Take for example chloroquine.  We used to have a dose plan: 

Day 1: 10 mg / Kg, followed by 5 mg / Kg 6 hours later.
And then 5 mg / Kg daily for 2 days.  

To me, even without equipment to measure plasma levels of chloroquine,
that dose plan -- even on day 1 alone, makes chloroquine reach steady
state concentration very fast.  So, there will be no time for plasmodia
to swim around in chloroquine, for longer than necessary.  Unlike this
other regimen, coined by 'research,' 

Day 1 : Chloroquine 10 mg / Kg 
Day 2: 10 mg / Kg  
Day 3: 5 mg / Kg

And after a few years in use.  Resistance to chloroquine emerges in full
gear.  At a rate faster than that with the first regimen.  Compliance is
a problem.  True, we can do alot on that.  Via education and retraining,
and continuing Pharmacy and Medical education.  Compliance for just 3
days should improve with a good programme.

The second regimen of chloroquine is not the same as the first -- on
pharmacokinetic ground!

My humble request is this.  Instead of spending money to change well
founded facts.  Developing countries and Donors could put money in
teaching and retraining health workers, and educating the general public.
 We could also be facilitated to do research on topics where information
is lacking, and, aided with facilities which are lacking.

Otherwise many changes in policies as a result of 'studies' -- many of
them lacking in depth analysis of facts and logic will continue to affect
us.  To affect us immediately, directly or indirectly, short term or
longterm, and in the negative sense.  

Sincerely,     

George Kibumba, MPS(Uganda).
Drug Information Pharmacist
Drug Information Desk,
Joint Medical Store,
P.O.BOX 4501, KAMPALA, Uganda(E.A)
e-mail: did.jms@imul.com
Tel:    256-41-268482
fax:    256-41-267298
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