E-DRUG: Why donations of sample/outdated drugs are welcome

[Adrie Mandrekar <mandrekar@memisa.nl>]

E-DRUG: Why donations of sample/outdated drugs are welcome (cont)
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I agree with the comments on the part of Wilbert Bannenberg and 
particularly with the point he makes about the 10% yield of usefull 
products, which can be extracted from the heap of assorted medicines I 
used to receive. Moreover I discovered soon, that the amount payed by 
the donor on transport of these kind and well meant donations was far 
over the value of the drugs I was receiving in my remote rural 
hospital in Kenya. In other words: if I had bought similar products as 
generics locally or from wholesalers such as IDA I would have spent 
less er have received a greater quantity than the donations contained 
and I would have been free to purchase the precise products in the 
quantities required. So I answered henceforth all such donations with a 
request to rather forward me the money, they were considering to invest 
in the transportation. 

Finally our dear colleague Hoehn should not forget to make a realistic 
estimate of the time (and thus the salarycost) of some of the highest 
qualified staffmembers of the hospital to sort out such mixed 
donations. The resulting volume of usefull products may represent less 
in value than the hours work I invested myself in sorting out such 
donations. And, as Wilbert puts it: it needs a doctor even a pharmacist 
to make the selection and to take the responsibility. One cannot leave 
it to the storekeeper...

Finally I disagree with our colleague Hoehn over his description of the 
justification of the existance of expiry dates. Few products are indeed 
so stable as to survive long term storage without deterioration in 
quality or strength. Depending on storage conditions, other products 
however are indeed loosing potency or even may start decomposing in 
less desirable components. It is not merely a matter of bureaucracy 
therefore, that manufacturers limit the period of guarantee to a 
certain time. They are liable to be prosecuted if the composition of 
the drug they manufactured can be demonstrated to differ from what the 
text on the container says.

Doctor Hoehn raises a number of ethical questions and tends to shy away 
from certain other ones, which one could and, in my humble opinion 
should ask oneself in this respect.

Happily, as I mentioned above, there are also sound economical reasons 
to avoid getting involved too much with such tricky questions: (and in 
this I fully agree with doctor Hoehn: our prime concern should be to 
ensure essential medicines for people in need). Procurement of essential 
drugs is considerably cheaper than transporting and sorting out of the 
kind of donations he described. I am almost sure, that if Dr Hoehn 
would have made a more thorough calculation at the time or if he would 
have had access to Wilberts advice, he would have been able to help 
more people at the same (overall!) cost.

Tom Puls
Memisa Medicus Mundi
Netherlands

Email: mandrekar@memisa.nl   [added manually; WB]
 
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