Multinasjonale firma og uetisk markedsføring av legemidler
Publisert i Southern Med Review
En RELIS-ansatt ble invitert til å skrive en leder om markedsføring av produkter, først og fremst i lav- og middelinntektsland, med tvilsom effekt og ofte ikke akseptable bivirkninger. Dette skjer også fra store internasjonale firma som ellers vil fremstå med et godt ’public image’. Lederen tar sitt utgangspunkt i en henvendelse til RELIS. Den berører også den situasjonen at land i EU har preparater på markedet som burde vært fjernet for lenge siden.
In today’s environment, the main focus of the critical mass
towards the multinational companies is on access to new
patented and more expensive products. Many of them essential
medicines, but many more non-essential ‘me-too’ medicines
developed to get a piece of the blockbuster cake or to go from
one patent to the next (evergreening). However, there are also
other issues that BigPharma could be confronted with and help
us solve. One of them is unethical marketing of products with
no medical value or which are potentially dangerous.
We know that products being banned in some countries still
exist and are actively promoted in other countries. The E-drug
and the WHO book of products
being banned have
many examples of that. Often the companies’ response when
confronted will be that it is up to the country’s regulatory
authority to take action as they approved it. Of course we
know that ideally that should be the case and I agree that some
countries in Europe such as Germany definitely should have
been able to clean the German market of such products, but
in the developing world the capacity and skills are often not
there. Should we accept that it is so? Or is it time to start getting
Recently, I was asked by a doctor to find Norwegian equivalents
to some medicines a small child with a chronic disease had
received in one of the worst conflict areas in Africa. Needless
to say, whatever little money these people have should not
be wasted. One of the medicines turned out to be a tonic,
Mosegor, that Novartis sells in several countries in Africa and
Asia (according to Google). I found it e.g. on a website (http://
thepharmaguide.com) in Pakistan, one of many awful websites
The following indications are listed on the website mentioned
above: anorexia in underweight patients, mood elevation in the
elderly, prophylactic (interval) treatment of migraine. The syrup
and tablets contain four B-vitamins and pizotifen, a sedating
antihistamine, which was registered for migraine prophylaxis
(Sandomigran) and still can be found in a few countries under
the name Sandomigran or as Mosegor
. Pizotifen also has
anticholinergic effects, hence it is not safe. Several websites
promote it as an appetite stimulant. Even with no indication
listed for use in children, Novartis gives dosage recommendations
down to children aged 2 years old!
Novartis is a research-based pharmaceutical company that
promotes an image of a responsible company with a public health focus. So why then promote useless tonics for under-/malnourished children in poor countries?
This case reminds me of other useless products I have come across such as Encephabol (pyritinol) from the German company, Merck3. When I worked in Botswana in the late 1980’s I received requests from doctors for this – for use in malnourished children as it ‘supposedly improves glucose uptake in the brain’. Surprisingly, that product still exists even in Germany with the indication ‘organic brain disorder’, in other countries also with other indications such as mental function disorder, but officially, not malnutrition.
There are of course numerous examples of potentially toxic or irrational products out there and many companies besides the multinationals that market such products. As I write this editorial, I have been told that Roche is continuing to manufacture Halfan for both children and adults. Halfan contains halofantrine, an antimalarial that has serious side effects but worryingly still seems to be on the French, Portuguese and South African markets3 as well as in many low- and middle-income countries.
By pointing finger at the multinationals, I want to highlight the paradoxes in the research-based companies that on the one side claim to do so much good for public health but continue to produce products detrimental to people’s health. Of particular concern is of course medicines for children. How can large research-based companies defend marketing useless products for malnourished children who need proper nutrition?It is time we start confronting BigPharma also with this side of their business. Other examples will be most welcome on E-drug!
Kilde: Myhr K. BigPharma and unethical marketing of medicinal products. Southern Med Review ( 2011) 4;2:1-1 doi:10.5655/smr.v4i2.1000.
- E-drug archives. http://www.essentialdrugs.org/edrug/archives.php
- Consolidated list of products whose consumption and/or sale have been banned, withdrawn, severely restricted or not approved by governments. Pharmaceuticals. 14th Issue (New data only) January 2005-October 2008. http://www.un.org/esa/coordination/CL-14-Final.for.Printing.pdf
- Martindale. The Complete Drug Reference. 37th Ed 2011. The Pharmaceutical Press.