Methinks they protest too much

Saturday, 14 June 1997

The expensive campaign run by the pharmaceutical industry to shoot down the Health Department's National Drug Policy should make us sit up and take notice

Not for the first time, I wish to place on record that I hold our minister of health, Dr Nkosazana Clarice Dlamini Zuma, in extremely high regard.

The woman may have made a R14-million screw up with the Sarafina II debacle, but the advances in primary health care, child care, safe abortion, and sex education that have taken place under her direction have been nothing short of phenomenal.

Given that background, I followed the unveiling of the Health Department's National Drug Policy with great interest.

The sequence of events that were of importance to me were as follows: Dr Zuma pointed out that our drug costs were fifth highest in the world. She said legislation would be tabled that would encourage use of generic drugs and imports to bring down prices. The pharmaceutical industry reacted with an advertising scare campaign.

There are many nature-loving earth children who sing the praises of holistic lifestyles, homeopathic remedies, and natural rhythms of the universe.

I'm not one of those. I think some prescription drugs are almost miraculous. Like Minoxidal — puts hairs on your chest.

But the propaganda machinery of the pharmaceutical industry is geared towards producing a medical mindset of "prescribe first, diagnose later." And doctors in this country tend to be no less sheep-like than the rest of us.

The South African general practitioner is a steady recipient of glossy brochures and free samples. He or she is regularly visited by pharmaceutical salescritters whose sole task is to persuade said doctor to switch brands.

The end result is that when presented with a pimply schoolgirl, said doctor is more likely to hit her with a course of hormones rather than first investigating whether her diet consists of sufficient quantities of fresh fruit and vegetables and lean meat.

How many times have you or a member of your family visited a GP with standard flu symptoms — fever, sniffles, sore throat? And how often has the physician responded with a broad spectrum antibiotic?

The fact of the matter is that influenza is a viral infection, and antibiotics are worthless against viruses. They are only useful against bacterial infections such as pneumonia.

American doctors prescribe antibiotics only under very specific conditions. Why? Because bacterial infections build up resistance to particular antibiotics. They become stronger and more threatening to the patient. So we have to develop stronger antibiotics. And the bacteria mutate further...

Meanwhile, all of those helpful bacteria that live in the patient's digestive tract are killed off by the antibiotic and one ends up with diarrhoea.

Many of you use paracetamol. You can buy this stuff under the brand names Panado or Tylenol.

Or you can be smart and ask your pharmacist for a generic version. All three do exactly the same thing: Produce analgesia by blocking generation of pain impulses; probably caused by inhibition of prostaglandin synthesis. Relieves fever by central action in the hypothalmic heat-regulating centre.

Panado and Tylenol may be easier to swallow. They won't fix your headache any faster that generic paracetamol. Generic is generally a lot cheaper.

As for imports, Indians often pay as much for drugs in rupees as we do in rands. One antibiotic made by the same international company retails there for Rs.37 and here for R37. At 8 rupees to the rand, we pay 8 times too much. The adverts don't explain why...