Learning from low income countries: Poor patients deserve more science and less advocacy

doi:10.1136/bmj.330.7489.479

BMJ 2005;330:479 (26 February), doi:10.1136/bmj.330.7489.479

Letter

Learning from low income countries

Poor patients deserve more science and less advocacy

The first 150 words of the full text of this article appear below.

EDITOR—Hogerzeil, who works for the World Health Organizationin Geneva, contends that WHO selects essential medicines withina therapeutic class on the basis of comparative efficacy, safety,and cost.¹ His reference text, Essential Medicines,² is at variancewith that contention.

WHO's choice to treat 3 million by 2005 is triple dose combinationantiretroviral treatment from India. In the April listing, WHOsays: "The Committee strongly recommends the use of three orfour drug combinations... The use of fixed dose preparationsfor these combinations is also recommended, with assured pharmaceuticalquality and interchangeability with the single products."

The regulatory test to judge whether a drug is interchangeableis the presence of an originator product. Since none of thepatent holders for the three separate originator antiretroviraldrugs has produced an equivalent combination product, thereis no comparator drug. An analysis of efficacy, safety, andcost has therefore scant . . . [Full text of this article]

Carol C Adelman, director

carola@hudsondc.org, Center for Science in Policy, Hudson Institute, 1015 18th Street NW, Suite 300, Washington, DC 20036, USA

Jeremiah Norris, senior fellow

Center for Science in Policy, Hudson Institute, 1015 18th Street NW, Suite 300, Washington, DC 20036, USA