Drug companies urged to make drugs available at cost price to the poor
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7376.1320/b (Published 07 December 2002) Cite this as: BMJ 2002;325:1320
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Sri Lanka has shown that other options should be attempted by the
state to bring down drug prices. The country's state sector (with its zero
charge services) has succesfully used the concept of an Essential Drug
List for some time, thus curtailing total costs on drugs. Two other
lessons from the country, applicable at the retail level are outlined.
1)The private retail drug market is poorly controlled as there is no
ceiling for prices nor on the number of preparations (of the same drug)
which can be imported.The government owned State Pharmaceutical
Corporation (SPC) has several retail pharmacies which sells high quality
generic drugs at cheap rates, thereby competing with the private sector.
This model can be made more effective by widening the network of outlets
at a national level.
2) Sri Lankan data shows that merely writing "generic" precriptions
wouldn't suffice because private retail pharmacies dispense higher priced
alternatives. We recently sampled 21 private pharmacies for the price of
14 common drugs where the precriptions were written using "generic" terms.
This was compared with the price from the SPC outlets. The mean cost for
drugs from all pharmacies was Rs. 38.20/day (95% confidence 32.90-
43.50)compared to Rs 14.97/day at the SPC, (with one selling at almost 3
times the cost at the SPC).
Competing interests:
None declared
Competing interests: No competing interests
Drugs, money and ethics in Lithuania
Lithuania is one of post-communistic countries in which the ethical
aspects of the collaboration between health professionals and
pharmaceutical industry are quite neglected. Aspects of ethical corporate
sponsorship, conflict of interests, professional bias in relationship
between medical staff and pharmaceutical companies is the reason of
various public scandals and are now often discussed in Lithuania. The new
expanding drug market is especially vulnerable to various kinds of
corruption in Lithuania.
For pharmaceutical companies the absence of clear and enforceable ethical
collaboration rules regulating registration procedures, insurance and
state coverage of medicaments, sponsorship, promotion and advertisement
represents a highly attractive temptation to stake out new claims abusing
the local conditions. As the candidate countries are now approaching
European Union, it is good time to work intensively on improvement of
ethical standards in this field.
These issues were discussed in the high-profile international conference
“Funding reformed mental health services”, which took place in Vilnius,
Lithuania on the 22-23 of November.
For the first time in Lithuania is was a trial to provoke open discussions
on sensitive issues. The medical professionals, representatives of
pharmaceutical firms, Lithuanian officials and foreign experts joined
their efforts and openly discussed the sensitive issues – corporate
sponsorship and medical ethics, ethical drug trials, financing a community
based integrated services. This international conference on funding
reformed mental health services and ethical issues of corporate
sponsorship was an important step regarding the changes, which are
expecting the pre-accession countries.
The conference joined together more than 70 reform-minded psychiatrists,
experts, representatives of pharmaceutical firms, politicians and experts
from Lithuania, Czech Republic, Slovakia, Austria, the Netherlands,
Switzerland, United Kingdom. The conference was attended by such grandees
of world psychiatry as Norman Sartorius - past president of World
Psychiatric Association, Jim Berley – past president of Royal college and
British Medical Association, well known professor of psychiatry from
Austria Heinz Katschnig, the president of British Royal College of
Psychiatrists in United Kingdom Mike Shooter, former advisor of Czech
Ministry of health, psychiatrist Jan Pfeiffer.
Two days high-level international conference was organized by
international organization’s “Geneva Initiative on Psychiatry” regional
office in Lithuania, Vilnius University, Lithuanian Psychiatric
Association, Association for Psychosocial Rehabilitation in Lithuania.
“Geneva Initiative on Psychiatry” is the international company
(headquarter based in Holland) which operates in Central and Eastern
Europe with task to reform and humanize the psychology in this regions.
The task of the conference was to provoke the open discussion on the
sensitive issues, to develop the clear guidelines with regard to corporate
sponsorship, to find the ways how to make the integrative chain of mental
health services sustainable through health insurance funding and the
corporate sponsorship.
The issues related to the pharmaceutical industry are very important and
not undisputed in Lithuania. Recently this issue resulted only in a flow
of negative articles in the press about expensive trips of doctors or
officials of Ministry of Health and incorrect prescription of drugs by
individual doctors. These publications only caused because of things being
unclear and vague, because the absence of regulations and of a regular and
universally accepted package of guidelines.
The president of British Royal College of Psychiatrists in United
Kingdom Mike Shooter presented to Lithuanian colleagues the ethical
sponsorship guidelines of British Royal College of Psychiatrists. This
experience will be very useful for
Lithuanian Psychiatric Association which is authorized to develop clear
guidelines for corporate sponsorship, in collaboration with the Lithuanian
Association of Ethical Pharmaceuticals and the National Bioethics
Committee in correspondence with similar guidelines by sister-
organizations in Europe.
Erika Umbrasaite,
Public relations officer
Geneva Initiative on Psychiatry-Lithuania office
Competing interests:
None declared
Competing interests: No competing interests