BAD MEDICINE

Silverman, Lydecker, and Lee—who took upon themselves the seemingly Sisyphean task of exposing the abuses of the pharmaceutical industry (Prescriptions for Death: The Drugging of the Third World, 1982, etc.)—now reexamine the situation in the Third World and conclude that a worldwide crisis exists. The present survey, begun in 1987, indicates that most multinational drug companies, under pressure from within and without, have improved the way they label and market their products. But apparently the public hasn't benefited—for, the authors contend, scores of useless and dangerous drugs are now put out by local or domestic firms, small in size but large in political clout. Fraudulent drugs abound, and badly needed ones are unavailable. The authors cite some small success stories- -India's ban on deadly, high-dosage hormones, and a pilot project in Gambia in which drug companies and the government cooperated to set up a drug-distribution system—but they observe that, in most developing nations, drug-regulation agencies are corrupt, weak, and underfunded, and their workers poorly trained. Bribery, the authors note, is a way of life throughout the Third World. They conclude that what's needed is constant surveillance, as well as continuous consultation among consumer advocates, the drug industry, government agencies, and the medical and pharmacy professions, with the World Health Organization leading the way. The scrutiny is close, the research impressive, though the presentation is so detailed that it may overwhelm all but the most concerned reader. Still, a thorough assessment of a perilous situation.