Global Trends by Martin
Monday 6 June 2005
Medicines becoming useless due to overuse
Blurb: The recent World
Health Assembly highlighted a major global health problem: that many
medicines are becoming ineffective because their overuse or wrong use
have enabled life-threatening microbes to become resistant to antibiotics
and other drugs. Action to curb irrational drug use is now urgent, yet
not much has been done until now.
The wrong prescribing and use
of medicines is contributing to increasing resistance by bacteria and
viruses that cause infectious diseases to antimicrobial medicines such
Both the irrational use of
drugs, and the anti-microbial resistance have reached alarming proportions.
These interrelated problems
was one of the more interesting issues brought up at the World Health
Assembly (WHA), attended by Health Ministers and officials in Geneva a
The World Health Organisation
says that antimicrobial resistance is one of the world’s most serious
public health problems. A major cause is the wrong use of medicines.
Though the WHA debated these
inter-related issues, measures to control irrational drug use were downplayed
because some major developed countries did not want the spotlight to be
placed on the marketing tactics of drug companies.
Proposals to control the sales
of drugs as growth-promoting agents in animals were dropped in a draft
resolution at the insistence of these countries.
Worldwide, more than 50% of
all medicines are prescribed, dispensed or sold inappropriately, and 50%
of patients fail to take them correctly. These startling facts were presented
by WHO officials at a briefing for WHA participants on “Irrational use
of medicines damages health and wastes resources.”
“Only two thirds of the world’s
population have regular access to medicines, and of the people who do
receive medicines, more than half of those people are prescribed medicines
incorrectly,” said Dr. Kathleen Holloway of the WHO’s Department of Medicines
Policy. “And of the people that are prescribed medicines, more than half
of those people fail to take them correctly.”
Arithmetically, that would
mean that less than a quarter of medicines prescribed are used appropriately.
Holloway also gave some data
on adverse consequences of irrational drug use:
- 2.3 to 4.7 million new cases of hepatitis B and C and 160,000 new
cases of HIV per year, resulting from 15 billion injections per year,
half of which are non-sterile.
- 4 to 10 percent of hospital inpatients suffer an adverse drug reaction
in developed countries. This is the fourth to sixth leading cause
of death in the US and costs $130 billion in the US and 466 million
pounds sterling in the UK yearly.
- There is increasing antimicrobial resistance, with resistance of
up to 70-90 percent to original first-line antibiotics for dysentery
(shigella), pneumonia (pneumococcal), gonorrhoea, and hospital infections
“Irrational drug use is a very
serious global public health problem and much more action is needed at
national level,” she concluded.
During question time, a member
of an Asian consumer organization remarked that a major cause of irrational
medicines use in developing countries was the unethical promotion of drugs
by drug companies, which practiced double standards in marketing and labeling
(in developed and developing countries) and gave incentives to doctors
to induce them to use more medicines.
He added that a large portion
of antibiotics produced were sold as inputs in animal feed to fatten the
animals, and as there was little control of this in developing countries,
this had contributed to resistance in the bacteria and viruses in the
animals which were then passed on to resistance in microbes that affect
He expressed concern that part
of a draft WHA resolution on antimicrobial resistance, that dealt with
the need to regulate drugs in animal feed had been removed.
A senior WHO official replied
that sales promotion by companies is effective in influencing the decisions
of doctors on their use of drugs. On what can be done towards more responsible
sales promotion, he said regulation seems to be the measure that works
as it was shown to prevent the worst aspects of promotion.
On the use of drugs in animals,
Hogerzeil said that the drafting group for the WHA resolution had decided
that the resolution should only deal with the medical problem as there
are other international agencies that deal with drug use in animals.
In his response, Prof. Otto
Cars, Director of the Swedish Programme for Rational Use of Antimicrobial
Agents, agreed that the ethical standards of drug companies is a very
important issue, and that there needs to be regulation on sales promotion.
On drugs in animal feedstuff,
he agreed it was a major issue, and that the European Union was going
to prohibit the use of drugs as growth promoters in animals in 2006.
As the discussion showed, there
were differences behind the scenes on how the WHO should deal with irrational
Some developed countries objected
to a focus on irrational drug use and narrowed the issue to antimicrobial
resistance. They did not want the marketing tactics of drug companies
to become a focus of attention.
During the discussions on antimicrobial
resistance, some countries proposed that governments should control the
use of antibiotics used to promote growth in animals that are for human
consumption, as this practice has been considered hazardous since the
1970s. However, the proposal was removed at the insistence of a major
A WHO policy paper on “Containing
antimicrobial resistance” says that many of the microbes that cause infectious
disease no longer respond to common antimicrobial drugs such as antibiotics,
antiviral and antiprotozoal drugs.
“The problem is so serious
that unless concerted action is taken worldwide, we run the risk of returning
to the pre-antibiotic era when many more children than now died of infectious
diseases and major surgery was impossible due to the risk of infection.”
WHO’s 2002-03 data show the
following antimicrobial resistance global prevalence rates: malaria (chloroquine
resistance in 81 out of 92 countries); tuberculosis (0-17% primary multi-drug
resistance); HIV/AIDS (0-25% primary resistance to at least one antiretroviral
drug); gonorrhoea (5-98% penicillin resistance); pneumonia and bacterial
meningitis (0-70% penincillin resistance in streptococcus pneumonia);
diarrhoea: shigellosis (10-90% ampicillin resistance, 5-95% cotrimoxazole
resistance); hospital infections (0-70% resistance of staphylococcus
aureus to all penicillins and cephalosporins).
Another WHO paper says that
irrational medicines use includes use of more medicines than are clinically
necessary, inappropriate use of antimicrobial agents for non-bacterial
infections; inappropriate selection or dosing of antibiotics for bacterial
infections; over-use of injections when oral formulations are more appropriate;
failure to prescribe in accordance with clinical guidelines; and inappropriate
self medication often of prescriptions-only medicines.
“The extensive misuse of antimicrobial
agents leads to bacterial pathogens becoming resistant, thereby rendering
treatment ineffective,” says the paper. “The rapid and alarming spread
of antimicrobial resistance around the world has not been matched by a
concerted and powerful public health response.”
The WHO paper lists measures
that governments can take, including regarding drug sales promotion.
“Pharmaceutical promotion often has negative effects on prescribing and
consumer choice,” says the WHO.
“Countries should consider
regulating and monitoring the quality of drug advertising and of the pharmaceutical
industry’s promotional practices, and enforcing sanctions for violations.”
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