Consuming Interest
Drugs On The Market
By LESLIE ADRIAN
Voltaire's jibe that doctors pour drugs about Which they know very little into patients about whom they know even less, has as much sting to- day, when doctors are faced with a choice of 5,000 or 6,000 preparations about many of which they know no more than the advertisements and the technical articles (if they read their journals) tell them. So we get fashions in drugs, like the sulfa drugs, then the antibiotics, especially peni- cillin with its useful 'broad spectrum,' which was eventually over-used and displayed allergic pro- perties as well. One .result of the enormous growth of the pharmaceutical industry with its undoUbted expertise has been that the medical profession has to a great extent lost control of the situation.
According to Dr. Ffrangcon Roberts it is sig- nificant 'that commerce should attempt to take over the task of academic instruction, using its, immense resources in the palatable presentation of scientific facts . . . If doctors are in fact re- duced to receiving instructions from trade, what becomes of their claim to be considered a learned profession?' The other side of the coin was turned up in a manufacturer's address to the Marketing Society recently. Mr. A. A. Smith. Managing director of Upjohn Ltd., said, 'The Pharmaceutical industry has placed itself in the social sphere in a relatively short time and the Managers of the industry find themselves with a Marketing problem strongly influenced by the attitudes of both senior civil servants and in- terested politicians. We are, perhaps, unique to- day in that no other industry in the private sector cuts so deeply into the question of public policy and, in the United Kingdom, the .situation is especially highlighted by the existence of a National Health Service.'
At this rate the patient is no more than a pawn, for even his doctor's control over the choice of drugs is severely limited, My own medical re- feree, who believes firmly in the social approach to prescribing. has four rules for the individual doctor. First, he should ask himself whether he should interfere with the patient at all. Secondly, if he decides to do so, what alteration in the patient's condition he hopes to achieve. Thirdly. he should ascertain that the drug he intends to use is capable of doing this and, fourthly, whether it may have other effects that may be harmful. One thing that the individual can contribute to improving the behaviour of the drug trade is to avoid self-medication as much as possible. And certainly to prefer a pinch of salt to a placebo advertised on television.
Alongside the growth of the so-called ethical drug business, there has been an equivalent boom in proprietary or brand-named medicamentS. Not only has the dispensary become a kind of thera- peutic supermarket, the traditional pharmacy has been replaced by the drug store with a dazzling display of cartons and containers bearing attrac- tive cure-all names and claims. The retail battle in the drug trade is as tough as the battle for the GP's preference in prescription writing.
Standard treatments available under a branded name are always going to be dearer than the comparable product sold as BP (British Phar- macopoeia) or NF (National Formulary).
Codeine compound tablets cost 4s. for 100, compared with Veganin or Codis at 3s. Id. for 20. Vitamin capsules NF are 2s. for 50: Multivita- min capsules 3s. 6d. for 50: APC (aspirin, phena- cetin and caffeine) tablets BP cost Is. 3d. for 25 compared with Anadin at 2s. for 20. Pholocodine cough linctus (the word 'linctus' means simply 'syrup') can be bought for 2s. 9d. a four-fluid- ounce bottle (about eight tablespoonfuls), while most branded cough syrups are 4s. or more. Ethnine, for example, is 3s. 10d. For the same size bottle of Milk of Magnesia you would pay 2s. Id., instead of Is. 6d. for Mag. Hydrox. BP. Nux vomica syrup costs 2s.. Metatone Tonic 4s. 101d. And so on. Why buy Aspro when aspirin BP is far cheaper? Soluble aspirin was added to the BP list years ago, yet people still pay over the odds for Disprin. Then there are over thirty dyspepsia relievers, all with fancy names. The same relief can be had from Mag. Trisil Compound NF for a matter of pence. Not all chemists will be infor- mative about this. They have to live. But Boots carry a large range of BP and NF medicines,
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