The drugging of the Third World.

This article reports an investigation of the promotion of more than 500 products marketed by over 150 pharmaceutical companies in the United States, Great Britain, Latin America, Africa, and Asia. In contrast to the promotional material provided to physicians in the United States and Great Britain, material presented to physicians in Third World countries was found to be marked by gross exaggeration of product effectiveness and minimized or completely omitted potential hazards. No substantial differences could be found between multinational and domestic companies, brand-name and generic firms, or companies based in capitalist nations and those in socialist or communist-bloc countries in terms of the adequacy and accuracy of their promotion. Little evidence was found to support industry claims that the discrepancies in promotion reflect the different policies of various drug regulatory agencies. Much of the promotion concerned "luxury products," including costly tonics and appetite stimulants marketed in poor countries where the pressing need is for food. Bribery of influential physicians and key governmental officials may play an important role in irrational drug promotion and use in the Third World. Some of the proposed corrective approaches to this problem are examined.