Unaffordable prices of drugs

Health Action Internaitonal Asia Pacific in an article sent to us focusing on unaffordable prices of drugs comments:

WHO estimates that currently one third of the world's population lacks access to essential drugs. Over fifty per cent of people in the developing world especially in Africa and Asia do not have access to even the most basic essential drugs. This is one of the pressing issues in the world that requires urgent attention at present.

Factors influencing unaffordable drug prices

Access to medicines depends on four critical elements: Affordable prices, rational selection and use, sustainable financing and reliable supply systems. Due to limited financial resources in the developing world drug pricing has become the most important factor that restricts access to medicines. There are many factors, which influence and maintain the higher and unaffordable prices of drugs.

However, lack of price control measures and the pricing policies of multinational pharmaceutical companies are considered the most important contributing factors.

Intellectual property rights

The paper presents an overview on Globalization, Intellectual Property Rights (IPRs) and Patents, which have taken a new turn with the introduction of the Agreement of Trade-Related aspects of Intellectual Property Rights (TRIPs Agreement).

WTO/TRIPs Agreement will make the current health crisis a disaster in the near future. WTO multi-lateral agreements play a crucial role in legitimizing globalization, which results in increased poverty, the reason that cuts off one third of the world's population from access to basic essential drugs and if implemented, the multinational way, will lead to a situation where over 50 per cent of the world population will have no access to essential drugs.

DOHA Declaration

Focusing on the DOHA declaration and the TRIPs Agreement, the paper outlines Parallel Importing and Compulsory Licensing provisions that can be used to limit patents and monopolies in the TRIPs Agreement and highlighted at the 4th Ministerial Conference in DOHA. These measures are stated as crucial in enabling access to affordable medicines.

The paper deals with many other important issues of access to medicines including; patents and research development, local production and technology transfer, drug donations, differential/preferential pricing and public private initiatives.

In conclusion the position paper recommends several steps that could be implemented at national, regional and international level to bring about change. Some important recommendations are:

. Adopt and implement National Drug Policies (NDP) based on the concept of essential drugs that are formulated with substantive involvement of citizens and NGOs.

. Produce National Drug Formulary and Therapeutic Guidelines based on the essential drugs concept and containing drug-pricing information.

. Promote and encourage generic competition

. Eliminate barriers to access to medicines and raw materials, including overly rigid and/or expensive regulatory requirements, unnecessary margins on prices.

. Develop systematic and transparent solutions to ensure equity pricing and cautious about accepting deals with unreasonable conditions.

. Countries should be able to exercise their rights in determining their public health priorities and be allowed to take necessary measures independently.

. Bilateral pressure from multi-national drug exporting countries placed on developing countries must be stopped.

. Countries that do not have local manufacturing capacities in producing medicines should have measures to issue compulsory licences to firms in countries that can meet their production needs and have the production shipped to them.

. Educate health activists and key policy makers of developing countries on the safeguards provided by the Doha Declaration on TRIPs that will enable the developing countries to manufacture or import cheaper drugs.

. Developing countries should develop a comprehensive international legal framework to ensure the optimal utilization of the Doha declaration safeguards and priority to public health interests.

For children with special needs, a hopeful era in sight

Children with Special Needs: Sri Lanka's Down's Syndromed Children and those with special needs are to be benefitted by a new foundation recently set up in Colombo to cater to their needs, welfare and rehabilitation. Lalith Weeratunga, Secretary to President Mahinda Rajapaksa in a message to a fund raising musical show of the new Dullewa Foundation for Children with Special Needs states:

It is a pleasure to be associated with this foundation, which has set a vision to be the Pioneer Charitable Institute providing effective for promoting health and well-being of the children with special needs. Sri Lanka is in need of such organisations that will work towards the well-being of children needing special attention.

The foundation, as I know, is the result of the extraordinary talent of a very special child, Kosala Dullewa. He has shown to the world what a child with special needs is capable of, although he has had to surmount many obstacles that other children do not have to face in life. Carefully nurtured, Kosala developed his remarkable skill to be a dancer with exceptional ability.

His parents, Mr. and Mrs. Dullewa along with his uncle and aunt domiciled in the US, Mr. and Mrs. Damitha Karunaratne have worked tirelessly over the years to crown their hard work with the establishment of the Kosala Dullewa Foundation. It was also their foresight that made the foundation a reality.

Many children in Sri Lanka who are born with special needs will be benefitted by the work envisaged by the Kosala Dullewa Foundation. These children and their parents can look up to this unique institution for solace, support, advice, guidance and above all, societal intervention that will make a qualitative difference in their lives.

Many philanthropists, I am sure, will recognise the need to help institutions of this nature and support in many ways to sustain and improve them, so that they will become entities valued by the communities in which they work.

Foundation's President Damitha S. Karunaratne speaking to the HealthWatch said: Kosala's little footsteps opened the door. "Though I live far away from Sri Lanka, I watched how little Down's Syndormed Kosala progressed. It was not an easy task for his parents, immediate family and friends, but with their support, Kosala's little footsteps opened the door to a world that we had not entered before.

The tremendous inspiration that he brought to all of us gave birth to the idea of establishing a foundation for children like Kosala and others who need special attention. It was equally encouraging to see how dedicated Kosala's parents were to bring out and nurture Kosala's talents. It is amazing to learn how much parental love can change a situation that once seemed so bleak.

This show 'Mavuni- Piyaneni' is a tribute to all parents who extended, and continue to extend their unconditional and everlasting love to their children regardless of their shape, form, colour or medical condition."

Untapped potential

As we recognise the untapped potential these children have and are inspired by their different abilities, it is a pity to see that most of these children are still being excluded and marginalised from our society.

If care, love, stimulus, encouragement and opportunities were available, the contribution these children can offer to the society would be tremendous.

'Mavuni-Piyaneni', the musical tribute to everlasting parental love, is staged to give all of us an opportunity to step back and think for a moment about the underprivileged children.

* To be the pioneer service organisation for mobilising and promoting health and well-being of children with special needs in Sri Lanka.

* To assist underprivileged children with different physical and mental disabilities irrespective of their caste, creed, nationality or religion, to become useful citizens who could contribute positively to the society.

* To become the driving force to change attitudes of the society towards the children with mental and physical disabilities.

Activities

* Register and create a National Database for all Down's Syndrome and those affected with Cerebral Palsy as soon as they are detected. Pilot projects to be launched in Colombo and Kalutara districts.

* Conduct a needs assessment to identify the gaps in services for children with special needs.

* Based on the outcome of the needs assessment, develop a Resource Centre for providing necessary information for rehabilitation of such children.

* To provide necessary counselling to parents of those children.

* Conduct awareness programmes and group discussions at community level for family members and caregivers to help them raise these children to become useful citizens.

* Organise support groups/self help groups to share best practices and success stories among other parents with such children.

Provide funds for assistive devices (aids and appliances) necessary for proper rehabilitation of children with disability among needy families.

Conduct regular TV programmes to create awareness among general public.

* Support National Level Special Olympic Programme

* Collaborate with other groups and service organisations that have similar interests in mobilising children with special needs and different abilities for them to be included in the society as productive citizens.

Resources needed

* List of dedicated people with diverse capabilities.

Medical and paramedical personnel engaged in working with persons with disabilities.

* Health personnel to collect data assigned to locate such children and inform their parents.

* Those capable of providing legal advice, counselling.

* Parents of disabled children who managed to overcome the problems and excelled in many ways.

Places in community to arrange such discussions with parents.

Those interested in helping could call Foundation Treasure/Trustee Athula Munasinghe on 071-2746334.

Warning symptoms often herald sudden cardiac death

NEW YORK - Cardiac arrest is often preceded by symptoms lasting for more than an hour, and usually occurs in cases with a known history of heart disease or risk factors, German investigators report.

These findings refute the theory that sudden cardiac death occurs at random in apparently healthy or low-risk patients, the authors say.

"These findings suggest that educating the public, patients and relatives to recognize and respond to symptoms of heart disease holds promise for reducing mortality attributed to sudden death," Dr. Dirk Muller and colleagues at the University of Berlin report in the journal Circulation.

Muller's team evaluated data analyzed the circumstances surrounding 406 patients who suffered sudden cardiac arrest and obtained cardiac histories and the median duration of warning for 323.

Results showed that 22 per cent of patients had experienced angina (chest pain) for 120 minutes. Dyspnea (difficulty breathing) was present in 15 per cent of patients for 30 minutes, nausea or vomiting in 7 per cent for 120 minutes, dizziness or fainting in 5 per cent for 10 minutes, while other symptoms lasting 60 minutes were reported by 8 per cent. Only 25 per cent had no warning symptoms at all.

The investigators report that in 90 per cent of cases, symptoms had lasted for at least 5 minutes before the patient collapsed and in some cases much longer. "These symptoms are misinterpreted, suppressed, or denied despite the presence of a pre-existing cardiac disease or cardiac risk factors," Muller and his associates write.

More than half of the patients had a history of heart disease, and many had other risk factors, such as diabetes, smoking and chronic lung disease.

The researchers also observed that when arrests occurred in public places, bystanders often initiated CPR. However, most collapses occurred when patients were at home in the presence of relatives, who are unlikely to attempt CPR. Of the 57 patients for whom bystander CPR was performed, 23 per cent were alive and discharged from the hospital. In contrast, only 4 per cent of 349 without bystander CPR survived.

(Reuters)

Continued from last week

Acne - in and out

Dr. Sharnika Abeykirthi

Senior Registrar Dermatology Unit NHC

Treatment methods

* Topical therapy

* Oral therapy Physical methods

Topical therapy

Wide variety of topical creams are available in the market. Some of them do not even mention the ingredients in it. The choice of therapy depends on your acne grade and several other factors. So it is very important that you consult your doctor prior to starting treatment. Some of the widely recommended and scientifically proven anti acne creams are-

1. Topical antibiotics

Available as creams or lotions. Has an antimicrobial effect. So it acts against propionibacterium acne.

These include erythromycin, clindamycin etc.

2. Benzoyl peroxide

Available in concentrations of 2.5, 4, 5 or 10% This also has an antimicrobial effect.

3. Azaleic acid

This has an antimicrobial as well as anticomidonal effect. It also reduces the marks (or pigmentation) seen in some acne patients.

Topical retinoids

This is a very effective treatment for acne. It has an antimicrobial, anti inflammatory as well as anticomidonal effect. It also reduces scarring. It is available as retinoic acid, Isotretinoin and adapalene.

As these have several side effects, it is very important that you should be under a doctor's supervision during treatment. Especially retniod drugs should not be used during pregnancy and lactation.

Oral therapy

When you are unable to control with topical therapy or for moderate to severe acne, oral therapy is given.

1. Antibiotics

eg. tetracycline, erythromycin

2. Hormonal treatment

Antiandrogenic hormones are used. Can also be used as a contraceptive method. Should not be used in males.

3. Oral Isotretinoin

This is the most effective antiacne therapy. But unfortunately because of its high cost and side effects, isotretinoin is not widely used in Sri Lanka.

It should be used with caution in women of child bearing age as it may lead to birth of deformed babies.

4. Other therapies like dapsone, zinc, Vitamin A are occasionally used.

Physical modalities

Physical modalities are used as an adjuvant to topical and oral treatment.

Comedone extraction is one such method. As this procedure is painful, it should be done by a skilful person. Although hot compresses help to remove comedones, facial saunas and heat can worsen acne. Cryotherapy with liquid nitrogen as well as intralesional steroids can be used for nodular lesions and keloids. Dermabrasion is useful for scars but it has its own side effects.

Whatever the treatment used, as acne is a chronic disease, the treatment should be long term. Even after you are free of acne sometimes maintenance treatment may be needed until you pass the age you are prone to get acne.

Doctor's advice

As acne is a chronic disease patience is important. Because your tendency to get acne persists for sometime, you should continue treatment as long as your doctor tells you.

It is important for you to realise that even if you have mild acne it will persist for about 5 years and if you have severe acne, it could be more than 10 years. With standard therapy little improvement is seen after one month. Sometimes acne can get worst initially even with treatment. So you should realize this and continue to follow your doctor's advice and the treatment given.

Finally if you have acne, don't just apply anything and everything you get hold of. It's a common disease which can be cured. So hurry up and get your doctor's advice.

(Concluded)

SLMA Award for Excellence in Health Journalism - 2006

Sri Lanka Medical Association wishes to call for entries from those who have contributed to the print media on Health issues during the July 1, 2005 to June 30, 2006 for the 'Annual Journalist Award for Excellence on Health Issues'.

The scheme is open to journalists, including free-lancers, from newspapers and health magazines of all three languages in Sri Lanka. Medical doctors registered with the Sri Lanka Medical Council are NOT eligible for this award.

The following criteria should be adhered to by all entrants.

*Contestant should apply personally with the endorsement of the relevant institution he is working for, to certify that he/she is a professional journalist (either full time, part time/free-lance)

*Contestant should submit not more than three (03) articles of his/her choice

*Contestant should certify that the articles are his/her own, and that they were published during the period July 1, 2005 to June 30, 2006. He should also name the date and source of the article.

*Entries should be accompanied with certification from the institution he works for, that is his/her own work.

*Completed entries should be sent by registered post to reach "The Chairman, Media Committee, Sri Lanka Medical Association, No. 06, Wijerama Mawatha, Colombo 07 on or before 12.00 noon September 15, 2006.

Recipient of the award will be selected by an independent panel of judges from among eminent health and media personnel.

For further information please contact:

Dr. Waruna Gunathilaka,
Co-ordinating Officer,
Media Committee,
Sri Lanka Medical Association,
No. 06, Wijerama Mawatha,
Colombo 07.
Tel: 2693324