Contents of this issue

HAI Europe criticises European Commission's move towards DTCA and calls for evidence of health benefits

HAI Europe deeply regrets the decision by the European Commission to recommend that pharmaceutical companies be allowed to mount 'disease awareness' campaigns. This is the thin end of a wedge to open the door to DTCA (Direct to Consumer Advertising) - i.e. allowing the promotion of prescription medicines to the general public.

Experience in the US and New Zealand - the only two developed countries to allow DTCA - suggest that drug promotion to patients has pernicious effects on the conduct of medicine and attainment of public health. DTCA is notably linked to higher drug prices and reduced access to medicines: in European health systems, it seems bound to lead to unsustainable demand. The New Zealand government is presently considering a ban on DTCA and over 50 bills on DTCA issues are working their way through a number of US State Legislatures. (Scott Levin, 2001)

Proposals from the European Commission are intended to relax the existing prohibitions, allowing companies to promote treatments for AIDS, diabetes and asthma. But why does the European Commission believe that companies will act responsibly in Europe, when their record is so poor overseas?

• Earlier this year, the San Francisco Department of Health warned it was considering banning DTCA for AIDS drugs within the city limits, following a public health survey showing that young gay men were less likely to practice safe sex because the unrealistic images in DTC ads for AIDS drugs made it seem like AIDS could be effectively controlled. Some adverts showed vigorous men climbing mountains - nothing like the reality of life on triple therapy. In Europe the emphasis has been on prevention of HIV infection, and patients already have access to much information from independent sources on treatment options and the pros and cons of different treatment regimes. (Josephson, 2001)
• A diabetes drug, banned in the UK in 1997 because of severe liver toxicity, was advertised to the US public for over two years, without mention in any advertising campaign of the UK ban. Troglitazone (brand name Rezulin in the US) was named as the probable cause of nearly 400 deaths, 63 from liver failure, before it was removed from the US market. The European Commission is recommending that companies involved in 'disease awareness' campaigns should regulate themselves - but what evidence does the Commission have that companies will behave more responsibly in Europe? (Gale, 2001).
• In New Zealand, the national drug benefit scheme (Pharmac), saw costs for asthma steroid inhalers increase astronomically after an advertising campaign led to large-scale substitution of one steroid inhaler, fluticasone (Flixotide) from a cheaper alternative steroid inhaler, beclamethasone, despite the lack of any good evidence of any advantage to justify the increased cost. What evidence does the European Commission have that company-sponsored information materials and campaigns leading to increased expenses and a strain on public health services and tax revenues will lead to improved health?
  

The EU nations presently have laws in place to prohibit DTCA and to protect public health. If the law is to be changed, the burden of proof should be on the European Commission and the pharmaceutical industry to show health benefits and lack of harm. However, after years of experience with DTCA - and expenditure now well over US$2.5 billion/year - not a single study has been published to back industry claims of health benefits from prescription drug advertising campaigns. If the evidence did exist, there is no way the industry would be keeping it quiet.

The European Commission has barely examined the health consequences.

This whole initiative seems to be driven by the EC's Directorate for Enterprise, with the DG for Consumer Protection and Health on the sidelines. The operative committee (G10) is a high level affair, which meets in secret, joining health ministers with senior industrialists. The G10 Committee is planning to extend the proposals by the European Commission - with its final report not due until April 2002.

HAI Europe is asking members of the European Parliament to reject this proposal, unless and until there is clear evidence that the benefits are real and greater than the considerable risks. Not least because any decision to open the door to DTCA would be irreversible, the precautionary principle should apply.

HAI Europe rejects the pharmaceutical industry's view that "the prohibition on the advertising of prescription medicines to the public is unsustainable … and that changes to legislation with therefore be required".

References:

• Consumers Association (UK): Promotion of prescription drugs: public health or private profit?
  10 July 2001 (http://www.which.net/whatsnew/pr/jul01/general/drugads.html)
• Gale E.A.M, Lessons from the glitazones: a story of drug development, Lancet, 9 June 2001, 357, 1870-1875.
• Jeffries M., The Mark of Zorro, Pharmaceutical Marketing, May 2000, 4-5.
• Josephson D, FDA warning to manufacturers of AIDS drugs, BMJ, 12 May 2001, 322, 1143
• Medawar C., Prescription Drugs: Direct advertising? (Guest Editorial), Int. J. Risk & Safety in Medicine, 2001, 13, 81-86. See also: http://www.socialaudit.org.uk (1998-2001).
• Mintzes B: Blurring the Boundaries - new trends in drug promotion, Amsterdam: Health Action International, 1998. See: http://www.haiweb.org/pubs/blurring/blurring.intro.html
• National Institute for Health Care Management, September 2000). See: www.nihcm.org
  New Zealand Ministry of Health, Summary of Submissions on the Direct-to-Consumer Advertising of Prescription Medicines in New Zealand Discussion Paper, Published online, April 2001.
• Pharmaceutical Industry Competitiveness Task Force, Final report, March 2001, available at http://www.doh.gov.uk/pictf/pictf.pdf
• Scott Levin Inc, "States Take Aim at Direct-To-Consumer Drug Ads" Press Release, 25 June 2001 (www.quintiles.com/products_and_services/informatics/scott_levin/press_releases/press_release/1,2226,245,00.html)
• Wilkes M , Bell RA, Kravitz RL, Direct-To-Consumer Prescription Drug Advertising: Trends, Impact, And Implications, Health Affairs, March/ April 2000. Full text available at: www.projhope.org/HA/marapr00/190210.htm.

Contributed by Lisa Hayes - Communications Director, HAI Europe

United Kingdom

Shared experience
DIPEx - a database of patient's experiences of illness - was launched in July. The site contains interviews with people living with acute or chronic diseases.

It details how they felt when they were diagnosed, what treatment was like and how they coped with the long-term effects. It offers facts, figures, theories and evidence on different conditions, and details of support groups.

So far the website focuses on high blood pressure and prostate cancer, but researchers plan to interview people with cancer of the bowel, breast or cervix, and those caring for people with Alzheimer's disease. Working with self-help groups, DIPEx will eventually cover all major, and some rare diseases.

Consumers' Association United Kingdom, made the first grant for a pilot study and major funding comes from the National Health Service and medical charities.

Dr Andrew Herxheimer, co-founder of the site, said "Nothing like this exists. It will help doctors, nurses and students understand patients' points of view".

For more details, visit www.dipex.org

Uganda

Civil Society Organizations concern as Uganda rushes to implement TRIPs, 5 years ahead of deadline

The Coalition for Health & Food Rights and Uganda's Industrial Property (IP) Bill has expressed concern at the way Uganda Law Reform Commission (LRC) is rushing to draft the IP Bill, submit to cabinet, with a view of submitting to parliament by the end of this year. This was contained in a letter by the Coalition, dated August 3, 2001, to Prof. Joseph Kakooza, the Commission Chairman.

"We are very concerned about the rush to implement TRIPs now, 5 years ahead of the legal TRIPs deadline for several reasons. First, before this Bill is drafted, we need to closely monitor the effects of the various IP laws that have been adopted elsewhere on this continent and in the world in order to avoid pitfalls that may result from its adaptation to TRIPs. Second, the TRIPs Agreement is subject itself to intense debates internationally and the WTO itself has commissioned an evaluation of the impact of TRIPs on socio-economic development that we should definitely wait for before we draft our Bill. Third, an early implementation of TRIPs means lesser or limited consultation at the public level, which in turn will translate into an instrument that does not truly represent the concerns and interests of Ugandans and may even result in a law that is more restrictive than what is required by TRIPs", the letter in part said.

Although the Coalition was accepted to sit on the Commission's IP Bill Taskforce as from June 2001, this has not been realised, according to the letter:

"We are especially concerned by the very insufficient consultation that has been conducted thus far in relation to this Bill. Ever since you granted our request to participate in the IP Bill task force, we have never been able to sit on this Task Force because it has not convened since that time. Moreover, we have never been able to see the IP Bill the LRC has prepared, which you promised to avail to us twice: first on July 10 when the Task Force was supposed to sit, and a week later as the meeting had been postponed. In our verbal communication since then, the last of them on July 27, you have informed us that the Task Force will not be able to sit before late August or September due to the Commission's excessive workload, and that consequently, you will not be able to give us a copy of the Bill before then. Thus until now, nobody outside the LRC has been able to see what is being proposed in the Bill and make relevant consultations, comments, or suggestions. This process requires time and yet, we are one month away from the Commission's planned date of submission of the Bill to Cabinet. You have informed us that the LRC may for this reason postpone this submission process by 1 or 2 months, but even so, we will have no time to fully study and comment on the Bill and consult with all the stakeholders concerned before the end of this year."

The Coalition for Health & Food Rights and Uganda's Industrial Property Bill, is an informal coalition of NGOs, international development agencies, health practitioners, academics, social action groups and agriculturalists who are motivated by the genuine belief that the human rights of Ugandans ought not to be trampled on by the drafting and possible enactment of an insensitive Intellectual Property Bill in Uganda.

The Coalition was born out of the recommendations of two workshops on TRIPs held in Kampala in May and June this year. On 10 May 2001, during the Drug Access Workshop, organised by HEPS - Uganda in partnership with HAI-Africa, health activists heard for the first time that the LRC had already embarked on the process of reviewing the Uganda Patent Law in order to make it TRIPs compliate. In their recommendations participants at this workshop emphasised the involvement of civil society organizations in the drafting of the new law in order to ensure the protection of the health rights of all Ugandans especially those living with HIV/AIDS.

The June workshop which took place in Kampala and organised by Uganda Consumer Protection Association, in addition to protection of health interests of Ugandans it also emphasised the protection of food rights and indigenous knowledge by the coming IP Bill.

As a consequence the Ugandan health and food rights activists have decided to combine forces in order to influence the LRC, Cabinet and Parliament during the process of enacting the new IP Bill. Efforts by the coalition to get a copy of the draft bill have so far been fruitless.

Mr Ezekeil Tuma, the Coalition lawyer maintains that, the Coalition understands and appreciates that Uganda is required to implement the TRIPs agreement, thus is not opposed to its implementation but seeks to ensure that the enactment of the new law is not unduly hastened. The new law should be sensitive to the pressing issue of access to health care and essential, affordable life saving drugs, provide a practical regime for compulsory licensing and permit parallel importing. It should also ensure protection of food security and sovereignty of Uganda's rural majority who depend for their food, medicine and shelter on free and uncontrolled access to biological materials, knowledge, innovations and practices.

However the Law Reform Commission is adamant that the earlier the law is put in place the better for the welfare of the people of Uganda.

Contributed by Rosette Mutambi - Coordinator HEPS Uganda.
HEPS - Uganda represents the interests of Health Consumers in this Coalition.

India

Setting up a Community Drug Depot

Community Development Medicinal Unit (CDMU) in collaboration with CARE West Bengal, conducted a training programme for health workers. Twenty-two health workers from the government and NGO sectors attended this training program, held on April 14 and 15, 2001. CARE West Bengal is involved in improving the nutrition and health status of women and children, through strengthening existing health service delivery systems. From research undertaken on community health financing in a target area, it was found that drugs constituted the major healthcare expenditure. The target population expressed a need for a community drug depot run by a local woman's group.

This workshop was held as basic preparatory training prior to establishing a drug depot at the local community level. The workshop had two objectives. Firstly, to build the capacity of health workers in recognising and managing common disorders, and where necessary refer cases to medical personnel for further attention. Secondly, to sensitise health workers on the concepts of essential drugs, and managing community drug depots.

The two-day interactive workshop included discussions on concept of rational drug use, drug selection, dispensing, immunisation and child health, malaria, diarrhoea, infection control, and family planning.

Philippines

Traditional / Alternative Medicines and HIV / AIDS

Health Action Information Network (HAIN) reports in AIDS Action that very little is being done in Asia about tapping traditional medicine for HIV / AIDS. Writer Michael Tan relates being met by strong scepticism about traditional medicine from many of those involved in HIV / AIDS care. This should not be surprising since traditional medicine has become more expensive than 'western' medicine. In China, AIDS experts warned about the many unproven claims being made about Chinese medicinal plants and how AIDS groups should be more careful in promoting these traditional therapies. This is unfortunate as it could lead to a complete rejection of traditional medicine and other alternative forms of health care.

The treatment of HIV/AIDS continues to be dominated by western medical traditions. The 'allopathic medicine' which emerged in Europe during the 19th century, centres on the germ theory. It is based on the idea that there are infectious causes of illness that can be treated with medicines that act like 'bullets', targeting the infectious agents and killing them.

For people living with HIV / AIDS, traditional medical systems offer many products and techniques that can be useful for dealing with common symptomatic ailments such as pain, diarrhoea and cough. Traditional medical systems also have great potential in dealing with stress and in helping to strengthen the immune system. This is very important for people living with HIV / AIDS.

It is unfortunate that many people still look to traditional medicine mainly in terms of producing a 'magic bullet' to cure HIV / AIDS. In reality, traditional and alternative medical systems offer many products and techniques that can be immediately tapped in the management of HIV / AIDS. Some of these remedies are not at all exotic or rare - a proven remedy for nausea, for example, is the use of ginger.

As traditional and alternative medical systems offer a vast variety of medicines and techniques, they should be studied carefully. It is necessary to determine whether a particular product or method is safe, affordable, effective and is needed.

Thailand

Campaigning on improving access to medicines

The Drug Study Group (DSG) has been actively involved in the campaign on improving access to medicines. On 19 May, the Drug Study Group, in collaboration with the Faculty of Pharmaceutical Sciences, Chulalongkorn University, Medecins Sans Frontieres - Belgium, and the Health and Development Foundation convened a one-day session on the 'Impact of IPR on Drug System and Public Health'. The objective of this session was to raise awareness on the impact of the TRIPs Agreement on access to medicines, and also for participants to share information. Participants attending this session included representatives from the media, NGO and academic sector.

The high cost of patented drugs is a major obstacle in improving access to medicines. A coalition of NGOs, working on HIV / AIDS issues and consumer protection, have developed a strong campaign to increase access to medicines. Technical seminars, demonstrations and negotiations have been held advocating the interest of the consumer. Open letters have also been sent to relevant organisations.

Apart from intellectual property issues, DSG is actively campaigning for a rational drug system, tackling issues such as registration, re-evaluation, the Drug Act, and anti-corruption in the Ministry of Public Health.

Mental Health

75% of People Living with Epilepsy Suffer from the 'Treatment Gap'

An estimated 39 million people in the world suffer from epilepsy, but some 30 million of them - almost three out of every four - get almost no help for the condition. In developing countries, 60-90% of people with epilepsy are excluded from treatment.

Epilepsy is the most common of the severe neurological disorders. But in contrast to other chronic diseases, such as diabetes and heart disease, epilepsy carries a heavy burden of stigma that is a major obstacle to treatment.

Although better understanding of the physical and social burden of epilepsy has moved this disorder higher on the world's health agenda, stigma towards people with epilepsy remains rife in many countries. Consequently, their quality of life remains well below that associated with other chronic illnesses.

Another cause of the treatment gap is the low priority health authorities often give to epilepsy.

Negative cultural attitudes, poverty, poor health infrastructure and inadequate supplies of anti-epileptic drugs are major obstacles to ensuring wider availability of treatment.

However, the treatment gap can only be properly closed if poverty and inequalities of income are dealt with simultaneously on the local, national and global levels.

Community-based projects, completed or currently underway, have illustrated how barriers can be overcome.

In these projects, in order to reduce stigma, community health workers educated the local population, including those with epilepsy, about the causes and treatment of the disorder. They also provided epilepsy sufferers with simple drug treatment free of charge.

In the Malawi project, 68% of the patients initially enrolled were still attending for treatment after six months, and most of them suffered no epileptic seizures during that time. Before treatment, 88% of them were having one seizure per month.

In a similar exercise in Kenya, 82% of patients were still complying with treatment after 12 months. Of these, 53% were seizure-free for 6-12 months, 25% of them being without seizures for 12 months. A further 26% had reductions in the frequency of seizures.

Similar approaches should be adopted in other countries and these measures may also prove to be of value in the treatment of other non-communicable diseases.

Source: WHO/2 Bulletin, 4 April 2001

WHO adopts mental health strategy

The 37 countries and areas of the Western Pacific Region of the World Health Organization* have pledged support for a strategy on mental health - the first of its kind in the region.

The strategy was adopted unanimously by the Member States of the Western Pacific Region at the fifty-second session of the Regional Committee for the Western Pacific in Brunei Darussalam.

The strategy will help guide the Western Pacific countries and areas in drafting policy on the rights of the mentally ill to competent and humane care. It will also support countries to plan health services for people suffering from mental illness. In addition, the strategy will help countries identify and to consider the impact on community mental health of such issues as conflict and the number of internally displaced persons, mass migration from rural villages to overpopulated urban centres with inadequate basic health care facilities, and the increasing number of people over the age of 65.

"Today, most countries in the region spend about 1% of health care budgets on mental health," said Dr Shigeru Omi, WHO Regional Director for the Western Pacific. "The corresponding resources and support to meet the overwhelming need of those living with mental disorders, is currently not there. The more we can help in the treatment and prevention of mental disorders - the more economically and socially engaged a large segment of our population would become."

• Advocacy: Providing information and advice about mental health and mobilize regional resources for services and health promotion.
• Providing health services: Enhancing mental health service delivery in primary care and evaluation at local and national levels. This includes support for training of a professional work force.
• Mental health promotion: Raising the position of mental health in scale of values of individuals, families and societies; decisions by government should improve and not compromise the population's mental health. Improving mental health of the population by reducing disease through prevention, treatment and rehabilitation.
• Policy and Legislation: Drafting appropriate legislation to inspire government action on mental health issues, including the guarantee of adequate and humane services to people with mental disorders.
• Research: Developing the capacity for research of mental disorders, evaluating services and standards, and developing tools to support mental health promotion.

* The 37 countries and areas comprising the WHO Western Pacific Region are: American Samoa, Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong (China), Japan, Kiribati, Lao People's Democratic Republic, Macao (China), Malaysia, Marshall Islands, Federated States of Micronesia, Mongolia, Nauru, New Caledonia, New Zealand, Niue, Northern Mariana Islands, Palau, Papua New Guinea, Philippines, Pitcairn Islands, Republic of Korea, Samoa, Singapore, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Vietnam, Wallis and Futuna.

Source: WHO Regional Office for the Western Pacific Press Release, 13 September 2001.

Herbs / Traditional Medicines

Pharmacies for life

Health policies of most developing countries have often favoured adopting and developing the modern medical system while tolerating, belittling, neglecting or abandoning existing traditional systems. Meanwhile local communities are denied the use of biodiversity in the name of conservation. The results of such policies have been a net loss both to health and economies, and the inability of poor countries to meet their needs for health care satisfactorily.

The cost of the modern medical system is beyond most countries: its services only reach the few who can afford them. Most people cannot pay the high costs of medicines and treatments. Non-affordability leads to non-accessibility and thus non-availability. Any system which provides a service that is not affordable and therefore not accessible and not available can never claim to be effective and efficient.

Poor but rich
About four fifths of the world's population now live in developing countries, which though economically poor are often rich in biodiversity. Most of their governments spend around US$10 per person per year on health care. At least 1.3 billion people in developing countries try to make ends meet on less than a dollar a day. The World Health Organization estimates that about 80 per cent of the world's people rely on herbal medicines (and thus biodiversity) at least to some extent.

Reflecting reality
If health policies and strategies are not achieving their goal, then new and appropriate ways must be sought. Rather than adopting the modern medical system wholesale, it must be adapted to complement existing local systems. It is necessary to reflect the realities of countries rich in biodiversity but poor economically by first meeting their health care needs with their biodiversity before resorting to external resources such as pharmaceutical products.

Integrated health care
A pilot programme in the village of Ambodisakoana, northwest Madagascar, from late 1993 to the end of 1997 showed that this approach is both feasible and viable. The Clinique de Manongarivo was based on the integrated health care system approach to providing health care and conserving biological and cultural (biocultural) diversity.

Three treatment protocols were established and applied in the clinic: treating diseases using biodiversity (medicinal plants) only; using pharmaceutical products only; and using the two in combination. Twenty-eight of the 36 different diseases or medical cases encountered in the area were treated effectively by local medicinal plants alone (for examples see box), two by pharmaceutical products, and the other six by the combination.

Appropriate plants and plant parts were selected to treat diseases effectively. Laboratory investigations resulted in, for example, using the leaves of a Burasaia sp. for the treatment of fever, instead of its roots, which had been used by the traditional medical practitioner and the community. Similarly, the oil extracted from the fruit of a Mauloutchia sp. was used to treat toothache, instead of the bark. Thirty different species of medicinal plants were selected and cultivated in the clinic's garden, thus helping to take undue pressure off some of those growing wild in the area.

The use of local biodiversity - which is often free and at worst, five to ten times cheaper than the pharmaceutical products - enabled patients at the clinic to save money. To give a few examples they saved around $5 by using ginger to take care of their motion (travel) sickness: $7 by using a Croton sp. to treat diarrhoea; up to $20 by using an Erythroxylum sp. for asthma; and around $35 by using a Mauloutchia sp. for herpes. (Pharmaceutical products are usually three to four times more expensive in rural areas than in urban centres and are often more difficult to find).

The savings made it possible for them to afford the pharmaceutical products needed for the diseases that had no effective local biodiversity remedy. The money saved was also used to help meet other family needs, such as paying for the cost of a child's education or improving the diet.

Mutual benefits
The target of 'Health for All by the Year 2000' never became a reality. But adapting the modern medical system to complement existing local ones - which reinforcing the relationship between humans and nature - through using biodiversity, could provide a way forward.

Source: Our Planet, Vol. 12, No. 2, 2001, pg 27-28

Alert on drugs disguised as herbals

Increasing numbers of Chinese health products are being found to contain prescription drugs.

The Hong Kong Department of Health (DH) recently issued a public warning regarding two new Chinese health products that have been found adulterated with sildenafil.

The two oral tonics, WX Men's Oral Liquid and Dura Tonic are imported from mainland China and both contain the erectile dysfunction agent.

Sildenafil is currently available in Hong Kong and most other Southeast Asian nations on a prescription only basis. It can cause headache, flushing, dyspepsia, visual disturbances, and in some cases severe cardiovascular adverse effect.

Products containing western medicine are considered pharmaceuticals in Hong Kong and therefore must be registered with the Pharmacy and Poisons Board. The two herbal products have not been registered and people are warned to stop using them.

Source: Medical Tribune, 15-30 September 2001.

Trade and Medicines

Princess Royal berates drug firms over prices

Drug companies were attacked by the Princess Royal for their "simplistic philanthropy" which was failing to tackle disease in developing countries. In a hard-hitting speech to the British Pharmaceutical Conference in Glasgow, Princess Anne said firms should focus on effective long-term measures such as cutting drug prices rather than short-term publicity stunts.

The princess, who is an honorary fellow of the Royal Pharmaceutical Society, which organised the conference, also warned that basic disease prevention measures, such as immunisation programmes, were in decline in many countries. She said donations of medicines often failed to cover their distribution costs, which sapped other scarce health spending.

The princess said cheap medicines were urgently required to treat conditions such as HIV and AIDS, and urged the drug industry to re-examine its pricing policies.

"Drug donations may raise a company's public profile and share price, but the transport, distribution, training and administration costs are usually not covered by the donor." The princess
said this could place a heavy extra burden on health systems and take money away from other important health programmes.

Source: http://www.thescotsman.co.uk

Olle Hansson Award

To recognise the work of an individual from a developing country who best demonstrates the qualities of Olle Hansson in promoting the rational use of drugs.

'It is time to act! It is time to act for all of us who believe in human dignity and justice'. - Olle Hansson

Olle Hansson
The Award is named in honour of Olle Hansson, a Swedish paediatric neurologist internationally known for his advocacy of SMON victims who were paralysed or blinded after using clioquinol, an antidiarrhoeal drug. Olle Hansson was a powerful campaigner against unethical promotion and marketing of drugs. In many ways, he represented the conscience of the medical profession. His influence was felt not only in Sweden and Japan, which have thousands of SMON victims, but also in Europe and developing countries. Olle Hansson will be remembered by all who campaign for the rational use of drugs.

Although he died of cancer on May 23, 1985, at the age of 49, he remains a continuing source of inspiration for public interest workers everywhere. May 23 is commemorated each year as 'Olle Hansson Day'.

The Award was first given in 1987. The recipients included Dr Mira Shiva of India and Dr Alfredo Bengzon of the Philippines.

• Promoting the concepts of essential drugs and their rational use, and
• Increasing the awareness among consumers of the dangers of irrational and hazardous drugs.

Nominations for the award, which can come from any individual or organisation, should contain:

1. A one-page biodata of the candidate (including educational background, positions held, affiliations, honours and awards).
2. A 500-word statement of the nominee's qualities and achievements in the field of rational drug use. Please provide documentation of work done.
3. A recent photograph of the nominee.
4. The nominator's name, affiliation and address.

Closing Date
Nominations will close on April 15, 2002.

Announcement
The recipient will be chosen by an international panel of judges, and named on Olle Hansson Day, May 23.

The Prize
The award, which is given annually, carries a price of US$2,000 and a commemorative certificate.

Management
The Olle Hansson Award Fund is managed by Consumers International Regional Office for Asia and the Pacific. CI is a federation of consumer organisations dedicated to the protection and promotion of consumer interests worldwide through research, information and education activities. CI links the activities of some 238 consumer organisations in 109 countries and represents the consumer interest at international forums.

Please send nominations to:

The Regional Director, CI ROAP
Lot 5-1 Wisma WIM
7 Jalan Abang Haji Openg
Taman Tun Dr Ismail,
60000 Kuala Lumpur, Malaysia.
Tel: (603) 7726 1599
Fax: (603) 7726 8599
Email: consint@ciroap.org

Corporate Conduct, International Codes and Citizen Action
by Judith Richter
Published by Zed Books

In 1981, the International Code of Marketing of Breastmilk Substitutes was adopted by the World Health Assembly and endorsed by the Executive Board of the United Nations Children's Fund (UNICEF). Yet, twenty years later it is estimated that each year one-and-a-half million infants still needlessly die because they are artificially fed rather than breastfed.

Efforts for more than two decades to curtail the aggressive marketing practices of infant food manufacturers represent one of the longest-standing attempts at international regulation of a particular industry practice. This book examines in detail the process by which the International Code was formulated, adopted and implemented.

Its findings are relevant to any study on the regulation of transnational corporations. The marketing code is one of the few international codes adopted under the aegis of the United Nations when the need for effective external regulation of TNCs was fully recognised. Today, co-regulation and industry self-regulation are being presented as the most promising ways of ensuring corporate social responsibility. This book argues that effective binding regulation of transnational corporations remains a critical - and unfinished - task of global democratic governance.

It shows how the International Code has come about and been kept alive in the face of fierce resistance on the part of the infant food industry. It reveals a gulf between corporate statements and actual corporate practice. It calls attention to international issues management - a strategic public relations discipline which used to be known by the name of 'engineering of consent' - and unveils how the corporate PR and lobby machinery continues to undermine efforts to establish effective checks and balances on corporate activities.

The infant food case calls into question the image of global governance as a harmonious rule-setting process among governments, international organisations, citizen action groups and business. If a particular regulatory framework impacts on profit-making, it is argued, conflicts are to be expected. They will have to be carried through if the public interests are to prevail. This case study shows how to effect a shift in the power balance.

Health Action International (HAI) is an informal network of individuals and NGOs working towards ensuring the availability of and rational use of medicines. Website: http://www.haiweb.org

HAI Coordinating Offices:

ARDA
Consumers International Regional Office for Asia and the Pacific
Lot 5-1, Wisma WIM
7 Jalan Abang Haji Openg
Taman Tun Dr Ismail
60000 Kuala Lumpur
Malaysia
Tel: +60 4 229 1396
Fax:+60 4 228 6506
Email: ardaroap@tm.net.my

HAI Europe
Jacob van Lennepkade 334-T
1053 NJ Amsterdam
The Netherlands
Tel: +31 (0)20 683 3684
Fax: +31 (0)20 685 5002
Email: info@haiweb.org

AIS Latin America
Aptdo 41-128,
Lima,
Peru
Tel / Fax: +51 1 346 1502
Email: ais@amauta.rcp.net.pe

HAI Africa
P.O. Box 78360
Nairobi
Kenya
Tel: +254 2 441090
Email: haiafrica@net2000ke.com

Articles in HAI News may be reproduced for non-profit use.
Please clearly credit HAI News as the source and send us a copy of the article.
ISSN 0128 1321