Table of Contents  
CORRESPONDENCE
Year : 2015  |  Volume : 6  |  Issue : 4  |  Page : 233  

Are we moving towards a new definition of essential medicines?


Department of Pharmacology, Weill Cornell Medical College, New York, USA

Date of Submission30-Sep-2015
Date of Acceptance16-Oct-2015
Date of Web Publication15-Dec-2015

Correspondence Address:
Marcus M Reidenberg
Marcus M Reidenberg, Department of Pharmacology, Weill Cornell Medical College, New York - 10065
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-500X.171874

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How to cite this article:
Reidenberg MM. Are we moving towards a new definition of essential medicines?. J Pharmacol Pharmacother 2015;6:233

How to cite this URL:
Reidenberg MM. Are we moving towards a new definition of essential medicines?. J Pharmacol Pharmacother [serial online] 2015 [cited 2019 Jul 15];6:233. Available from: http://www.jpharmacol.com/text.asp?2015/6/4/233/171874

Sir,

A number of issues concerning the definition of an essential medicine are raised in the editorial.[1] This is worthy of discussion.

The problems of health care in 1977 when the definition of an essential medicine was written were different than those of 2015. Then the focus was on helping developing countries improve the inadequate health care available for many people in these countries.[2] Infectious disease was upmost in people's minds. Thirty-nine anti-infective drugs were in the main list then, along with seven antineoplastic drugs. Around 1990, some middle-income countries desired advice about cancer medicines. A World Health Organization (WHO) consultation was held and divided cancer medicines into three categories: Drugs that significantly prolonged survival, those that improved quality of life, and those that did neither.[3] An expert committee decided that those in the first two categories were essential. It appears that this determination that drugs in these two categories are essential continues to the present.

Relevant to this determination are some policies stated in 1977. Most important is that the list was seen as a Model List to illustrate how to implement the concept of essential medicines. The report stated that each country must develop its own list of essential drugs based on that country's needs and resources. Today the Model List is used in many other ways. If diagnostic and laboratory resources are unavailable to utilize some of the modern antineoplastic drugs that prolong life or give meaningful palliation of cancer, these drugs need not be on a national list. Their absence illustrates a gap between what can be done locally and what exists in medicine.

Another important issue is whether drugs for uncommon diseases are essential. The 1977 report stated that the proposal was to help countries obtain the drugs for the most prevalent diseases because this was the priority then. The priorities now are more diverse and numerous. The issue of whether it is right to exclude an effective treatment of a disease because it is uncommon should be considered. The principle of distributive justice states that the people who bear the burden should share the benefits. If a drug for an uncommon condition has the same cost-effectiveness as the drugs on the national list, it is unjust for people with that condition sharing the burden of supporting the health service to be precluded from sharing the benefits of treatment just because of the prevalence of their disease.[4]

There are many other issues, price being one, raised in the editorial that are worthy of thoughtful discussion. Medicine has changed much since 1977. The Model List is being used for many purposes rather than just as a model of how to implement the essential drugs concept, its original intent. The expert committees and WHO must deal with all the issues raised in the editorial and the continuing advances in therapeutics. A thoughtful discussion of these issues and a new definition of an essential medicine may be needed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Manikandan S. Are we moving towards a new definition of essential medicines?. J Pharmacol Pharmacother 2015;6:123-5.  Back to cited text no. 1
  Medknow Journal  
2.
apps.who.int. Geneva: World Health Organization Technical Report Series 615-The Selection of Essential Drugs. Available from: http://apps.who.int/iris/bitstream/10665/41272/1/WHO_TRS_615.pdf. [Last accessed on 2015 Sep 10].  Back to cited text no. 2
    
3.
Essential drugs for cancer chemotherapy. WHO consultation. Bull World Health Organ 1994;72:693-8.  Back to cited text no. 3
    
4.
Reidenberg MM. Are drugs for rare diseases “essential”? World Health Organ 2006;84:686.  Back to cited text no. 4
    



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