access to medicine. The wealthy can buy what they want, but the EML must cover drugs for conditions that specifically affect poor people, especially treatments for diarrheal diseases, respiratory infections, and tuberculosis, as well as vitamins and dietary supplements. Rich people go to private pharmacies when they are ill, but when we poor people get sick we have to choose between feeding our children their one meal a day and buying some drugs at the public hospital. Even when we are not sick, we cannot afford to feed our children a healthy diet. We live in shacks without running water—who can afford meat or fresh vegetables? How can the ministry of health justify spending money on fancy medicines that make money for international companies when these poor children don’t get enough vitamins and minerals to grow properly? And how can you refuse to supply the inexpensive tonics that so many of us rely on, just because doctors look down their noses at the treatments we here have known about and used for a thousand years?” • CEO of a local generic pharmaceutical company: “This EML is not just a medical issue—it’s also an economic one. Only drugs that are proven to be cost-effective and are available in affordable generic formulations should be on the EML. That would promote our national economic well-being. Putting patented, expensive drugs on the EML means that too much of our national budget for medicines would be sent out of the country to multinational pharmaceutical corporations. In contrast, we in the local generics industry employ many people and provide reliable, affordable products that save many lives. We understand that the ministry may want to list a few imported drugs for which there is no alternative. But that should only be done when those compounds would have a significant effect in reducing the burden of disease among the productive members of society.” • Professor of cardiology at the national university: “I am here to speak on behalf of my colleagues in the Department of Medicine at the university. We feel that the whole concept of the essential medicines list needs to be rethought, at least in the context of our institution. Yes, we are a government hospital. But at the same time, we on the faculty are the best trained and most experienced doctors in the nation. You know that yourself, Dr. Medina, from your days there as our student (and a very good student you were, I might add). If we are to keep the best-of-the-best practicing here in Sudamerica they have to be free to use their knowledge and judgment to provide the best care to their patients. The only antihypertensives now on the EML are outdated diuretics. Yes, they are off-patent and very inexpensive; and yes, they show up well in clinical trials. And some Defining an Essential Medicines List in Sudamerica
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