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Containing Global Antibiotic Resistance: Ethical Drug Promotion in the Developing World

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Antimicrobial Resistance in Developing Countries

Abstract

The introduction of antimicrobial agents was a breakthrough health intervention that helped save millions of lives around the world and that provided a sense of control on the part of clinicians over host–pathogen interactions. Yet despite the concrete advances in prevention and treatment of infectious diseases, there has been a parallel surge in resistance to antimicrobials that is seriously compromising the gains made over the past century. Acknowledging the underlying mechanisms such as inappropriate use of antibiotics in humans and the agricultural applications of antibiotics for growth promotion and prophylaxis is a first and essential step to contain global antimicrobial resistance. However, it is also critical to consider in parallel the broad social, economic and political drivers and ethical significance of antimicrobial promotion in developing countries. Moreover, these socio-ethical factors constitute tangible targets against which public policy interventions can be developed to remedy growing concerns over the spread of antimicrobial resistance. In this chapter, we focus on drug promotion practices in the developing world that have important repercussions on physician prescribing habits, antimicrobial use and development of resistance. Other social factors that are endemic in developing countries – such as inadequate resources in health and education systems – can amplify erratic or suboptimal drug use. The public health consequences of, and ethical responsibilities associated with, drug promotion are substantially larger when viewed through the prism of the realities faced by persons living in developing countries. In our world of increasing urbanization and globalization, the actions of pharmaceutical companies have a global impact. Thus, their social responsibilities extend beyond developing medications for the populations of the developing world, to include socio-ethical and public health consideration for populations worldwide. Focusing on the fact that ‘what happens in the developing world does not stay in the developing world’, we propose that ethical considerations should be included as an integral part of the framework in the evaluation of appropriateness of drug promotion practices.

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Acknowledgments

Supported in part by an ethics operating seed grant from the Canadian Institutes of Health Research and a career scientist award in ethics, science and society research from the Fonds de la recherche en santé du Québec to Vural Ozdemir. We thank Anne-Marie Dion for constructive critique and expert advice on pharmaceutical advertising and promotion. Catherine Olivier was supported by a fellowship from the Centre de Recherche en Éthique at the University of Montreal, and from the Canadian Institutes of Health Research. The ideas expressed represent the personal views of the authors only.

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Authors and Affiliations

  1. Programmes de bioéthique, Département de médicine sociale et préventive, Faculté de médicine, Université de Montréal, Montréal, Québec, Canada

    Catherine Olivier & Bryn Williams-Jones

  2. Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Montréal, Québec, Canada

    Béatrice Doizé

  3. Faculté de médecine vétérinaire – Université de Montréal, Montréal, Québec, Canada

    Béatrice Doizé

  4. Bioethics Programs, Department of Social and Preventive Medicine, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada

    Vural Ozdemir

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  1. Catherine Olivier
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  2. Bryn Williams-Jones
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  3. Béatrice Doizé
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  4. Vural Ozdemir
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Correspondence to Bryn Williams-Jones .

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Editors and Affiliations

  1. Advisor Alliance for the Prudent Use of, Tufts University, Kneeland St. 75, Boston, 02111, U.S.A.

    Aníbal de J. Sosa

  2. Dept. Zoology, Makerere University Kampala, Kampala, Uganda

    Denis K. Byarugaba

  3. Fundación Lusara, Playa Rosarito 353, Mexico, 08810, Mexico

    Carlos F. Amábile-Cuevas

  4. Depts. Laboratory Medicine, National Taiwan Univ. Hosp., Taipei, Taiwan R.O.C.

    Po-Ren Hsueh

  5. Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, 00100, Kenya

    Samuel Kariuki

  6. Dept. Biology, Haverford College, Lancaster Avenue 370, Haverford, 19041, U.S.A.

    Iruka N. Okeke

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Olivier, C., Williams-Jones, B., Doizé, B., Ozdemir, V. (2010). Containing Global Antibiotic Resistance: Ethical Drug Promotion in the Developing World. In: Sosa, A., Byarugaba, D., Amábile-Cuevas, C., Hsueh, PR., Kariuki, S., Okeke, I. (eds) Antimicrobial Resistance in Developing Countries. Springer, New York, NY. https://doi.org/10.1007/978-0-387-89370-9_29

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