A Case Study of a Successful Health Campaign

The pharmaceutical industry in India continued to market the high-dose estrogen-progesterone (EP) drugs even though they were found to be unsafe and been banned in many countries. The drugs were grossly misused by pharmacists and prescribed by doctors for pregnancy testing and as abortifacients in India, even though their efficacy for such indications was not established. Moreover the drugs were found to cause birth defects and the World Health Organization had alerted its Member States on the dangers of these drugs. For more details of the drug use and its hazards, see Landmark Judgments on EP drugs in Chapter 4. In 1982, as a result of a nation-wide campaign, the drug was banned by the Drug Controller of India (DCI). However, the pharmaceutical companies obtained a stay on this order on technical grounds. One of the petitioners was Infar, the Indian subsidiary of the Dutch multinational company Organon, which was not allowed to manufacture and market the drug in the Netherlands. Following this, a campaign was launched by health, consumer and women's organisations and it was sustained till the ban was re-enforced in 1988. The campaign was led by the All India Drug Action Network (AIDAN) co-ordinated from Delhi. Non-governmental organisations involved in health, consumer and women's issues, journalists, academicians, lawyers and other concerned individuals including doctors and health practitioners were actively involved in the campaign. It started with the collection, compilation and dissemination of information including listing of brand names of EP drugs. The network also reviewed the medical literature on EP drugs and collected scientific data. This information was widely disseminated through the media. The media played a crucial role in influencing public opinion. Newspapers gave good coverage to latest developments on the EP case, numerous features written by AIDAN activists were carried and letters arguing the pros and cons of the drug kept the issue alive for six years. Network members used all possible forms to publicise the issue, giving television interviews, and took advantage of the various for a to increase public awareness, including street corner meetings, addressing meetings of women's committees, Rotary and Lions clubs and such like.

Prescription for healthy consumers   All patients have the right to: 1. Appropriate and accessible health care 2. Freedom from discrimination 3. Information and education 4. Choose a doctor or other health worker 5. Choose a health care establishment 6. Informed consent about treatment 7. Participate in their own health care 8. Respect, privacy, confidentially and dignity 9. Complain 10. Redress in the event of injury

As a result of such high-pressure campaign, the Supreme Court directed the DCI to hold public hearings to seek the views of consumers and health groups in four metropolitan cities of Delhi, Calcutta, Madras and Bombay. This struggle was also supported by international organisations like the Health Action International, International organization of Consumers Unions, WEMOS - a Dutch women's health group, and the Australia-based Medical Lobby for Appropriated Marketing (MaLAM). Finally in 1988, a year after the public hearings, the Indian government banned the manufacture and sale of high-dose combinations of EP drugs. Though the EP product is not important in economic terms to the drug industry, the industry went to such extreme lengths to oppose the ban. This is the first time in the history of the drug industry in India that the industry has been forced to face a public inquiry to defend its products. So, it wanted to scuttle the movement before it snowballed and became too powerful. Despite knowing fully well that the drug was not allowed to be marketed in several countries, it obtained a stay order on the ban in 1982. Moreover, it used deceit, falsehoods and even threats of violence to oppose the ban. What is disturbing is that the industry could persuade highly-qualified endocrinologists and gynecologists to use questionable and possibly unethical tactics. Their opposition is a sad commentary on the status of the Indian medical profession and an indication of the highly disturbing stranglehold of the drug industry on the medical profession. The industry perceives any argument or inquiry, however scientific and rational it may be, as a threat to profitability and will go to any extent to thwart it. Under such circumstances, the ban on the high-dose drug was a great achievement. Despite the powerful industry's stranglehold, the people's movement proved strong as they stood united for one single cause. From: Menon, Lakshmi. "Till We Have Won: Campaign to Ban High-dose Estrogen-Progesterone Drugs", in Organising Strategies in Women's Health: an Information and Action Handbook. Manila: Isis International, 1994. pp. 117-120.