MORE appropriate use of generic medications, particularly to treat ulcers and arthritis, could reduce the price of a Medicare prescription drug benefit by more than 16%, says a study released in the USA in January 20021. Medicare is the country's largest health insurance programme, covering over 39 million Americans.

Researchers from the Schneider Institute for Health Policy at Brandeis University used data provided by the USA's largest pharmacy benefit management firm, to calculate what percentage of drugs used by the Medicare-eligible population is generic. Pharmacy benefit managers contract with insurers to structure and deliver prescription drugs in a cost-controlled way. They found that boosting the rate of generic use by roughly 50% would reduce drug spending per person from $1,647 to $1,377, and save a total of $250 billion between 2003 and 2012.

The study concluded that nearly half the savings could come from increased use of generics to treat ulcers and arthritis - two conditions for which brand-name drugs are now most heavily advertised. According to the researchers, health plans that use larger proportions of generics include not only "tiered co-payments" that give consumers a financial incentive to use cheaper medicines, but also comprehensive physician education programmes. "Counter-detailing" is used as part of the programmes to demonstrate to practitioners that newer, more expensive drugs are not always better or more appropriate.

Reference

1. Wallack S, Ritter G, Thomas C. Greater use of generics: a prescription for drug cost savings. Waltham, Mass: Brandeis University; 2002. On the web at: http://www.gphaonline.org/pdf/brandeis-text.pdf

Pharmacoepidemiology - Principles and Practice, B. Waning, M. Montagne, 2000, 209 p.

This basic text on pharmacoepidemiology is mainly intended for pharmacy students. It provides a clear and concise introduction to the epidemiology of drug use, valuable concepts of public health, primarily measures of risk, "real-life" applications of risk assessment, screening, and diagnostic testing, practical methods in epidemiology, post-marketing drug surveillance studies, and pharmacoeconomics.

Available from: McGraw-Hill, 1221 Avenue of the Americas, New York, NY 10020, USA. Tel: + 212-512-4100, fax: + 212-512-4105, web site: http://www.bookstore.mcgraw-hill.com Price: £34.95.

Seeing Through the Spin. Public Relations in the Global Economy, D. Richards, Baby Milk Action, 2001, 189 p.

This innovative education pack examines how public relations influence our perceptions of transnational corporations and NGOs, and how these organizations affect public health, development and the environment.

As companies increasingly sponsor school materials, Seeing through the Spin questions whether commercial sponsorship of education is justified, and whether its benefits are outweighed by its risks to health and society. At a time when the promotion budget of the world's largest food company is four times the size of WHO's total budget and eight times more than that of the United Nations Children's Fund, the issues it raises are particularly pertinent, the author believes.

Intended for secondary and further education teachers and facilitators, the pack contains 14 participatory-style lesson plans, case studies and background material, to help students deconstruct public messages - from companies and their critics.

Available from: Baby Milk Action, 23 St Andrew's Street, Cambridge CB2 3AX, UK. Price: £15, plus postage and packing. Parts of the pack can be downloaded from the web at: http://www.babymilkaction.org/spin/

Determinants of Antimicrobial Use in the Developing World, A. Radyowijati, H. Haak, Child Health Research Project Special Report, 2002, 36 p.

Antibiotics play a key role in treating diseases of bacterial origin in developing countries. High levels of consumption, often clinically unnecessary, have led to a steady increase in drug resistance, particularly to antibiotics used in treating high prevalence diseases. This review provides information from well-designed scientific studies on the factors that influence the use of antibiotics by health providers, dispensers and community members in low-income countries. It concludes that practices tend to be determined by a complex and multi-layered mix of medical, psychosocial, cultural, economic and political factors. Understanding these factors can lead to the development of more effective policies and programmes to address inappropriate antibiotic use.

The authors call for concerted action by governments, public and private institutions and medical leaders to stem the rapid growth of antimicrobial resistance. To achieve lasting change they argue that interventions will need to be multifaceted, long-term and based on solid understanding of the behaviours involved. Highlighting the lack of research on determinants of antibiotic use, the report argues that the most productive approach would be a combination of quantitative and qualitative studies. Quantitative research on the patterns of antibiotic use would complement the great variety of qualitative methods, including case simulations, focus group discussions, in-depth interviews and illness diaries to explore determinants.

Available, free of charge, from: Centre for International Health, Boston University School of Public Health, Attn. Ms. Liz Edmonds, 715 Albany Street, T-4W Boston, MA 02118, USA. Available on the web at: http://www.childhealthresearch.org/doc/AMR_vol4.pdf

Research on Rational Drug Use in India: A Glimpse, Delhi Society for Promotion of Rational Use of Drugs, India-WHO Essential Drugs Programme, 2000, 25 p.

Although knowledge and experience of effective drug management is spreading rapidly in India, there is still a great need to publicise the benefits good management brings. This booklet is part of the campaign to do that. It presents short reports of research interventions in seven states, which covered rational prescribing, improving essential drug availability, dispensing practices and patient adherence, and reducing treatment costs.

Available from: Delhi Society for Promotion of Rational Use of Drugs, National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi - 110 067. Fax: 9111 616 2125, e-mail: dsprud@satyam.net.in

Prevention of Mother-to-Child Transmission of HIV: Selection and Use of Nevirapine, Technical Notes, World Health Organization, WHO/HIV_SIDS/2001.3, 2001, 17 p.

In October 2000, WHO convened a consultation on prevention of mother-to-child transmission of HIV, and this document contains the technical notes from the meeting. It provides basic information on the design of a comprehensive mother-to-child transmission-prevention programme, and the choice of antiretroviral regimens. The efficacy and safety of nevirapine for preventing transmission, and for preventing and treating HIV/AIDS, and management of nevirapine donations are also covered. The document is intended for policy-makers, programme managers and practitioners.

Available, free of charge, in English and French, from: World Health Organization, Family and Community Health Cluster, Department of HIV/AIDS, 1211 Geneva 27, Switzerland. Available on the web at: http://www.who.int/HIV_AIDS/ or http://www.who.int/Reproductive_health

A Human Rights Approach to Tuberculosis, Guidelines for Social Mobilization, World Health Organization, WHO/CDS/STB/2001.9, 2001, 23 p.

Many factors contribute to vulnerability to tuberculosis (TB). Being poor, of a minority group, a migrant or refugee, a child or prisoner, or having a weak immune system due to HIV or substance abuse are all factors that can make someone more likely to get TB.

This document looks at the human rights dimensions of issues affecting such groups and their access to TB cure. Limits on access to treatment are created by stigma, inadequate information and inadequate resource allocations for those most in need, the authors state. They call for a cross-sectoral approach with increased synergy among the various health and development sectors, and an end to fragmented interventions. The document examines key human rights principles, such as the right to information and education, in order to generate new thinking and action in the global response to stop TB.

Available, free of charge, from: World Health Organization, CDS/STB, 1211 Geneva 27, Switzerland.

Public Health: an Action Guide to Improving Health in Developing Countries, J. Walley, J. Wright, J. Hubley, 2001, 290 p.

The publication explains public health approaches to developing effective health services and preventive care programmes. It gives practical methods for assessing health needs and working with communities to improve health services. Chapters cover key public health skills, such as managing medicines, communicable disease control, health financing and implementing health services and programmes. With its numerous examples, illustrations and case histories, the publication will be a useful resource for doctors, nurses and other health professionals.

Available from Oxford University Press Book Shop, 116 High Street, Oxford OX1 4BZ, UK. Tel: + 44 1865 242913, fax: + 44 1865 241701, e-mail: bookshop@oup.co.uk (http://www.oup.com) Price: £24.95.

Legal Status of Traditional Medicine and Complementary Alternative Medicine, World Health Organization, WHO/EDM/TRM/2001.2, 2001, 189 p.

Various types of traditional medicine (TM) and medical practices referred to as complimentary or alternative medicine (CAM), are increasingly used in both developing and developed countries. National policies and regulations on TM/CAM could ensure the safety, quality and efficacy of these therapies and products, and help to promote integrated health care systems. However, relatively few countries have developed policies and regulations on TM/CAM so far. The present document provides a summary of the legal status of several major practices in TM/CAM from 123 countries. Data are included on the current use of TM/CAM, the regulatory situation of TM/CAM remedies and practitioners, health insurance coverage and practitioners' education and training.

Available from: World Health Organization, Marketing Information and Dissemination, 1211 Geneva 27 Switzerland. Price Sw.fr.37, US$31.50, and in developing countries Sw.fr.24.50.

Understanding, Influencing and Evaluating Drug Use: An Outline of the Complex Issues Relating to the Quality Use of Medicines and Drug Usage Evaluation, J.G.A. Dartnell, 2001.

This review of drug use evaluation includes a detailed account of the environment in which drugs are used at local and national levels, how drug use can be changed and the methodology of drug use evaluation. The appendices bring together information about international and Australian groups involved in quality medicines use, and examples of drug use evaluation studies. The book is intended for students, practitioners and researchers.

Therapeutic Guidelines: Palliative Care, Therapeutic Guidelines Ltd, 2001.

Palliative care as a discipline emphasises many of the old traditional values of medicine, especially compassionate support and symptom relief. Specialists now have a vast array of developments and therapeutic options to draw upon. Therapeutic Guidelines: Palliative Care gives an outline of all issues relating to this important and sensitive area. Many skills are called for if the best care is to be provided, so the importance of collaboration and communication between all is stressed. This book seeks to demystify palliative care, giving carers the confidence to manage the dying patient, and providing practical advice as to what to do and when to call upon more experienced help.

Among the topics covered are ethical issues, loss, grief and bereavement, domiciliary care, getting to know analgesics and adjuvants, and complementary and alternative therapies.

Price information for both books is available from: Therapeutic Guidelines Ltd, Level 2, 55 Flemington Rd, North Melbourne Victoria 3051, Australia. Tel: +61 3 9329 1566, fax: + 61 3 9326 5632, e-mail: sales@tg.com.au web site: http://www.tg.com.au/home/qumf.html Concessionary rates are available for students and for purchasing multiple copies.

Network for Monitoring the Impact of Globalization and TRIPS on Access to Medicines, World Health Organization, Health Economics and Drugs, EDM Series No.11, WHO/EDM/PAR/2002.1, 2002, 67 p.

At a meeting in Bangkok in February 2001, WHO initiated a process to monitor and analyse the impact of trade agreements on access to drugs. This is a report of the meeting, which developed the framework for the new monitoring network. The document includes highlights of the opening speech by the Director-General Designate of the World Trade Organization, Dr Supachai Panitchpakdi, in which he called for globalization to be a more balanced process, and referring to essential drugs, said that there "must be a compromise somewhere between funding arrangements and patent protection."

The document also covers the key requirements in the WTO TRIPS Agreement in relation to pharmaceuticals, and concludes with selected model indicators to monitor the impact of globalization and TRIPS on access to medicines.

Available, free of charge, from: Department of Essential Drugs and Medicines Policy, World Health Organization, 1211 Geneva 27, Switzerland.

New Products into Old Systems. The Initial Impact of the Global Alliance for Vaccines and Immunizations from a Country Perspective, Save the Children, 2002, 68 p.

As the context of public health provision changes rapidly, new forms of funding are emerging through increasing support from the commercial private sector and private foundations. This publication looks at one such joint public-private initiative, the Global Alliance for Vaccines and Immunizations (GAVI), which was formed in 1999.

Based on research in Ghana, Lesotho, Mozambique and the United Republic of Tanzania, the publication examines GAVI's impact on national health priorities and public health systems. It focuses on country experiences of applying for support, the capacity of systems to incorporate and use new vaccines effectively, and sustainability. The authors conclude that most countries are pleased about the political interest immunization systems are gaining through GAVI. However, there are concerns about what countries viewed as the pressure to make rapid decisions on vaccine selection, the usefulness of reward and evaluation criteria, and delays in vaccine availability. The report also discusses serious health system weaknesses that are an obstacle to safe and effective vaccine delivery.

Available from: Save the Children, Publications and Sales, 17 Grove Lane, London SE5 8RD, UK. Price: £6.95.

Scaling-up Antiretroviral Therapy in Resource-Limited Settings. Guidelines for a Public Health Approach, World Health Organization, 2002, 163 p.

Currently, fewer than 5% of those needing antiretroviral treatment can access these medicines in resource limited settings. These guidelines serve as a framework for selecting the most potent and feasible antiretroviral regimens as part of an expanded national response. The framework aims to "standardise" and simplify antiretroviral therapy, while acknowledging the relative complexity of HIV treatment. The publication presents options for first- and second-line regimens, bearing in mind the needs of health systems that often have limitations in staffing and monitoring facilities, without compromising the quality and outcomes of treatment.

The topics addressed include antiretroviral treatment, which antiretroviral regimens to start, reasons for changing the treatment and what regimens to continue if treatment is changed.

Treatment monitoring methods are also discussed, with specific reference to side-effects. The publication's Executive Summary is primarily intended for treatment advisory boards, national AIDS programme managers, and other senior policy-makers involved in planning national and international HIV care strategies in resource-limited settings. (The Summary is available as a separate document in English, French, Spanish, Russian, Arabic and Chinese). The full document is targeted towards physicians and other health workers involved in clinical care of people living with HIV/AIDS.

Available, free of charge, from: World Health Organization, Department of HIV/AIDS, 1211 Geneva 27, Switzerland. Available on the Web in English at: http://www.who.int/HIV_AIDS/CARE/ScalingUp_Guidelines_Final021002.pdf

The English version of the Executive Summary is at http://www.who.int/HIV_AIDS/CARE/Scaling_UP_ENG_021002.pdf

The French version: http://www.who.int/HIV_AIDS/CARE/Scaling_UP_FRE_021002.pdf

The Spanish version: http://www.who.int/HIV_AIDS/CARE/Scaling_UP_SPA_021002.pdf

For further information contact: Dr Basil Vareldzis in the Department of HIV/AIDS. Tel: + 4122 7914670, e-mail: vareldzisb@who.int

Changing National Malaria Treatment Protocols in Africa: What is the Cost and Who will Pay? J-M Kindermans, Médecins Sans Frontières, 2002, 15 p.

In recent years, increasing parasite resistance has rendered antimalarial drugs such as chloroquine virtually useless in parts of East Africa. As a result countries in the region are about to change national malaria treatment protocols and MSF has issued a report calling for them to think carefully about their long-term strategies.

According to the report, malaria experts agree that to offer patients effective treatment and prevent further spread of resistance, protocols should include drug combinations with the Chinese drugs known as artemisinin derivatives. However, because of a lack of resources and what the report terms donor preference for cheap solutions, many health ministries are considering changing protocols to transition strategies, using combinations of drugs that in MSF's view are often no better than placebos.

In MSF's report, increased costs of more effective drugs are pinpointed as one of the chief barriers to widespread implementation in the public sector. Current drug combinations cost just US$0.25 per adult dose, while more effective combinations with artemisinin derivatives cost approximately US$1.30. However, the report shows that for Burundi, Kenya, Rwanda, Uganda and the United Republic of Tanzania combined, the additional costs to implement the more effective combinations would only amount to US$19 million a year. The report concludes that the cost of switching to effective combinations is affordable if international donors are willing to help.

For more details contact: MSF: Rue du Lac 12, PO Box 6090, 1211 Geneva 6, Switzerland. Tel: + 41 22 849 84 07, fax: + 41 22 849 84 04.

The report is available on the web at: www.accessmed-msf.org