Norway provides an interesting and significant example of a successful National Drug Policy. Characteristics such as a "need clause" (which implies that a drug is assessed not only from a scientific and technical viewpoint but also in relation to medical need, and thus the social perspective of health priorities), a restrictive attitude to fixed combination drugs and the limiting of approval and registration of a drug to a five-year period have kept the number of pharmaceuticals at a reasonable level-just over 2,000-and protected consumers from useless or unnecessary drugs. This development towards an equitable National Drug Policy has occurred without any major conflicts between the health authorities, the professional organisations and the drug industry. The reason for this may be that the Norwegian drug policy has developed in stages through most of this century and has been part of a health policy and an overall social policy- which may be characterised as typically Scandinavian-where the emphasis on equity has been one of the main pillars. This emphasis goes right through the system as it now works and has been particularly evident in the field of drug distribution, where the less profitable pharmacies in marginal areas are sustained by more profitable ones located in more populated areas, a modern "Robin Hood approach". The importance attached to the last link in the drug chain-patients and prescribers-is another example of this emphasis.
The story of Norway’s highly relevant experience in this field is told here by two Norwegians and a Swede who all have been closely involved in the development of drug policies, nationally and internationally. Marit Andrew is Assistant Director of the Department of Pharmaceutical Services at the Norwegian Board of Health in Oslo. Before taking up this position she spent ten years working with the government pharmaceutical wholesaler, the Norwegian Medical Depot, and another ten years at the Department of Pharmacotherapeutics at the University of Oslo. She has also been involved in the development of WHO’s Ethical Criteria for the Promotion of Medicinal Products. Bjørn Jøldal served as Director of the Department of Pharmaceutical Services on the Norwegian Board of Health from 1964 to 7997 in close cooperation with the Directors-General Karl Evang and Torbjørn Mork, who together were instrumental in forming the Norwegian drug policy. He was also very active in Nordic and European cooperation efforts in the field of medicinal drugs, and, above all,
within WHO where together with Mork and Professor Per Knut M Lunde, now at the Department of Pharmacotherapeutics, he played an important role in the development of the Essential Drugs Concept and the Drug Action Programme. Since 1991, he has been the proprietor of Sandvika Apotek (Pharmacy). Göran Tomson, an Associate Professor at the Unit of International Health Care Research (IHCAR) at Karolinska Institutet in Stockholm, is a paediatrician who has worked in the broad fields of public health and health policy, international health systems research and global pharmaceutical issues. His doctoral dissertation was entitled Drug Utilization Studies in Sri Lanka. Towards an Understanding of Medicines in Society (1990). Göran Tomson coordinated the work on the study presented here.