[The pharmaceutical industry in scandal: Mercury or Aesculapius?]. / De geneesmiddelenindustrie in opspraak: Mercurius of Aesculapius?

During the last decade public sympathy for the pharmaceutical industry has gradually been eroded because of excessive protectionism and profit margins. Its reputation as a healthy, profitable and prosperous industry has recently been seriously damaged by several errors of judgement. Data from early trials proved to be less positive than expected. The responsible drug manufacturers decided to cover the results up. So far the pharmaceutical industry has managed to weather the criticism, but recently a multitude of damaging data was published by an unexpected outsider. Angell, a former editor in chief of one of the most respected, peer-reviewed medical journals in the world, the New England Journal of Medicine, decided to collect such data and to analyze them critically. She also used this analysis to draw up recommendations for improving of what she regarded as an unhealthy situation. The book gained bestseller status on the American market and received much praise from reviewers. Although quickly denounced by the industry as controversial and excessively negative, it contains a lot of data, opinions and conclusions that also apply directly to the European situation.

[Travel experiences in Central and Eastern Europe: Romania: the general's kisses]. / Reiservaringen in Centraal- en Oost-Europa; Roemenië: de zoenen van de generaal.

The public face of Rumania is characterized by extreme contrasts between very poor and very rich people. The state is near bankruptcy, industry is slow in recovering from many years of madcap rule: politics, tourism and agriculture are in chaos, doctors are seriously underpaid and good health care is only available to the newly rich. World Bank loans have been largely spent on sophisticated hospital instrumentation, but the primary health care barely manages to survive. The capital has seriously suffered from Ceausescu's megalomania and many historic cities show the remnants of past glory. The country sometimes resembles a disorganized beehive. Rumanians try to steer a middle course between bouts of self-pity and their intense wish to become full members of the European Union. They are not averse to play-acting and one should not be surprised to receive a cordial accolade from a medical professor who chairs government committee meetings in full general's attire.

[Travel experiences in Central- and Eastern Europe: Bosnia--the land behind the mirror]. / Reiservaringen in Centraal- en Oost-Europa: Bosnië--het land achter de spiegel.

Bosnia-Herzegovina is an artificial state created after four years of gruesome war; it is composed of two countries intertwined like the pieces of a jigsaw puzzle. An uneasy truce binds the two halves, the Republika Srpska and the Muslim-Croat Federation of Bosnia-Herzegovina together. Under the conditions of the Dayton accord these two have to collaborate and unify their administrative systems under the watching eye of the European Union (EU) and thousands of heavily armed soldiers and policemen. One of these EU-sponsored programmes is the unification of systems of acquisition, registration and distribution of medicines, delegated to the EU reconstruction programme PHARE. Whereas the Serbian half used to buy its drugs from Belgrade, the Muslim-Croatian half was almost fully dependent on international aid. Though some of the local experts have been very helpful, both systems are riddled by corruption and inefficiency and a successful outcome will be little short of a miracle.

[European registration of medicines: pros and cons for prescriber and patient]. / Het Europees registreren van geneesmiddelen; consequenties voor voorschrijver en patiënt.

Since the European Medicines Evaluation Agency (EMEA) in London started its activities, the registration of medicines in the European Union (EU) has gained momentum, and its relevance to national drug registration procedures is steadily increasing. Its main objectives are centralization and standardization of assessments and promoting free trade within the EU. From its early beginning the EMEA has promoted transparency and full disclosure of expert opinions. Since the EMEA is largely operating beyond the scope of the average prescriber and patient, an attempt was made at improving information, based on interviews of a number of responsible or interested persons and parties. Though the overall opinion seems favourable, the quality of the assessment reports has notably improved, and the implementation of decisions has gained speed, this has made little impact on medical practice. The approach towards collating reports of adverse drug reactions has been divisive, and feedback to reporting physicians has been largely neglected. The eventual introduction of the Eudrawatch database and further improvements in transparency will hopefully correct these initial problems. So far as legally possible national drug agencies should follow the example of EMEA by offering public disclosure of documents and expert opinions.

Drugs for the elderly

The purpose of this book is to describe the principles of drug treatment in old age and the best therapeutic practice for the elderly. In the treatment of elderly people, many variations are necessary from “standard” recognized therapy. This is due both to ageing itself and to common age-related diseases. Without a proper appreciation and knowledge of them, prescribers will place elderly patients at serious risk of harmful drug effects or will deny them the many advantages of correctly conducted treatment. The objective should always be safe and efficacious therapy. When the WHO Regional Office for Europe launched the first edition, it was an immediate success. Since then, remarkable progress has been made in clinical pharmacology and pharmacotherapy. In particular, ageing of the world’s population has stimulated interest in the use and misuse of drugs in the elderly. Many textbooks have been published since the first edition was published, and scores of articles and reviews are now available. However, most of this information is either out of reach of the poorer countries or is too expensive to obtain. The second edition was published as there seemed to be a niche for a small, internationally available and understandable book on the subject. Fundamental changes have been introduced throughout this edition in the views on drug therapy and the choice of available drugs.