Indonesia's Love Affair With Antibiotics and Drug Treatments...

There is little doubt that Indonesian doctors on the whole over-prescribe antibiotics. It is unfair to generalise because quite simply there are always exceptions to the rule. However, even if a doctor does not prescribe a course of antibiotics, then most people will self-prescribe and go to any one of the myriad of road-side drug vending stalls.

The overuse of antibiotics, and other drugs, is not without risks as the nasty things that make us sick also have an ability to build up immunity to the drugs designed to kill them. This means that Indonesia is without a doubt on the road towards creating a whole swathe of drug-resistant bacteria and viruses. Simply, the trend seems to be towards over-prescribing and poly-pharmacy no matter what the illness is. Generally, doctors or patients prescribe antibiotic and drug cocktails in an attempt to get well.

Interestingly, some Indonesian doctors have recognised the trend and are intent on arresting the malaise that is poor diagnosis and subsequent poor treatment options being prescribed. But, it would appear that changing the culture is an uphill battle if the data collected by the Foundation for Concerned Parents is anything to go by.

For example, in 2008 the Foundation found that antibiotics were prescribed in more than 78% of cases of respiratory or stomach illness. This is an increase on the slightly more than 54% in 2006. Perhaps more interestingly is the trend of prescribing certain brands of drugs in preference to cheaper locally produced generic medicines. The suggestion, albeit implied, seems to be that doctors might be being encouraged to prescribe certain drug regimes at every opportunity they get to do so. One would hope that doctors were getting a little more for their efforts than just the odd free pen or mouse pad.

The issue is one that the government is aware of and it is one that the government is keen to address. The World Health Organization (WHO) has also recognised that the over-prescribing of certain drug treatments in Indonesia is leaving the Republic susceptible to future outbreaks of super bugs and viruses that are resistant to all standard treatment options. Therefore, the WHO and the government have commenced a study to look at what can be done to turn back the tide.

Hmmm.

Avian Influenza or H5N1

Fortunately, this nasty little virus has not become the pandemic that everyone supposedly in the know thought that it might! However, this is not the end of the story but merely the beginning as the potential remains and questions remain as to whether Indonesia and others have been accurately reporting avian influenza deaths. Instead of calling this thing its scientific name or the somewhat pompous avian influenza, I am just going to call it bird flu!

History has seen an earlier form of bird flu that was either called chicken flu or the Spanish Flu. The Spanish Flu was thought to have originated in the battlefields of the First World War and migrated from chickens to a mutant strain into humans. The number crunchers are whacking out the scary statistics that if this thing was to take off then it could conceivably kill up to 3 billion people. Now, there is one way to ensure population control and turn back the effects of global warming!

This brings us to Indonesia's claim of some kind of intellectual property rights over the bird flu virus and that if anyone wants samples of the virus then they must pay by the Indonesian Health Minister. This seems to say to her fellow citizens that we do not care whether you live or die but we are going to ensure that we make a few dollars at your expense.

She then trots out the argument of the big bad west and the fact that they are trying to rape and pillage Indonesia's intellectual property and profit from it! If Indonesia has the ability to develop medicines and drugs to treat bird flu then it should do it and profit from it if it can. However, the reality would seem to suggest that Indonesia does not think that it can do this and is therefore now seeking to sell samples.

It is at this point the story takes a truly bizarre and perhaps disturbing turn. The Health Minister publishes a book and by a number of accounts Health Department funds were thrown at the task. The truly bizarre and disturbing part is not so much the claim that WHO and large pharmaceutical companies are conspiring to defraud developing countries of their rights but the idea that the west is desperately seeking samples of Indonesian bird flu in order to develop a biological weapon that might be used against Indonesia in the future...

Stupid, stupid, stupid conspiracy theory with absolutely no grounds based in even the slightest realities of current geo-political relationships! These kind of xenophobic conspiracy theories do nothing but stoke the fires of hatred. These are fires of hatred that Indonesians, not just foreigners, should fear and loathe. These things also only serve to perpetuate the hatred and stereotypes that some people hold of others.

The fact that the Indonesian government has remained relatively silent on this book is of some concern as the question that arises is, "is this silence in fact an endorsement of the views of the Health Minister?" To be fair the book was withdrawn temporarily and many believed much of the xenophobic vitriol and the idea that bird flu is the work of God would be removed (redacted) from this tome. The idea that Allah gave Indonesia the deadliest strain of bird flu to date in order that Indonesia could make money off of it is as ludicrous as it is offensive to those that have already died from infection with the virus. However, it allegedly reappeared pretty much in tact and with some words of encouragement from the President.

I must be honest and admit that I have not bought the book and do not intend to (if someone wants to give me copy then they can). I have been following this primarily in the news and my comments here are interpretations of what I have read. I, therefore, encourage you to read them in that context.

As as side note perhaps it is worth noting that conspiracy theories abound in the supposed dark world of pharmaceutical development where men and women in suits sit in high-rise office buildings developing sinister plans to keep the world sick in order to maximize profits.

Similar conspiracy theory type arguments have been trotted out with regard to HIV/AIDS. The idea that pharmaceuticals stand to make more money out of treatment than they ever would out of cure. Simply, the conspiracy theory goes that allowing people to remain sick is more profitable in the long term than being able to cure them. It is my belief that the Indonesian Health Minister has done nothing than adopt this view and change the virus to H5N1.

Viral Marketing

It is being reported that Indonesia and the US are getting close to a deal on sharing samples of the bird flu virus. This is a good thing presumably because it will allow for vaccines and treatments to be developed and the medicines and vaccines developed will be provided cheaply to developing nations.

This development is also interesting because it was only recently that the Indonesian Health Minister, Siti Fadilah Supari, claimed that the US was conspiring with the World Health Organization to force developing nations into buying expensive medicines, drugs, and vaccines. Her book, Saatnya Dunia Berubah, Tangan Tuhan di Balik Flu Burung (Time for World Change, The Hand of God Behind Bird Flu), ruffled a few feathers (pun intended)!

The book has been hotly debated in various blogs because not only were the US and WHO conspiring, but the US was also using the bird flu virus to create biological weapons. One for the conspiracy theorists out there!

But with only two Indonesian provinces being free from bird flu, then it is likely that Indonesia stands to gain from this arrangement providing both sides keep their promises and commitments to the other.