Twenty-five years of essential medicines.
Twenty-five years of essential medicines.
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DOI：
10.1590/s0042-96862002001100014
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发表时间：
2002
影响因子：
11.1
通讯作者：
J. Quick;H. Hogerzeil;G. Velásquez;L. Rágo
中科院分区：
文献类型：
--
作者：
J. Quick;H. Hogerzeil;G. Velásquez;L. Rágo
20世纪开始时，只有一种现代药物被广泛使用：乙酰水杨酸（阿司匹林）。在20世纪40年代，第一种抗生素、第一种大规模生产的抗疟疾药和第一种抗结核药问世。20世纪50年代和60年代，口服避孕药、糖尿病药物以及精神疾病、许多传染病、心血管疾病和癌症药物迅速问世。到20世纪70年代，几乎所有重大疾病都有有效的药物，尽管并不总是理想的。然而，对于世界上一半的人口来说，他们仿佛还生活在世纪。对他们来说，现代药物无法获得、负担不起、质量差或因使用不当而无效。1975年，世界卫生大会提出了“基本药物”和“国家药物政策”的概念，它们很快成为全球公共卫生词汇的一部分。卫生大会借鉴了斯堪的纳维亚、北美和一些开拓性发展中国家，如巴布亚新几内亚、秘鲁、斯里兰卡和坦桑尼亚联合共和国的先例，希望这些先例将提供一种途径，开始缩小受益于1900年代中期医药收获的人与未受益者之间的巨大差距。1977年10月，世卫组织制定了第一份基本药物示范清单，1978年《阿拉木图宣言》将“提供基本药物”确定为初级卫生保健的八个要素之一。根据目前的世卫组织基本药物选择和使用专家委员会，“基本药物是满足人口优先保健需要的药物。它们的选择充分考虑了疾病流行率、疗效和安全性证据以及比较成本效益。基本药物的目的是在正常运作的卫生系统范围内随时以适当的剂量和有保证的质量以及个人和社区能够负担的价格提供足够的数量。实施基本药物概念的目的是灵活和适应许多不同的情况;究竟哪些药物被视为基本药物仍然是国家的责任。“部分由于这些原则的承认和适用，自1977年以来，情况发生了巨大变化。下面的例子给出了一些对比的概念。1977年，也许只有十几个国家拥有现在被认为是基本药物清单或基本药物方案。今天，五分之四的国家----总共至少156个国家----已经通过了国家基本药物清单。国家清单广泛用于公共采购系统、偿还计划、培训、公共教育和其他国家卫生活动。大多数国家最近更新了其清单，世卫组织在25年来平均每两年更新一次自己的基本药物示范清单。1977年，几乎所有人都不知道国家毒品政策的概念。今天，100多个国家已经制定或正在制定国家药物政策。这些政策正在每个区域以越来越快的速度实行。更重要的是，越来越多的国家正在直接从政策走向行动。国家药物政策日益成为一个框架，有关各方可在这个框架内努力进行国内制药部门的改革。1977年，关于合理使用药物的客观资料极为有限，特别是在发展中国家。如今，至少有135个国家拥有自己的治疗手册和处方集，为卫生专业人员提供有关合理使用药物的最新、准确和公正的建议。此外，今年还推出了《世卫组织示范处方集》。1977年，医学培训往往以品牌为基础，很少注意合理用药的系统教学。…
The twentieth century opened with only one widely available modern medicine: acetylsalicylic acid (aspirin). In the 1940s the first antibiotic, the first mass produced antimalarial, and the first antitubercular were introduced. The 1950s and 1960s saw the rapid introduction of oral contraceptives, medicines for diabetes, and then medicines for mental illness, many infectious diseases, cardiovascular diseases, and cancer. By the 1970s effective medicines--though not always ideal--existed for nearly every major illness. Yet for half the world's population, it was as if they were still living in the nineteenth century. For them, modern medicines were unavailable, unaffordable, of poor quality, or ineffective because not properly used. In 1975 the World Health Assembly introduced the concepts of "essential drugs" and "national drug policy", and they quickly became part of the global public health vocabulary. The Health Assembly was building on precedents set in Scandinavia, North America and some pioneering developing countries, such as Papua New Guinea, Peru, Sri Lanka, and the United Republic of Tanzania, in the hope that they would provide a way to begin closing the huge gap between those who were benefiing from the pharmaceutical harvest of the mid-1900s and those who were not. In October 1977, WHO produced the first Model List of Essential Drugs and in 1978 the Declaration of Alma-Ata identified "provision of essential drugs" as one of the eight elements of primary health care. According to the current WHO Expert Committee on the Selection and Use of Essential Medicines, "Essential medicines are those that satisfy the priority health needs of the population. They are selected with due regard to disease prevalence, evidence of efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms with assured quality, and at a price the individual and the community can afford. The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility." Thanks partly to the recognition and application of these principles, the situation has changed enormously since 1977. The following examples give some idea of the contrast. In 1977, perhaps a dozen countries had what would now be considered an essential medicines list or an essential drugs programme. Today, four out of five countries--at least 156 countries in total--have adopted national essential medicines lists. National lists are widely used for public procurement systems, reimbursement schemes, training, public education, and other national health activities. Most countries have recently updated their lists, and WHO has updated its own model list of essential medicines on average every two years for the 25 years. In 1977, the concept of a national drug policy was unknown to almost everyone. Today, over 100 countries have national drug policies in place or under development. These policies are being introduced at increasing speed in every region. More importantly, a growing number of countries are moving directly from policy to action. The national drug policy is increasingly serving as a framework within which interested parties can work for pharmaceutical sector reform within countries. In 1977, objective information on rational use of drugs was extremely limited, especially in developing countries. Today, at least 135 countries have their own therapeutic manuals and formularies, which provide health professionals with current, accurate and unbiased advice on the rational use of drugs. In addition, this year the WHO Model Formulary was launched. In 1977, medical training was often based on brand names, and little attention was given to systematic teaching about rational drug use. …