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Colombia depende de la importación de medicamentos, así como de gran parte de los materiales (principios activos y excipientes) requeridos para su elaboración; problemática que genera consecuencias sanitarias y macroeconómicas, las cuales se agudizan en el contexto de desindustrialización nacional y de disrupción tecnológica. De esta manera, se acepta que la disponibilidad y acceso a medicamentos y otras tecnologías sanitarias esenciales son un requisito fundamental para alcanzar la autonomía sanitaria de un país. Por lo tanto, resulta imprescindible coordinar esfuerzos entre diversos sectores sociales para desarrollar una agenda pública enfocada a la creación de condiciones que fortalezcan las capacidades científicas y tecnológicas de la industria farmacéutica local, y con ello, mejorar el suministro farmacéutico del país. En el presente documento se presentan conceptos teóricos y prácticos que deberían ser considerados en la definición y materialización de una política pública encaminada a fortalecer la industria farmacéutica y favorecer la autonomía sanitaria de Colombia.

Colombia has a notorious dependency on the importation of medicines, as well as a large part of the materials (active ingredients and excipients) required for their manufacture. This problem generates health and macroeconomic consequences, which are exacerbated in the context of national deindustrialization and technological disruption. In this way, it is accepted that the availability and access to medicines and other essential health technologies are a fundamental requirement to achieve the health autonomy of a country. Therefore, it is crucial to coordinate efforts between several social sectors to develop a public agenda focused on creating conditions that allow strengthening the scientific and technological capabilities of the local pharmaceutical industry, thereby, improving the country's pharmaceutical supply. This document presents conceptual and practical topics that should be considered to defining and materializing a public policy aimed at strengthening the local pharmaceutical industry and favoring Colombia's sanitary autonomy.

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Resumen La implementación en instituciones de salud de un cuadro básico permite adquirir y administrar una larga lista de medicamentos que presenta a los médicos las alternativas de tratamiento, así como la descripción académica colegiada de indicaciones, dosis, efectos secundarios, interacciones y análisis de costo-beneficio, con lo que se facilita la prescripción médica y la administración de insumos para la salud. El Comité de Ética y Transparencia en la Relación Médico-Industria emite diversas recomendaciones para la optimización de los beneficios generados por los cuadros básico de medicamentos.

Abstract The implementation of an essential medicines list in health institutions allows acquiring and administering a long list of drugs that offers treatment alternatives to physicians, as well as a collegiate academic description of indications, doses, side effects, interactions and cost-benefit analyses, thus facilitating medical prescription and administration of health products. The Committee of Ethics and Transparency in the Physician-Industry Relationship issues several recommendations for optimizing the benefits generated by essential medicines lists.

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The adoption of the goal of universal health coverage and the growing burden of cancer in low- and middle-income countries makes it important to consider how to provide cancer care. Specific interventions can strengthen health systems while providing cancer care within a resource-stratified perspective (similar to the World Health Organization-tiered approach). Four specific topics are discussed: essential medicines/essential diagnostics lists; national cancer plans; provision of affordable essential public services (either at no cost to users or through national health insurance); and finally, how a nascent breast cancer program can build on existing programs. A case study of Zambia (a country with a core level of resources for cancer care, using the Breast Health Global Initiative typology) shows how a breast cancer program was built on a cervical cancer program, which in turn had evolved from the HIV/AIDS program. A case study of Brazil (which has enhanced resources for cancer care) describes how access to breast cancer care evolved as universal health coverage expanded. A case study of Uruguay shows how breast cancer outcomes improved as the country shifted from a largely private system to a single-payer national health insurance system in the transition to becoming a country with maximal resources for cancer care. The final case study describes an exciting initiative, the City Cancer Challenge, and how that may lead to improved cancer services.

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The implementation of an essential medicines list in health institutions allows acquiring and administering a long list of drugs that offers treatment alternatives to physicians, as well as a collegiate academic description of indications, doses, side effects, interactions and cost-benefit analyses, thus facilitating medical prescription and administration of health products. The Committee of Ethics and Transparency in the Physician-Industry Relationship issues several recommendations for optimizing the benefits generated by essential medicines lists.La implementación en instituciones de salud de un cuadro básico permite adquirir y administrar una larga lista de medicamentos que presenta a los médicos las alternativas de tratamiento, así como la descripción académica colegiada de indicaciones, dosis, efectos secundarios, interacciones y análisis de costo-beneficio, con lo que se facilita la prescripción médica y la administración de insumos para la salud. El Comité de Ética y Transparencia en la Relación Médico-Industria emite diversas recomendaciones para la optimización de los beneficios generados por los cuadros básico de medicamentos.

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Background: The World Health Organization (WHO) ethanol-based handrub (EBHR) formulation contains 1.45% glycerol as an emollient to protect healthcare workers' (HCWs) skin against dryness and dermatitis. However, glycerol seems to negatively affect the antimicrobial efficacy of alcohols. In addition, the minimal concentration of glycerol required to protect hands remain unknown. We aim to evaluate the tolerance of HCWs to the WHO EBHR formulation using different concentrations of glycerol in a tropical climate healthcare setting. Methods: We conducted a cluster-randomized, double-blind, crossover study among 40 HCWs from an intensive care unit of a tertiary-care hospital in Brazil, from June 1st to September 30, 2017. We tested the WHO EBHR original formulation containing 1.45% glycerol against three other concentrations (0, 0.5, and 0.75%). HCWs used one formulation at a time for seven working days during their routine practice and then had their hands evaluated by an external observer using the WHO scale for visual inspection. Participants also used a WHO self-evaluation tool to rate their own skin condition. We used a generalized estimating equations of the logit type to compare differences between the tolerability to different formulations. Results: According to the independent observation, participants had 2.4 times (95%CI: 1.12-5.15) more chance of having a skin condition considered good when they used the 0.5% compared to the 1.45% glycerol formulation. For the self-evaluation scale, participants were likely to have a worst evaluation (OR: 0.23, 95%CI: 0.11-0.49) when they used the preparation without glycerol compared to the WHO standard formulation (1.45%), and there were no differences between the other formulations used. Conclusion: In a tropical climate setting, the WHO-modified EBHR formulation containing 0.5% glycerol led to better ratings of skin tolerance than the original formulation, and, therefore, may offer the best balance between skin tolerance and antimicrobial efficacy.

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Doctors require flexibility for prescription. However, some limits are laid down both by current knowledge and by restrictions imposed by access and rules and regulations. The Committee for Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine proposes several suggestions to help patients, which include the selection of the best alternatives for each case, formalization of prescription standards variations (doses, drug indications, etc.) written down in the medical records, and avoidance of fashions, untested novelties, argumentations solely based on advertising or commercial promotion and conflicts of interest.

Los médicos requieren flexibilidad para sus prescripciones. Sin embargo, algunos límites están marcados tanto por el conocimiento vigente como por las restricciones de acceso, normas y reglamentos. El Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) propone varias sugerencias para ayudar a los pacientes, que incluyen la selección de las mejores alternativas para cada caso, la protocolización de variaciones a los estándares de prescripción (dosis, indicaciones, etcétera) por escrito en el expediente y eludir modas, novedades no probadas, argumentos simplemente publicitarios o promocionales y conflictos de interés.

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Resumen Los médicos requieren flexibilidad para sus prescripciones. Sin embargo, algunos límites están marcados tanto por el conocimiento vigente como por las restricciones de acceso, normas y reglamentos. El Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) propone varias sugerencias para ayudar a los pacientes, que incluyen la selección de las mejores alternativas para cada caso, la protocolización de variaciones a los estándares de prescripción (dosis, indicaciones, etcétera) por escrito en el expediente y eludir modas, novedades no probadas, argumentos simplemente publicitarios o promocionales y conflictos de interés.

Abstract Doctors require flexibility for prescription. However, some limits are laid down both by current knowledge and by restrictions imposed by access and rules and regulations. The Committee for Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine proposes several suggestions to help patients, which include the selection of the best alternatives for each case, formalization of prescription standards variations (doses, drug indications, etc.) written down in the medical records, and avoidance of fashions, untested novelties, argumentations solely based on advertising or commercial promotion and conflicts of interest.

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Introduction: The relevance of medications for health depends on their quality, accessibility and appropriate use. Objective: To determine the potential therapeutic value of antibiotics that are not included in the World Health Organization Essential Medicines List (EML) but that are part of the National Essential Medicines List (NEML) of the Mexican Ministry of Health, and categorize them according to their intrinsic value. Method: Descriptive analysis of antibiotics not included in the 2013 World Health Organization EML; literature review to obtain efficacy and safety evidence; and application of quality and intrinsic value scales. Results: Four hundred and fifty-two abstracts were identified for 19 antibiotics; 56.9 % were excluded; 195 clinical trials were reviewed in full-text articles, out of which 37.9 % were of good quality, and intrinsic value was determined; 54 % were superiority studies, whereas 46 % were non-inferiority or equivalence studies; 32 % of the antibiotics were classified without intrinsic value and nearly 50 % were inconclusive. Conclusion: An elevated proportion of antibiotics of the NEML had uncertain or no intrinsic value, which favors their inappropriate use, bacterial resistance and puts the population at risk.

Introducción: La relevancia de los medicamentos para la salud depende de su calidad, acceso y correcto uso. Objetivos: Determinar el valor terapéutico potencial de los antibióticos no incluidos en la lista de medicamentos esenciales (LME) de la Organización Mundial de la Salud pero que forman parte del Cuadro Básico de Medicamentos (CBM) de la Secretaría de Salud de México y categorizarlos por su valor intrínseco. Método: Análisis descriptivo de los antibióticos no incluidos en la LME de la Organización Mundial de la Salud 2013, revisión de la literatura para obtener evidencia de eficacia y seguridad y aplicación de escala de calidad y de valor intrínseco. Resultados: Se identificaron 452 resúmenes para 19 antibióticos, se eliminaron 56.9 %. In extenso se revisaron 195 ensayos clínicos; 37.9 % fueron de calidad y se determinó valor intrínseco; 54 % fueron estudios de superioridad y 46 % de no inferioridad o equivalencia; 32 % de los antibióticos fueron clasificados sin valor intrínseco y aproximadamente 50 % fueron dudosos. Conclusión: Una elevada proporción de antibióticos del CBM tuvo valor intrínseco dudoso o nulo, lo que favorece su uso inapropiado, resistencia bacteriana y coloca a la población en riesgo.

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Resumen Introducción: La relevancia de los medicamentos para la salud depende de su calidad, acceso y correcto uso. Objetivos: Determinar el valor terapéutico potencial de los antibióticos no incluidos en la lista de medicamentos esenciales (LME) de la Organización Mundial de la Salud pero que forman parte del Cuadro Básico de Medicamentos (CBM) de la Secretaría de Salud de México y categorizarlos por su valor intrínseco. Método: Análisis descriptivo de los antibióticos no incluidos en la LME de la Organización Mundial de la Salud 2013, revisión de la literatura para obtener evidencia de eficacia y seguridad y aplicación de escala de calidad y de valor intrínseco. Resultados: Se identificaron 452 resúmenes para 19 antibióticos, se eliminaron 56.9 %. In extenso se revisaron 195 ensayos clínicos; 37.9 % fueron de calidad y se determinó valor intrínseco; 54 % fueron estudios de superioridad y 46 % de no inferioridad o equivalencia; 32 % de los antibióticos fueron clasificados sin valor intrínseco y aproximadamente 50 % fueron dudosos. Conclusión: Una elevada proporción de antibióticos del CBM tuvo valor intrínseco dudoso o nulo, lo que favorece su uso inapropiado, resistencia bacteriana y coloca a la población en riesgo.

Abstract Introduction: The relevance of medications for health depends on their quality, accessibility and appropriate use. Objective: To determine the potential therapeutic value of antibiotics that are not included in the World Health Organization Essential Medicines List (EML) but that are part of the National Essential Medicines List (NEML) of the Mexican Ministry of Health, and categorize them according to their intrinsic value. Method: Descriptive analysis of antibiotics not included in the 2013 World Health Organization EML; literature review to obtain efficacy and safety evidence; and application of quality and intrinsic value scales. Results: Four hundred and fifty-two abstracts were identified for 19 antibiotics; 56.9 % were excluded; 195 clinical trials were reviewed in full-text articles, out of which 37.9 % were of good quality, and intrinsic value was determined; 54 % were superiority studies, whereas 46 % were non-inferiority or equivalence studies; 32 % of the antibiotics were classified without intrinsic value and nearly 50 % were inconclusive. Conclusion: An elevated proportion of antibiotics of the NEML had uncertain or no intrinsic value, which favors their inappropriate use, bacterial resistance and puts the population at risk.

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