WHO List of Essential Medicines | Hacker News Reader

WHO List of Essential Medicines

list.essentialmeds.org

130 pointsbreck68 comments

Even outside of WHO's list, the number of prescription drugs in existence is surprisingly low. People might imagine there are "millions" of drugs. But it seems to be in the ballpark of ~600 based on looking at:

- items in the Compendium of Pharmaceuticals and Specialties (Canada) or the United States Pharmacopeia

- number of Drug Identification Numbers (DIN) (Canada) or National Drug Codes (NDC) (USA)

- how many SKUs a large pharmacy has (when I asked a pharmacist)

The WHO Model List of Essential Medicines gives just 460 medicines, by the way.

The drug manufacturers give basic drugs different names depending on the country or market, or combine basic drugs in combo pills with new names, and make extended release versions and whatnot. Therefore we have the perception that there is much more variety than there really is.

EDIT: The FDA has approved 1,453 drugs in its entire history[1] but it's not clear how many were withdrawn or are no longer marketed.

[1] https://www.raps.org/regulatory-focus%E2%84%A2/news-articles...

"There are over 20,000 prescription drug products approved for marketing."

https://www.fda.gov/about-fda/fda-basics/fact-sheet-fda-glan...

> "There are over 20,000 prescription drug products approved for marketing."

But how does that square with the claim that the FDA has approved 1,453 drugs in its entire history?

I wonder what they mean by drug products? I'm guessing that the FDA Fact Sheet you found is counting every combo pill, extended release or sustained release form, oral vs injectible vs suppository formulation, and maybe even different dosages as different drug products.

Whereas the paper mentioning 1,453 drugs is counting only new molecular entities.

It could be, I agree. The numbers from your article seem low to me, but of course I'm not an expert. Also drugs aren't just discovered in the US, so world wide it's surely more.

I think there are still many less commonly prescribed drugs. I'm a dialysis patient and atleast three I'm prescribed in not there: Febuxostat, Sevelamer, and Cinacalcet.

I've got a weird case here in The Netherlands about mebendazole. These are pills that kill intestinal parasites, which is important for my child who is at the age where they touch everything and anything, and then suck their thumb.

Mebendazole has been sold out for about half a year now. I had two strips stashed away, and I needed those for my child. Only last week, I could buy new ones.

It’s one of the drugs that is said to be useful in treating COVID. https://www.utsouthwestern.edu/newsroom/articles/year-2020/t...

Interesting. Are you using it prophylactically? Is this common in The Netherlands?

No, perhaps my wording was unclear. It's an on-demand thing. The kid complains about itchiness, I give her a pill.

If you're curious what categories they fit into here's Wikipedia's list https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Me...

While I support the WHO and its efforts to provide standardised information - this attempt fall too short to be useful. It would not have taken much to provide a little more meta-data for this to be far more useful. In the UK we have a SNOMED extension (dm+d) for medicines and some great work has been done here: https://openprescribing.net/dmd/

The Essential Medicines list has a very clear purpose, which it satisfies.

It states what medicines are essential - to give an indication of what minimum preparations can to be made (by states) for these to be stocked and affordable.

But, it's not intended as a dictionary/classification system. It's not intended to be a comprehensive list of medicines available in the UK. That's for the UK to decide.

This list was not made for you (nor anyone else commenting negatively in this thread). It doesn't fit your purpose, and that's fine.

I'll respectively disagree that it provides a list of medicines. It provides a list of 'Chemical agents', their ideal form and dose. My point is the over generalisation of these lists. Behind each chemical is an actual product that has actually been licensed to use in a specific jurisdiction and the indications for which it is licensed. This gap between the general and the 'actual' is one of the main reasons medicines health data is so difficult to share and these ambiguities can be dangerous. To your point that it does not fit my purpose - I agree. But what purpose does this list serve? Who is the 'user' of such a general list?

Last time I checked, every item one this list developed since the year 2000 was developed entirely or mostly in the US except one which was developed in Japan. Would love it if anyone knows if this is still the case as it wasn’t trivial for me to figure this out the one time I researched this.

Where would you say the Pfizer COVID vaccine was developed?

Notable entries on this list include Ivermectin and Hydroxychloroquine.

Interesting that ranitidine is still on the list, given the concerns about NDMA. I wonder if it will be removed in the future, and what the recommended replacement will be.

Oral ranitidine is the issue. IV ranitidine is still fine.

An once of prevention is worth a pound of cure.

How can we make money selling this idea?

Most cancers cannot be prevented, they're genetic.

Other diseases that can be prevented (obesity, smoking-related), require long-term media campaigns, cannot all of a sudden change people behavior. We have free will.

Even if “most” cancers are genetic (do you have a source on that?) they absolutely can be prevented. For example, people with a family history of colon cancer can get colonoscopy screenings to check for polyps. Same goes for people with BRCA2, etc.

And environmental factors play a gigantic role in the prevalence of cancer today.

Cancers are failure of immunosurveillance.

Yes, some genetic factors increase risks, but even in those cases cancers tend to show up after the age 40, when your immune system begins to falter due to thymus involution. At that point - everyone has some cancerous cells in their body, and often even multiple tumors.

If you live long enough - you WILL gets some sort of a cancer.

From a good pool of autopsies: 1.1 per patient.

"There were 250 malignancies diagnosed in 225 patients, an average of 1.1 malignancies per patient. The average age of all patients autopsied was 48.3 years (range, 1-98 years)."

doi:10.1001/jama.280.14.1245

Incentivize people by reducing health insurance premiums when they take part in appropriate preventative activities.

Please elaborate.

If a policy holder:

  * completes a smoking cessation class
  * has a mammogram/pap smear/PSA test/colonoscopy
  * has cholesterol levels checked
  * attends a monthly diet/nutrition group class
  * attends a participating gym twice a week

then discount the insurance premium appropriately for each positive lifestyle behavior.

I think this idea is good in theory, but has practical problems:

- Privacy concerns

- Administrative overhead

- Potential for fraud/people losing coverage if they miss attending their gym

That's basically what Vitality does https://www.vitalitygroup.com/

This is just a coupon scheme for rich people. If you have the time and energy to jump through the technical hoops, you get the discount.

Plenty of people go through the gym gate, meeting the Vitality discount condition, and then sit and read a newspaper.

AFAIU their model is successful because incentivising people to make healthy life choices really does reduce their actuarial predicted health costs - so on aggregate the cheaters can't be that significant.

> attends a participating gym twice a week

I exercise at least an hour every day of the week, I cycle, walk, or lift weights in my home gym. How would I prove to my insurance that I'm in fact working out? I rarely miss a workout, but your proposed mechanism would make me pay a higher premium despite being way more active than the average policy holder.

Could be a free fitness tracker they provide you? Or you share your fitness data from Apple health with their app?

It's not such a crazy idea. There are already car insurance companies that give you discounts by putting a GPS tracker in your car and bill you based on driving behavior.

Even if we were to accept the privacy invasion that would entail, it would most likely only work for the cycling and walking (average speed, distance) but it wouldn't really work for lifting weights. There's not really a way to see how hard I'm straining on my deadlifts, squats, pullups, etc.

I'm sure there will be similar issues for other modalities of exercise and training as well.

All they'd need is a heartrate monitor to cover every type of exercise. Some healthcare companies already offer monitoring for a discount as well. The most common I've seen is a pedometer that reports if you've reached a target amount of steps during a day, but I've also seen companies that can track heartrate through an apple watch.

Heart rate is not really a useful metric when lifting weights to be honest. My heart rate might spike a little when I do a set of heavy deadlifts, but putting away the plates afterwards sometimes feels like more of an exercise than the lift itself.

And then there are the cases where wearing a monitor around your wrist or chest might not be such a good idea or impractical (I can imagine ring gymnastics being one). I fear this is one of those cases where technology simply falls short. Some problems are more social than technical.

Is it a privacy invasion when you volunteer to a friend where you work out?

Engaging consensually in a business transaction where you volunteer information willingly is not a privacy violation unless the market is broken (like, for example, ISPs or GSM carriers).

> Engaging consensually in a business transaction

Healthcare is not a business.

If it's provided by other people who are not themselves enslaved, it absolutely is. Maybe a state-subsidized one, but money is changing hands for services whether it comes out of your pocket or not.

Further, we're not talking about healthcare. We're talking about de-risking potential future financial liability by purchasing insurance.

Insurance is absolutely a business.

> If it's provided by other people who are not themselves enslaved, it absolutely is.

What a leap.

> but money is changing hands for services whether it comes out of your pocket or not.

It doesn't mean it's a business in the sense of "commercial activities"

> Further, we're not talking about healthcare.

Let me see:

- we're in the comments section to "World Health Organization: List of Essential Medicines"

- dicsussing denying people healthcare based on invasive monitoring of their activities

Yes. We're definitely talking about healthcare.

> Insurance is absolutely a business.

It definitely is. Especially in the states. And in case of healthcare it definitely shouldn't be. And it definitely shouldn't be advocated for.

My health fund actually has some kind of fitness app which you earn 'points' in for doing various healthy things. I haven't used it but from the sound of it, it's not far off what you're suggesting here.

Sell vaccines?

It may be apocryphal but there's the story about Japanese doctors being paid a retainer by healthy patients in return for being responsible when they fall ill.

methadone is on the list but buprenorphine isn't... the WHO needs to step up

It is not essential as it has cheaper substitute - which is methadone.

Lots of newer and expensive medications are not on the list. e.g. not that many antibodies although they could mean life or death for cancer patients.

Just to add it's not just about expense directly, but mainly about supply. There's no point putting a new medication, even a very effective and life saving one, on a list of essential medicines if the supply pipeline could not come close to meeting global scale demand.

yeah you're both right, I just hope supply & cost get to a point where methadone can be replaced w/ buprenorphine whenever necessary. could save a lot of lives

Whats wrong with Methadone?

nothing, it's just that buprenorphine has certain advantages that it lacks: because it's a partial agonist, it causes less respiratory depression/is much harder to overdose on/you can safely titrate it faster; high receptor affinity means it largely blocks the action of other opioids (to the extent that it can be used to reverse overdose https://ccforum.biomedcentral.com/articles/10.1186/s13054-02...), longer half-life at high doses so you can maintain smoother levels/administer it less frequently. this is more speculative but it also seems to have an antidepressant effect, & in general I think it's less harmful to cognition & mood than other opioids incl. methadone. doesn't work better than methadone for everyone but availability issues mean we're still not at the point where that decision can always be made on a purely clinical basis

No albuterol? Terrible list.

It’s there under the name Salbutamol

What is albuterol? Why does not having it render the entire list terrible? Could you elaborate in a way that inspires useful discourse?

> Albuterol is used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma and chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways). Albuterol is in a class of medications called bronchodilators. It works by relaxing and opening the air passages to the lungs to make breathing easier.

From https://medlineplus.gov/druginfo/meds/a607004.html

It's a front-line medicine used for the treatment of asthma and COPD. As your sibling comment notes, it's on the list, just under its generic name.

https://en.wikipedia.org/wiki/Salbutamol

Albuterol is also a generic name, just that it's USAN and different from INN.

Doesn't make it terrible, but I think Clonidine and Hydrocodone/acetaminophen should have been there too.

Acetaminophen is there under the equivalent name Paracetamol.

I’m guessing that clonidine didn’t make it because it’s not pregnancy safe (yes there are probably tons of those on the list).

I think it's also because it treats things for which there are safer alternatives on the list (especially for reducing blood pressure).

It's actually called Paracetamol in the rest of the world except USA. It's in the list.

It saddens me that there is no medical cannabis on the list. This medication is life changing for many people suffering from chronic diseases. That begs the question whether the list is genuine. If medical cannabis is not included, what else isn't? Pain medication is one of the biggest money maker for big pharma, so they work hard to keep it that way by corrupting anyone in power to change that.

Due to status, a. there is no huge global demand and b. large-scale global supply of medicinal cannabis is flat out impossible. And I'm not saying that's a good state of affairs, but it can't go on a list of essential medicines that need global availability because it's clearly not essential and not globally available.

Also, calling some BS on the big pharma conspiracy stuff w/r/t cannabis/cannaboids. Sure, when there wasn't a prevailing wind they're going to lobby for anti-drug laws, but now in the US, South America etc. there is. They can't really be amoral money grabbers if they start ignoring the money -- if "they" (as some bloc) are what you're saying, then what, they're not going to not bother with cannabis-derived pain relief drug research?

I'd say the supply is purely artificial problem. If the medicine was mandated as essential, the supply issue would have been solved within a year.

I am sure that in many countries or jurisdictions it was possible to beat big pharma lobby (for example in the US by direct ballot initiatives), however, there are countries where big pharma is actively blocking adoption of this medicine because in case of chronic pain, one of the major money makers, they risk losing a good chunk of profits. Here in the UK senior doctors (that happen to be shareholders or involved in others ways with those companies) lie public in the face that there is no evidence medical cannabis actually works and block any routes for prescriptions to be available on the NHS.

> large-scale global supply of medicinal cannabis is flat out impossible

Just because of legal issues or is there some logistical issue? I can't imagine it's any harder to commercialize than tobacco and left unchecked that was huge.

It's got nothing to do commercialisation. It's illegal in well over half the countries in the world, so issues are legal and logistical. And it's going to a bit hard to persuade, say, the UAE that it should be added to the list. Just because research seems to strongly suggest it (or more specifically derivatives of) can be very helpful for certain conditions doesn't mean it's going on a list of critical medicines that have to always have a large global supply available anytime soon.

Yeah, fair point. Bit hard for the WHO to label something essential when it's widely illegal.

It includes condoms, which means my definition of essential is quite different from WHO's one. Honestly, not that I really had one, but I expected something like "Medicines we need to prevent humans from extinction", while it obviously includes more than that.

Isn't prevention of AIDS a way to prevent humans from extinction?

Health organization usually aim a little higher than “avoid extinction”.

Paracetamol is on the list, for example, because people in pain need painkillers. It can also reduce a fever, altho that said, a normal fever is beneficial albeit unpleasant.

It includes things which treat conditions humans typically present with (which could well be caused by them - such as unsafe sex, drug overdose, etc.) - it's not just a minimum list for an 'ideal' group that abstains from all unnecessary or unsafe activity.

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