In Reply: We thank Dr Kessel for pointing out the important issue of health care professionals' training. The effectiveness of drugs does indeed depend on a long chain of factors; in short, essential drugs must be available, affordable, and properly used. Kessel's example from Calcutta is one of the many initiatives from the field that permits rational use of drugs by health care professionals and patients. In some of the current 400 field projects run by Mèdecins Sans Frontiéres, training activities are provided to health workers. We have published a number of practical treatment guidelines1,2 in many languages for use in the field to support the rational use of drugs.
Pécoul B. Access to Essential Drugs in Poor Countries—Reply. JAMA. 1999;282(7):631. doi:10.1001/jama.282.7.631a
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