American consumer groups have expressed concern about the way pharmaceutical companies lavish gifts and speaking fees upon doctors. They say this may influence what drugs doctors prescribe. But, according to a recent study published by the organization Consumers International, the situation in the developing world is even more extravagant. The study notes that gifts from drug companies include school fees, cars, even down-payments on homes.

Consumers International says they’ve documented that 50 percent of the drugs in the developing world are what they call irrationally prescribed. This means the drugs are unnecessary, or they’re prescribed in doses that are too large, or expensive drugs are prescribed in place of generics. And money spent on unnecessary medicine in poor countries has a much greater impact on overall health than, say, here in the US. The group worries these over-the-top gifts are at least partly to blame. Plus, they say, this type of behavior violates the written ethical policies of drug companies. Those same companies declined to be involved with the report when it was under development. Now that it’s been published, the self-policing regulatory body of the pharmaceutical industry says it intends to deal with these issues.

—Cynthia Graber