The International Society to Improve the Use of Medicines (ISIUM) is an independent nonprofit organisation which has the aim to “raise awareness and promote the best use of medicines throughout the world to improve health and the management of disease in human beings, including all situations that involve or affect health and the use of medicines in the wider environment.”

The Society was formed some years ago by a group of enthusiasts who had been working on different aspects of quality use of medicines for many years. The World Health Organization (WHO) had funded occasional meetings over the years that had focussed on better use of medicines, but there was never any ongoing structure in place to encourage and/or facilitate coordination, collaboration or worthwhile initiatives. The formation of the Society was intended to fulfil this gap and provide a stable framework within which like-minded people could collaborate and support each other to continue this important work.

You can find out more about ISIUM on their website.

ISIUM held its second formal scientific meeting in Chiang Mai in October 2023, the first having been held in Bangkok in early January 2020 (just before Covid struck). It had some hundreds of registrants from all around the world, was extremely well organised by the Faculty of Pharmacy at Chiang Mai University, and contained an excellent mixture of research presentations, workshops, and plenary lectures.

One of the major themes of the meeting was to value seeing problems from different perspectives. The conference achieved this by including presentations from low, middle and high incomes countries and speakers across disciplines such as medical anthropology, communications and policy as well as medicine and pharmacy.

Several of the keynote addresses were highlights. One was given by Professor Phaik Yeong Cheah, a bioethicist and head of Bioethics and Engagement at the Mahidol Oxford Tropical Medicine Research Unit (MORU) in Thailand who focused on antimicrobial resistance. Despite the undoubted importance of antimicrobial resistance, she noted that, worldwide, more people actually die from lack of access to antibiotics than from multi-resistant organisms. She also introduced the concept of a “just transition”, where, notwithstanding the importance of reducing overall antibiotic use, we must endeavour to ensure that the people who most need antibiotics in LMICs should not pay the price for the profligate use of antibiotics in high income countries.

Another particular highlight was the plenary lecture by Associate Professor Luechai Sringernyuang, a medical anthropologist, also from Mahidol University, Thailand, who reflected on the “medicalisation” of society and how it influences the use of medicines. Whilst the lure of a “pill for every ill” is as old as humanity, he brought fresh eyes to the problem and gave practical illustrations of the complexities of turning the vicissitudes of everyday life into medical problems needing a medicine. Interestingly, he drew particular attention to how strongly the encouragement of “natural” medicines, and the general promotion of “wellness”, feed into this overall problem.

The Partnership Program facilitated a workshop on “Integrating guidelines with essential medicines lists”, focussing on the difficulties that commonly arise in a LMIC when guidelines are being written (or revised), but a drug that the writing group considers the best treatment option for a particular condition is not on the country’s EML.

Most readers of this newsletter will be familiar with how strongly the EML drives prescribing. They are probably not quite so familiar, however, with the processes required to add a drug to the EML, and how those processes differ from those involved in writing or revising prescribing guidelines. Although the details vary between countries, guideline writers are usually clinicians who principally focus on evidence for efficacy (and harm) in making their recommendations, whereas custodians of the EML focus much more on cost-effectiveness when making their decisions. So, the administrative processes involved, and, importantly, often the people involved, can be quite different and difficult to harmonise.

The workshop considered several practical examples, such as dapagliflozin for type 2 diabetes and oral cefazolin for surgical antibiotic prophylaxis, and participants were invited to share the barriers they anticipated would need to be overcome in their country if use of such drugs was proposed by a guideline writing group, but the drug was not on the EML. Whilst not providing any clear solutions, it was hoped that the discussions could assist participants tackle such problems if and when they were faced with them.

Following the conference, there was an opportunity for delegates to visit local sites in and around Chiang Mai. These included hospitals, primary care clinics, clinics especially for disadvantaged groups such as refugees from nearby Myanmar, and various community education activities focussing on better use of medicines – eg discouraging the use of the many easily available local OTC medicines used for pain relief that are often adulterated with corticosteroids and/or NSAIDs.

Overall, the meeting was very worthwhile, and there was general acclaim when a group of members from Nepal volunteered to host the next meeting provisionally planned for three- or four-years’ time.

If readers are interested, a full report of the Chiang Mai meeting will soon be available on the ISIUM website.