Mr. HEILMAN. My understanding is that no licenses were amended or would be permitted to be amended for wide-spectrum antibiotics after these dates. Prior to these dates there were some amendments of the purchase authorization extending delivery dates, extending the authorization for delivery of commodities, of pharmaceuticals, under these authorizations, under these licenses. So the troublesome thing to us was that we wanted to effectively cut off wide-spectrum antibiotics earlier than, in fact, we were able to cut off the flow of them. I am not sure, Senator, whether this answers your question adequately or not. Senator MUNDT. It is my understanding that some of these licenses were changed and concessions were made. I may be wrong. The effective action taken on March 13 was not the question of final cutoff, but there were some loopholes through which some of these practices continued. I gather from Mr. Hall that that is correct, and I gather from you that it is not correct. Mr. HALL. No; I think that was correct. I think Mr. Heilman didn't mean to say it wasn't true. There were some extensions of effective dates of licenses. I think in a few cases of antibiotics and in connection with one company that had been put on suspension. We were disturbed about this. The only explanation we have been able to come to on it has been that there was a lack of communication between Washington and Vietnam and the man out there didn't get the word. We have looked at this very carefully to see whether there is anything more involved. We haven't been able to find anything more than that. We have been concerned about it. It was a case where he had some discretion. Senator MUNDT. Have you closed it up now? Mr. HALL. Yes, sir. This will not happen again. I am just not able to explain why we didn't get the message to him. It is just one of those things that happens sometimes in human relations that people don't get the word. Senator MUNDT. We don't know, either, what the reason is. Senator MUNDT. We do know, however, that this has happened. Mr. HALL. We have had an investigation of this and I have looked at the results of that investigation. My preliminary conclusion is that it was just a case of lack of communication with this particular individual. Senator MUNDT. Back to Mr. Tamblyn. On page 272 you mentioned two companies. Are they American concerns, Roussel and Labs. Vanco? Mr. TAMBLYN. Roussel, of course, is the No. 1 French firm. There is no firm in France that is as large as Roussel and they have their own operations in Vietnam. Labs. Vanco is a local operation, local Vietnamese. Senator MUNDT. In Vietnam? Mr. TAMBLYN. Yes, sir; in Saigon. Mr. HALL. There is a Roussel subsidiary in New York that you might want to mention to complete the record. Mr. TAMBLYN. That is correct. Mr. HALL. There is a wholly owned subsidiary which operates in New York in the United States. Senator MUNDT. On page 272, Mr. Tamblyn, you have a paragraph (g) which intrigues me. I wish you would elaborate on it. You say. "Since in the period under review, South Vietnam leads, by far, all other countries as the source of supply, it would appear that Saigon is the major source of Vietcong access. In our general discussion you seemed to indicate that this was purely a supposition rather than a fact. Do you have some factual information to substantiate that statement? Mr. TAMBLYN. Yes, sir. As I recall, the percentage of material found on a country basis, Vietnam was first, and this is based on the number of instances of findings and then taking the percentages from that Senator RIBICOFF. Would the Senator yield for a moment? Senator MUNDT. Yes. Senator RIBICOFF. Mr. Hall, could you arrange to sit down with Mr. Adlerman and arrange for what parts of these reports could be declassified so they could go into the record? I will let Senator Mundt look at them because I think it answers some of the questions he has. Mr. HALL. I would have to talk to the Defense Department, since I think they are the source of the portion of classified material. Mr. ADLERMAN. It is a rather low classification. It is "limited use only." I imagine there will be no difficulty. Mr. HALL. But under our security arrangements, we have to get their consent and agreement. Senator RIBICOFF. Would you check with them and then check with the Defense Department? Mr. HALL. Yes, sir. Senator MUNDT. Don't let them take out anything that has appeared in the American newspapers, as they did recently in our Appropriations Committee where they classified something concerning an article which appeared in the Washington Post. Mr. HALL. Mr. Chairman, I am not sure I will be more persuasive than Senator Mundt with the Defense Department. I cannot give you an assurance. I will do my best. Senator MUNDT. All right. (Documents referred to were marked "Exhibits No. 14A, B, and C" for reference. A and B follow and C will be found in the files of the subcommittee.) EXHIBIT No. 14A U.S. GOVERNMENT, To: Mr. William F. X. Band, Assistant Director/Special Projects. To determine the adequacy of USAID-financed imports for the products Chloramphenicol, Tetracycline, Chlortetracycline, Oxytetracycline, all import licenses 78-726-68-pt. 2-5 for pharmaceuticals (2,169) were searched at the National Bank of South Viet Nam. Broad spectrum antibiotics only are covered in this report because of their high price and versatility as compared to penicillin, streptomycine, dihydrostrep tomycine and combinations of these products whose price levels and availability place them now in the category of a "commodity". It should be emphasized that the report does not include imports by the Gor ernment of South Viet Nam, the U.S. Military, U.S. Public Health, and Free World Assistance. Importation figures for these programs is not complete, however, the import value of CIP products alone totals approximately $3,800,000. Therefore, it is of real significance. 1. To eliminate the possibility of selecting other than Wide Spectrum Antibiotics from the import licenses by personnel who have no pharmaceutical ex perience, I selected the licenses and supervised the reporting into the correct gen. eric name category. I recorded the information from the license and passed it to others who made separate records for final report purposes. Finally the two sets of reports were cross checked to eliminate any errors. 2. The products imported in finished condition were converted to kilos of antibiotics-since these products constitute only 3% of the total, the degree of error in conversion would at best be small. 3. Licenses were issued for importation as follows: Chloramphenicol Tetracycline Oxytetracycline Chlortetracycline Kilos Total 4. A comparison of kilo usage in certain countries has been obtained for the calendar year 1965-other comparisons will be made as information is received Existing information was gathered from responsible sources within the pharma ceutical industry and figures coincide with my knowledge of the countries listed As will be noted, importation in Viet Nam in total quantity under the purchase authorization for FY-1966 is nearly equal to the combined totals utilized by the Philippines, Thailand, Taiwan, Malaysia/Singapore, Hong Kong and New Zeal and. Combined population total of these countries is one hundred and one mil lion compared to Viet Nam's approximate sixteen million. (U.S. Public Health uses the population figure for South Viet Nam of ten million-I have used the larger figure to cover everyone who might have access to these products in one way or another.) South Africa is included in the list only for its similarity in population. Practice of medicine in that country is at a very sophisticated level since 80% of the M.D. population are Jewish doctors who were very successful in their practice in Middle Europe and chose South Africa rather than Israel to migrate to. With this medical ability existing in 8,000 doctors and the availability of 1,000 hospitals with 130,000 beds, it still used % of the Wide Spectrum Antibiotics that Viet Nam imported. 2 Under national health program patient pays only 33 cents United States for the prescription-then he is reimbursed by the Government for his total cost of the antibiotic. The patient pays very little for his medicine; therefore, this tends to higher usage and availability to all regardless of their economic status. 5. The question arises as to the use of the apparent superabundance of these Wide Spectrum Antibiotics. It is recognized that usage here following the French influence may be of a higher level per capita than other countries in the area; however, the following points should be born in mind: a. The VC has a grave requirement for Wide Spectrum Antibiotics. b. It is well known that the Communist nations do not have the production capacity for these types of antibiotics. Production does exist in the satellite Mid-European countries and the U.S.S.R.; however the satellites prefer to move their products into the Western European countries and East Germany. There they can obtain higher prices and they can obtain consumer goods that the U.S.S.R. cannot deliver. c. The supported piaster exchange on imports of these products could permit comfortable profits to re-exports (smuggling to Bloc Nations or others). This is especially true of Chloramphnicol which represents 70% of the total imports of these products and its import has increased from less than 12,000 kilos to over 17,000 kilos from the 1965 Fiscal Year program to the 1966 Fiscal Year program. It is imported at $84 per kilo as opposed to a world market price and a Saigon import price of $245 per kilo for Tetracycline and $400 per kilo for Oxytetracycline and Chlortetracycline. d. It bears repetition that these figures cover only the imports made under the Commodity Import Program. They do not include imports by the Government of South Viet Nam, U. S. Public Health, U. S. Military, or Free World Assistance Programs. e. [Deleted.] The danger in indiscriminate use of Chloramphenicol cannot be overemphasized-its preponderance of usage here is in reverse relation to other world markets. Due to its inherent danger, its sales do not compete in other markets with the "safer" antibiotics. In fact, Chloramphenicol as marketed in the United States is the only Wide Spectrum Antibiotic and only antibiotic of any nature which under FDA regulations must carry this significant information under the heading "Warning". Warning. Serious and even fatal blood dyscrasias (aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) are known to occur after the administration of chloramphenicol. Blood dyscrasias have occurred after both short-term and prolonged therapy with this drug. Bearing in mind the possibility that such reactions may occur, chloramphenicol should be used only for serious infections caused by organisms which are susceptible to its antibacterial effects. Chloramphenicol should not be used when other less potentially dangerous agents will be effective, or in the treatment of trivial infections such as colds, influenza, or viral infections of the throat, or as a prophylactic agent. PRECAUTIONS: It is essential that adequate blood studies be made during treatment with the drug. While blood studies may detect early peripheral blood changes such as leukopenia or granulocytopenia, before they become irreversible, such studies cannot be relied on to detect bone marrow depression prior to development of aplastic anemia. PRELIMINARY REPORT-PHARMACEUTICALS AND HOSPITAL PRODUCTS REPORTED CAPTURED FROM THE VIETCONG; DECEMBER 1965 TO FEBRUARY 1967 PART I Source Information was obtained from 71 [deleted] Reports on Vietcong medical material captured during the period indicated. Method This information was developed by a review of recorded data which, although incomplete, did provide trends and patterns which became obvious through repetition of incidence. Repetition existed in the frequency of reporting specific classifications of products, manufacturers, pharmacies, and source of material. Instruments including numerous types of surgical instruments, thermometers. bandages, needles, syringes and sutures were considered separate from pharmaceutical products. Pharmaceutical Products The following table provides, in the order of importance, all classes of pharma. ceuticals that were reported. The number of instances that these occurred in the analysis is indicated in Column II. Column III indicates the percentage of each individual classification to the total pharmaceutical products reported. It should be noted that the first ten classifications, omitting Chinese Medicines. provides 73.3% of the total pharmaceuticals recorded. 2 Packages include: Hydrogen peroxide, permanganate, soap powder, alum, cotton. Vietnam Laboratories and Pharmacies 140 84 79 48 2322 21.6 13.6 12.3 39 6! 30 46 26 4. 24 3.1 23 3. 17 From the reports, analysis was made of the suppliers whose products were most frequently found in the caches. The first ten suppliers accounted for 56.6%the first fifteen accounted for 70%. This information follows: [Deleted.] Country Source An analysis was made to ascertain country of origin whenever possible. These figures were also established by the number of instances, and the table provides these frequencies in order of importance. It will be noted that there are a total 1.2 |