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Executive Summary

MERCK's PERIACTIN PROMOTION IN THIRD WORLD COUNTRIES is directed "exclusively to physicians and for the same uses, including appetite stimulation, as are approved in such countries as Canada, the U.K., France and Western Germany," Merck told "The Pink Sheet." The promotion of the drug as an appetite stimulant in Asia, Latin America and Africa was recently criticized by the U.K. public interest group Social Audit in an advertisement to physicians. Under the large heading "Double Standards," the Social Audit ad states that Periactin (cyprohepatadine) is marketed in Pakistan and other developing countries with the claim: "For the growing child who lacks appetite, for the growing child who is underweight. . ." The ad states that such promotion "inevitably encourages the belief that loss of appetite calls for drug treatment -- - and suggests that malnutrition should be treated with drugs, not food." The four page ad also objects to the Swiss company Sandoz' marketing of Mosegor (pizotifen) as an appetite stimulant. Social Audit maintains that Mosegor is marketed as a treatment for migraine in some countries and that a company manual for physicians notes that side effects with the drug include "a slight increase in body weight . . .in some patients" due to increased appetite. The Sandoz drug is not marketed in the U.S. Merck said Periactin "has not been available in the U.S. as an appetite stimulant since 1971" but is marketed as an antihistamine.

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