A detective story: Who Killed the Rational Use of Medicine?

2026-09-24

ReAct Latin America brings a complex public health challenge to life through theatre, puppets and the adventures of two unconventional detectives.

“Who killed the rational use of medicine? ” Was it doctors, pharmaceutical companies, governments, pharmacists, patients – or a whole system in which different interests and circumstances combine to encourage the inappropriate use of medicines?

This is the mystery at the heart of “Who Killed the Rational Use of Medicine?”, a publication by ReAct Latin America that is now being adapted into a theatrical performance using actors and puppets. The production offers an imaginative way to explore why medicines, intended to protect health, can sometimes cause harm when used unnecessarily or incorrectly.

The play was performed on 2nd September 2026 at the Sala Alfonso Carrasco in Cuenca, Ecuador. It is part of ReAct Latin America’s ongoing campaign to promote rational medicine use and prevent the misuse and overuse of antibiotics in particular. The production is also intended to travel to different parts of Latin America, including Bolivia, during World AMR Awareness Week in November.

Bringing the mystery to life

Through actors and puppets, the play brings together the multiple forces shaping how medicines are prescribed, sold and consumed. Rather than blaming a single group, it invites audiences to examine the relationships between healthcare practices, commercial interests, public policies, media influence, patients’ expectations and unequal access to healthcare.

The theatrical format makes these complex relationships accessible, encouraging audiences to question assumptions about medicines and the decisions surrounding their use.

From a technical conference to a detective novel

The original book emerged from the first international conference of the International Society to Improve the Use of Medicines (ISIUM), held in Bangkok in January 2020. Titled “People Improving the Use of Medicines: What We Know and Don’t Know”, the meeting brought together 175 participants from 34 countries.

The organisers decided to produce two reports: a conventional technical report for professionals, researchers and policymakers, and a second publication for a wider, non-technical audience.

The result was “Who Killed Rational Use of Medicines?”, which was published through a collaboration between ISIUM and ReAct Latin America.

Instead of presenting conference proceedings in a conventional report, the book is in the form of a detective novel featuring two detectives, Herlock Sholmes and Dr Whatsup. The duo attend conference sessions, workshops and discussions, gathering clues and interrogating assumptions as they investigate the mysterious death of rational medicine use. Although fictional in form, the narrative draws on the actual presentations, debates and discussions at the conference. Humour, dialogue and illustrations make technical material accessible while retaining its scientific and social substance.

Uncovering the multiple causes

The book’s central message is that irrational medicine use cannot be explained simply by individual behaviour. Inappropriate prescribing, self-medication, commercial incentives, inadequate regulation, misinformation and unequal access to healthcare can reinforce one another.

Antibiotics provide a particularly important example: unnecessary or inappropriate use contributes to antimicrobial resistance, making infections increasingly difficult to treat.The book therefore calls for more than advice to patients. It highlights the need for changes in healthcare practices, policies and commercial influences, alongside greater public participation in decisions about health and medicines.

Its broader questions are fundamental: What is health? What do medicines mean to different people? And who gets to decide how they should be used?

Experts welcome an engaging approach

The book has received encouraging responses from public health experts in Latin America.
Susana Ramírez Hita, a Peruvian member of MARC, UCSNAL and the Plataforma Perú País Libre de Transgénicos, said, “The book is original and educational; it presents the content of the conference through a story.

Nila Heredia Miranda, physician, activist and former Bolivian Minister of Health, welcomed the book’s entertaining presentation of medicines, policies, public perceptions and the influence of pharmaceutical companies and commercial actors.

According to her,

“I cannot imagine a more educational and entertaining way of presenting and explaining the different aspects related to medicines: their use, policies, public perceptions, and their discretionary management by doctors, pharmaceutical companies and medicine distributors.”

From classrooms to communities

The publication is currently being used in several medical colleges to teach students about the complexity of rational medicine use. Its storytelling approach encourages future health professionals to look beyond pharmacology and consider the social, economic, cultural and institutional influences on prescribing and medicine consumption.

The theatrical adaptation extends this approach to wider audiences. By combining performance, puppetry and storytelling, it creates opportunities for communities to engage with issues often confined to technical discussions.