Clinical Trials

Politics, The Economy

I’m a huge fan of director Fernando Meirelles after seeing City of God, and I wasn’t disappointed with his breakthrough Hollywood movie, The Constant Gardener. Interestingly enough, the Hollywood film was more languidly paced than the intense Brazilian blockbuster. I loved how he cut between the intense chaos of public scenes (whether in the Third World or in England) and the quite of official, intimate and domestic environments. It left you a little off kilter throughout. It wasn’t without its flaws (Alright, already, his dead wife is a saint — move on!), but still, it was good cinema.

Except for one thing. The basic premise doesn’t make any sense whatsoever. Not because pharmaceutical companies don’t engage in the kind of practices described in the move. They do much worse, in fact. As this 2000 Washington Post series, entitled The Body Hunters,” documented. The thing is, they don’t need to kill anybody to cover up what they are doing. They do it right out in the open, and continue to do so!

In the second-to-last issue of the New York Review of Books, Marcia Angell discusses big pharma practices which are actually much worse than those described in the film (some of which she culls from the Washington Post reporting), like a 1996 meningitis study by Pfizer where a drug, Trovan, was tested in the middle of an epidemic, and patients given the competing drug, ceftriaxone, were not given the proper dosage. Or an NIH (i.e the government, not Pharma) study on a drug aimed at reducing the transmission of HIV/AIDS from mother to infant” where

instead of comparing the transmission rate in women who received an experimental short course of treatment with that in women receiving the standard course, the researchers compared it with the transmission rate in women who received only a placebo—thus consigning many babies in their care to be born with HIV/AIDS that could have been prevented.

But the real question is why clinical trials are being conducted in the developing world in the first place. Angell suggests that less oversight by the FDA, easier to manipulate results, and a ready supply of people willing to take tests simply because they need medical care (which they might not be getting). Moreover, those populations which are so conveniently used for testing often never get access to the final product when it is released.

In the end she advises:

Companies should no longer be allowed to conduct research in the third world that they would not be permitted to do at home.

Common sense, but I doubt anyone will listen.

Finally, one last note [warning, a spoiler ahead (the stuff about the wife getting killed isn’t because she’s killed off at the beginning of the film)], one of the most shocking moments for me was when he goes to visit a doctor in the field and they are raided by Janjaweed on horseback. We suddenly realize that they are in Darfur. It was shocking only because images from Darfur have been shockingly absent from the mainstream media. Wikipedia seems to have the latest on what the situation is there now.

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