As we all know, literature has much more power than polemics. The Food & Drug Administration owes its existence to an Upton Sinclair novel, “The Jungle.” Efforts to improve the lot of farm workers drew their initial sustenance from John Steinbeck’s novel, “The Grapes of Wrath.” And the modern consciousness on treatment of African-Americans can be traced to Richard Wright’s 1940 novel, “Native Son.” Indeed, literary critic Irving Howe declared: “The day ‘Native Son’ appeared, American culture was changed forever.”
So it should not be surprising that the most devastating appraisal of the pharmaceutical industry should appear in a novel, one that comes from a most unlikely source, John Le Carré, the British novelist best known for his elegant spy stories whose context was the Cold War. Now that the Cold War is over, some fans of Le Carré may have been wondering where he would find his inspiration.
Never fear, he has found it in the machinations of drug companies. His new novel, “The Constant Gardener,” which has just been published in this country by Scribner, sketches a horrifying picture of giant drug manufacturers – Big Pharma, he calls them – who have a callous disregard for humanity. They use poor Africans as guinea pigs for new drugs. Many of these people die from the side effects. The game plan is always to develop these new formulations not to treat needy Africans but rich Americans who will pay top dollar.
Of course they cover up any reports of deadly side effects. Not only that, in Le Carré’s riveting story, played out largely in Kenya, the drug lords resort to every device, including murder, to silence activists. Complicit in this seedy exercise is the British government, through its Foreign Office, which Le Carré knows very well. The most striking characters in this book are the people who work for the British Foreign Office.
In the end, “The Constant Gardner” leaves the reader with revulsion at the actions of drug companies. A scientist who helped develop a drug to treat tuberculosis describes how the trials “are designed only to get the drug on the market as soon as possible. Certain side effects were deliberately excluded… Most of the patients are in undemocratic countries with very corrupt systems. Theoretically they give their informed consent to the treatment. That is to say, their signatures are on the consent forms even if they cannot read what they have signed.” As one observer puts it, “If it poisons a few people who were going to die anyway, what’s the big deal?”
And when a British government official tells the head of a drug company that he doesn’t know how much help he can give him, the CEO screams: “You’re history, Donohue. You think countries run the f- – -ing world! Go back to f- – -ing Sunday school. It’s ‘God save our multinational’ they’re singing these days.”
The Foreign Office works hand-in-glove with the drug companies and with corrupt African governments. The rationale, cruelly put, is: “Foreign Office isn’t in the business of passing judgment on the safety of non-indigenous drugs, is it? Supposed to be greasing the wheels of British industry, not going round telling everybody that a British company in Africa is poisoning its customer. You know the game. We’re not paid to be bleeding hearts. We’re not killing people who wouldn’t otherwise die. I mean, Christ, look at the death rate in this place. Not that anybody’s counting.”
The drug companies featured in Le Carré’s tale are Swiss and British but it’s clear that he is indicting the entire pharmaceutical industry for putting profits over medicine, which is the reverse of what the companies themselves say when they talk about their missions. I know people at these companies, especially at Merck and Pfizer, and I don’t recognize them in this novel. But a novelist’s job is to express in dramatic terms the logic of a way of life or, in this case, a way of business. Le Carré’s book appears just at a time when the pharmaceutical industry is under fire for worrying more about its patents than helping sick people to heal.
Le Carré felt constrained to add an “Author’s Note” at the end of his novel. There he disclaims that his characters or companies are based on real people or actual corporations. As he points out, “In these days when lawyers rule the universe, I have to persist with these disclaimers.” However, he also felt constrained to add: “As my journey through the pharmaceutical jungle progressed, I came to realize that, by comparison with the reality, my story was as tame as a holiday postcard.”
In an article he wrote recently for “The Guardian,” Le Carré expanded on his thesis. He noted that many of the antiretrovirals used to treat HIV positive patients were developed in publicly funded U.S. research projects, and he pointed out that while Africa has 80% of the world’s AIDS patients, “it comprises 1% of Big Pharma’s market.”
The standard argument of drug companies is that they need to charge the prices they do to fund research that will discover new drugs. To which Le Carré responds: “Then kindly tell me how come they spend twice as much on marketing as they do on research and development?”
Nowhere are the issues of corporate social responsibility and profits joined so tightly as they are in the pharmaceutical area. Indeed, Merck has long been applauded – by me and others – for adhering to a code laid down by George W. Merck: “Medicine is for the patients. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.”
“The Constant Gardener” stands as a sharp rebuttal to that message.
Meanwhile, John Le Carre’s message is being heard. Leading pharmaceutical
makers were shamed into withdrawing a suit they had filed in South Africa to
protect their patents. Both Merck and GlaxoSmithKline have signaled that
they would be prepared to sell their AIDS drugs at lower prices in Africa.
And in a very unusual development, the Swiss drug giant Novartis announced
that it would make available its drug Glivec to American patients, pricing it
according to ability to pay. Glivec is used to treat myeloid leukemia and is
normally priced at $2,000 to $2,400 a month. Dr. Daniel Vasella, chairman of
Novartis, said: “To whom would we sell if people can’t afford it?”