-Caveat Lector-
Do you think people will eventually see the connection of the Big Pharma to
the "war on 'some' drugs"?
Sandee
===========================================
"The Nation, April 9, 2001 page 11
In Place of Nations
by John Le Carre
Times have changed since the cold war, but not half as much as we might
like to think. The cold war provided the perfect excuse for Western
governments to plunder and exploit the Third World in the name of freedom;
to rig its elections, bribe its politicians, appoint its tyrants, and, by
every sophisticated means of persuasion and influence, stunt the emergence
of young democracies in the name of democracy.
And while they did this - whether in Southeast Asia, Central and South
America, or Africa - a ludicrous notion took root that we are saddled with
to this day. It is a notion beloved by conservatives, and, in my country,
New Labour alike. It makes siamese twins of Tony Blair, Margaret Thatcher,
Ronald Reagan, Bill Clinton, and George W. Bush. It holds to its bosom the
conviction that, whatever vast commercial corporations do in the short term,
they are ultimately motivated by ethical concerns, and their influence upon
the world is therefore beneficial. And anyone who thinks otherwise is a
neo-Communist heretic.
In the name of this theory, we look on apparently helpless while
rainforests are wrecked to the tune of millions of square miles every year,
native agricultural communities are systematically deprived of their
livelihoods, uprooted and made homeless, protesters are hanged and shot, the
loveliest corners of the world are invaded and desecrated, and tropical
paradises are turned into rotting wastelands with sprawling, disease-ridden
megacities at their center.
And of all these crimes of unbridled capitalism, it seemed to me, as I
began to cast around for a story to illustrate this argument in my most
recent novel, that the pharmaceutical industry offered me the most eloquent
example.
I might have gone for the scandal of spiked tobacco, designed by Western
manufacturers to cause addiction and incidentally cancer in Third World
communities already plagued with AIDS, tuberculosis, malaria, and poverty on
a scale few of us can imagine.
I might have gone for the oil companies, and impunity with which Shell,
for instance, triggered a vast human disaster in Nigeria, displacing tribes,
polluting their land and causing an uprising that led to kangaroo courts and
the shameful torture and execution of very brave men by a wicked and corrupt
totalitarian regime.
But the multinational pharmaceutical world, once I entered it, got me by
the throat and wouldn't let go. Big Pharma, as it is known, offered
everything; the hopes and dreams we have of it, its vast, partly realized
potential for good; and its pitch-dark underside, sustained by huge wealth,
pathological secrecy, corruption and greed.
I learned, for instance, of how Big Pharma in the United States had
persuaded the State Department to threaten poor countries' governments with
trade sanctions in order to prevent them from making their own cheap forms
of the patented lifesaving drugs that could ease the agony of the 35 million
men, women, and children in the Third World who are HIV-positive, 80% of
them in sub-saharan Africa. In pharma jargon, these patent-free drugs are
called generic. Big Pharma likes to trash them, insisting they are unsafe
and carelessly administered. Practice shows that they are neither. They
simply save the same lives that Big Pharma could save, but at a fraction of
the cost.
Big Pharma did not invent these lifesaving drugs that they have patented
and arbitrarily overpriced, incidentally. Anti-retrovirals were for the
most part discovered by publicly funded US research projects into other
diseases, and only later entrusted to pharmaceutical companies for marketing
and exploitation. Once the pharmas had the patent, they charged whatever
they thought an AIDS-desperate Western market could stand: $12,000 to
$15,000 a year for compounds that cost a few hundred to run up. Thus a
price tag was attached, and the Western world, by and large, fell for it.
Nobody said it was a massive confidence trick. Nobody remarked that, while
Africa has 80 percent of the world's AIDS patients, it comprises 1 percent
of Big Pharma's market.
Do I hear you offering the drug companies' time-worn excuse that they
need to make huge profits in one drug in order to finance the research and
development of others? Then kindly tell me, please, how come they spend
twice as much on marketing as they do on research and development?
I was also told about the dumping of inappropriate or out-of-date
medicines by means of "charitable donations" in order to get rid of
unsaleable stock, avoid destruction costs and earn a tax break. And about
the deliberate widening of a drug's specifications in order to broaden its
sales base in the Third World. Thus, for instance, a drug that in Western
Europe or the STates would be licensed only for extreme cancer pain might be
sold in Nairobi as a simple headache cure - and at several times the cost of
buying it in Paris or New York. And in all probability no contraindications
would be provided.
And then of course there is the patent game itself. One compound can
carry a dozen or more patents. You patent the manufacturing process. You
patent the delivery system, pills, medicine or serum. You patent the
dosage, now daily, now twice weekly. You patent, if you can, every footling
event in the drug's life from research lab to patient. And for every day
that you fend off the generic manufacturer, you earn yourself another
fortune, because markup, for as long as you own the patent, is astronomic.
But Big Pharma is also engaged in the deliberate seduction of the
medical profession, country by country, worldwide. It is spending a fortune
on influencing, hiring and purchasing academic judgement to a point where,
in a few years' time, if Big Pharma continues unchecked on its present happy
path, unbought medical opinion will be hard to find.
And consider what happens to supposedly impartial academic medical
research when giant pharmaceutical companies donate whole biotech buildings
and endow professorships at the universities and teaching hospitals where
their products are tested and developed. There has been a steady flow of
alarming cases in recent years where inconvenient scientific findings have
been suppressed or rewritten, and those responsible for them have been
hounded off their campuses with their professional and personal reputations
systematically trashed by the machinations of public relations agencies in
the pay of the pharmas.
The last bastion, you might reasonably hope, would be the "objective"
scientific journals. But here, too, alas, we need to be wary, just as they
do. The New England Journal of Medicine, America's most prestigious,
recently confessed to its chagrin that some of its contributors have turned
out to have had undeclared connections with the pharmaceutical industry. As
to less august journals, who have neither the clout nor the resources to
check on the hidden interests of their contributors, many have become little
more than shop windows for pharmas peddling their wares. And more than one
"opinion leader" - i.e. research professor - has been known to add his name
to an article that has helpfully been written for him back at the shop.
The general press, by contrast, has started to serve the public a great
deal better than it used to, particularly in the United States. Perhaps
they are a little less worried about their advertisers. A Washington Post
eleven-month investigation last year into the malpractices of US and
multinational pharmas in poor countries culminated in a series of
devastating articles that should earn the writers a Pulitzer Prize, the
thanks of all decent people and the naked loathing of the industry.
A recent, equally splendid article by Tina Rosenberg in The New York
Times Magazine held up Brazil as the way forward, and showed us the
limitations, in law, of the pharmaceutical companies' grip on their own
patents. Brazil has put the survival of its own people above the huffing
and puffing of Big Pharma. It has produced its own generic anti-retrovirals
at a fraction of the cost of the patented equivalent adn it is dishing them
out to every Brazilian who needs them. At first, instead of rushing
screaming to its lawyers and lobbyists in the US State Department, Big
Pharma bit the bullet and dropped its prices to compete. Under George W.
Bush, it is already preparing to put the clock back to day zero.
George W. Bush came to power on the back of a lot of very greedy people,
not least Big Pharma, which poured millions into his campaign, more than
twice the sums it gave the Democrats. Several of the godfathers and
grandfathers who packaged and promoted George W. have more than close
connections with the pharma industry. Clinton, by the end of his second
term, had started to resist Big Pharma's draconian Washington lobby and was
even timidly advocating the release of generic AIDS drugs to people who were
dying by the million for want of them. But a huge court case, brought by
Big Pharma in South Africa and now imminent, proposes to entrench patent law
at any price. The price, of course, is the lives of millions of the Third
World's citizens.
Do governments run countries anymore? Do presidents run governments?
In the cold war, the right side lost but the wrong side won, said a Berlin
wit. For the blink of a star, back there in the early nineties, something
wonderful might have happened: a Marshall Plan, a generous reconciliation of
old enemies, a remaking of alliances and, for the Third and Fourth worlds, a
commitment to take on the world's real enemies: starvation, plague, poverty,
ecological devastation, despotism and colonialism by all its other names.
But that wishful dream supposed that enlightened nations spoke as
enlightened nations, not as the hired mouthpieces of multibillion-dollar
multinational corporations that view the exploitation of the world's sick
and dying as a sacred duty to their shareholders.
Tina Rosenberg in her New York Times piece offers one of those very rare
simple solutions that are, of course, too obvious and clearheaded to be
acceptable to the health bureaucrats of the world community: Let the World
Health Organization treat global AIDS in the same way that UNICEF has
treated global vaccination, which saves 3 million lives a year and prevents
crippling diseases in tens of millions more. She calculates the cost at
around $3 billion, which she suggests isn't too bad a number if you're
heading off the collapse of a continent.
She might have added - and perhaps in her mind she did - that the sales
of just one pharma giant, Pfizer, amounted last year to $29.6 billion and
its profits to $3.7 billion. GlaxoSmithKline did even better, with lower
sales of $27.5 billion and greater profits of $5.6 billion. And all for the
love of mankind.
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Om, Shalom, Salaam.
Em Hotep, Peace Be,
All My Relations.
Omnia Bona Bonis,
Adieu, Adios, Aloha.
Amen.
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