THE BIGGEST PUSHERS OF ALL

Excerpted from an article by John Le Carr in THE SPECTATOR, December 23, 2000.

John le Carr‚ on his new novel, The Constant Gardner, and why decent people should rebel against the cant corruption and greed of the international drugs companies.

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 interference, stunt the emergence of young democracies in the name of democracy.

And while they did this -- whether in South-east 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 of conservatives and, in my country, New Labour alike. It holds to its bosom the conviction that, whatever profit-driven corporations do in the short term, they are ultimately motivated by ethical concerns, and their influence upon the world is therefore beneficial -- and so God help us all.

In the name of this deluded theory, we look on, apparently helpless, while rain-forests 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 globe are invaded and desecrated, and tropical paradises are turned into rotting wastelands with sprawling, disease-ridden mega- cities at their centre.

And of all these crimes of unbridled capitalism it seemed to me that the pharmaceutical industry offered the most eloquent example. I might have gone for the scandal of spiked tobacco, deliberately designed by Western manufacturers to cause addiction -- and cancer -- in 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 the 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.

But the pharmaceutical world, once I entered it, got me by the throat and wouldn't let me go. It had everything: the hopes and dreams we have of it; its vast, partly realised potential for good; and its pitch-dark underside, sustained by corporate cant, hypocrisy, corruption and greed.

And it is not only the obvious sins that the pharma giants have to answer for: the dumping of inappropriate or out-of-date medicines on people they reckon won't know the difference; the arbitrary over-pricing of their products, underpinned by the draconian exercise of patent rights. It is not the deliberate widening of a drug's specifications at whatever cost to the patient in order to broaden its sales-base -- so that, for instance, a drug that in this country or the USA would be prescribed only for extreme cancer pain is represented to Africans as a simple headache cure.

It is not even the suppression of contra-indications and side-effects, and the repeated campaigns, supported by the US government, to halt the manufacture of generic drugs by countries that can't afford inflated Western prices. When the Thais wanted to manufacture their own generic drugs, for instance, the US state department threatened to impose sanctions on the import of Thai timber.

No, it's bigger even than all that -- and, in the long run, worse. The pharmas, whether they know it or not, are engaged in the systematic corruption of the medical profession, country by country.

Do we ever think to ask our MD, when he or she prescribes a drug for us, whether he or she is being paid by the drug company to prescribe it? Of course we don't. It's our child. Our wife. It's our heart or kidney or prostate. And, thank God, most doctors have refused the bait. But others have not, with the consequence, in the worst cases, that their medical opinions are owned not by their patients but by their sponsors.

Do we ever ask our governments to tell us what cash payments and benefits in kind are on offer to our doctors from the pharmaceutical companies -- the 'seminars' and 'training courses' in sunny holiday resorts, with free travel for yourself and your partner, and accommodation thrown in?

Do we ever ask our corner-street pharmacist, when he hands us the latest new-blue, all-conquering headache cure, why it costs six times as much as a bottle of aspirin, and what exactly it does that aspirin can't do? Mostly we are simply too diffident, too scared, too lazy, too polite.

Do we ever ask ourselves just why the pharmas have taken to direct advertising, to us the public, over the heads of the medical profession?

Do we ever stop to wonder 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 trickle of alarming cases in recent years where inconvenient scientific findings have been suppressed or rewritten, and those responsible for them 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.

In The Constant Gardener I made an amalgam of these unfortunate cases and called them Lara. She is a chemical research scientist in Canada -- hounded by the pharma giant that hired her, and by the academic colleagues whose livelihoods, like hers, depend on its favour. Multiply those concerns by tens and you begin to understand the corrupting power of pharmaceutical companies when they operate in emerging countries and can delegate huge slush funds to local 'managers' who know how to get a drug accepted by local officials and ministers.

Doubtless there are companies with clean records. There are even a few genuine heroes among them. But they are not my subject. My subject -- and the subject of The Constant Gardener -- is the dilemma of decent people struggling against the ever-swelling tide of heedless corporate greed, and our own complacency in letting the corporations get away with it -- even, at government level, helping them to do so in the joint names of profit and full employment.

Perhaps we do indeed need a great new movement, an international, humanitarian movement of decent men and women, that is not doctrinal, not political, not polemical, but gathers up the best in all of us: a Seattle demo without the broken glass.

The mainstream media, I decided as I went on my journey, have failed us completely, here and in the USA. The subject is just too damned uncomfortable to handle: too complicated, often deliberately, too scientific for the layman. Many hacks who should know better have been lunched, holidayed and bamboozled into silence. Fake nostrums are taken as gospel. For every new drug that reaches the market, the spinners assure us, $600 to $800 million have been spent in research and development. Yet the companies' accounts, where they are visible, rarely support these claims. And many compounds are acquired by pharmaceutical companies after they have been partly developed at taxpayers expense.

When we read that pharma giants have donated their products to the Third World, we think: so that's all right then. But it isn't. For one thing, the Third World doesn't want to live on free handouts, and least of all of drugs that have been superseded in the West. For another, we're not talking philanthropy but profit, business expediency and market protection.

When a US corporation donates medicines to the Third World, it gets a tax break, rids itself of the cost of warehousing old stock, and saves itself destruction costs. It also gets to look like a saint. Above all --witness the 'philanthropically donated' triple-therapy Aids cocktail that has yet, in reality, to be donated -- their charity heads off the local manufacture of generic drugs than which, in the eyes of the donors, there is no greater evil. To call it enlightened altruism is to do the pharmas a favour.

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, the most prestigious of them all, recently confessed to its chagrin that some of its contributors have turned out to have had undeclared connections with the pharmaceutical industry. As for 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. So-called 'opinion leaders' -- i.e., research professors -- have even been known to add their names to articles that have helpfully been written for them back at the shop.

As I storm off, here's an appeal for your charity. One of the pluckiest pharmawatch organisations, BUKO* of Bielefeld, a caring body of responsible doctors and activists devoted to highlighting the excesses of the pharmas, has recently been told by the EU that its application for funding for the years 2001-2003 has been turned down. The EU professed to be in favour of BUKO's application, but a mysterious 'expert committee' has popped up just in time to torpedo it. It seems that BUKO were deemed unsound on the maintenance of patent laws in the Third World.

And, as a last thought, please consider this. The 'triple' Aids therapy presently on offer in the USA costs $10,000 per patient per year. All its components are patented. A US generic manufacturer, asked to calculate, the price of the same therapy if he didn't have to respect patents, put it at $230 per patient per year, and he'd still make a profit. In Brazil, Thailand or India, the cost would be even lower. Nice work if you can get it.

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The Constant Gardener is published by Hodder &' Stoughton and is available as an audio book read by John le Carr

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