Medical ImperialismNYC 05 Sep 2007 21:39 GMT
The Body Hunters: Testing New Drugs on the World’s Poorest Patients is a book in which investigative journalist Sonia Shah exposes the exploitation of impoverished patients as a result of outsourcing clinical trials to the developing world.
Shah describes the practices of the “pharma monolith” which excels in creating markets by convincing people to pop pills even when there is very little evidence that it actually helps. Before these drugs are snatched up by the “drug marinated” West they must first be screened for overly obvious negative effects. This is done on the bodies of the world’s poor.
In the last decade pharmaceutical companies have quietly moved over half of their clinical trials to developing countries. The advantages of testing in Africa, Asia, Latin America and Eastern Europe are numerous: the availability of sick people, the extent to which their illness tends to progress, the lack of ethical oversight etc. Lured by the promise of receiving Western-style care, impoverished patients are more than willing to surrender themselves for experimentation. As one clinician gushes: “the best thing about Zambia is that they just cannot say no.”
But it is the instances when patients could clearly benefit from a trial that turn out to be the most ethically contentious. The placebo control, despite its unquestionable scientific merit, demands that one half of the patients enrolled in a study are not given any treatment. In a trial for a novel AIDS drug this means that doctors and scientists watch and do nothing as one half of their HIV-positive patients deteriorate, despite the existence of proven antiretroviral treatments, a situation which would incite outrage and disgust in Europe and the US. This type of double standard is typically dismissed with a passive fatalism on behalf of the researchers, federal regulators and pharmaceutical executives. ‘They are poor and wouldn’t get treated anyway’ is what they seem to say.
Shah does not attempt to mask the complexity of the issue. Patients and facilities do occasionally benefit from joining trials. And governments of developing countries actively advertise the bodies of their own populace as the best material for experimentation, in the hope of luring millions of dollars worth of clinical trial money. Similarly, pharmaceutical executives are not the only ones that are held responsible. Scientists are continuously revealed as shockingly callous in their ruthless pursuit of data.
With the soft cover version due to be published by the New Press in fall of 2007, Sonia Shah has made an essential contribution by being among the first to broach the topic at a critical time. The book is written in a clear and engaging manner, with insightful description of cases. The abuse inherent in the current system of testing drugs in the developing world is painfully clear and so is the need for deep, radical change in the way clinical trials are handled.