Guinea Pigs and "The Constant Gardener"
My wife and I watched the movie “The Constant Gardener” last night. It’s a somewhat depressing film about a British diplomat in Kenya, Justin Quayle, whose wife is mysteriously murdered. Although he is by nature a submissive man who prefers the quiet, controlled solitude of a greenhouse to the messiness of the world, the catastrophic death of his wife forces him to take a stand against his superiors, and he uncovers a sinister plot to take advantage of the poor in Kenya.
The movie itself is very well made. It moves carefully and precisely, at a pace appropriate to the personality of the main character. The cinematography is excellent, the story is pretty good, and the acting is fantastic.
But movie-making skills to one side, the subject matter is disturbing. Over the course of the movie Justin learns that the British government has agreed to help a large Canadian pharmaceutical firm test an experimental new drug on native Kenyans. In exchange for the British government casting a blind eye to the pharmaceutical company’s lack of ethics, the company will invest millions of dollars into economically depressed areas of England. The Kenyan test subjects are not informed about the tests, do not consent to be a part of the trial, and many of them suffer fatal side effects that are suppressed from the official results. Justin learns that his wife uncovered this plot and told the British Government, who in turn had her “silenced.” Sounds like fantasy, right?
Well, I would have thought so to, had I not just read an article in Wired about the outsourcing of clinical trials to poverty-stricken areas of countries such as India. The article, titled “A Nation of Guinea Pigs”, won’t be available online until March 1st, so I can’t link to it here, but the gist is that major pharmaceutical companies are starting to do clinical medical trials for new drugs in the rural areas of countries such as China, India, and Brazil.
While not quite the same scenario as the movie, the article follows the impacts, both positive and negative, of such trials in a small hospital in rural India. In a region where medical care of any sort is scarce, doctors and hospitals are more than happy to enroll their patients in medical trials that will bring in significant amounts of cash:
This is pretty scary to me. I mean, I suppose this is not exactly an isolated case and possibly the same sorts of things happen everywhere, all the time. Life is all about compromises. But, I think that with a heart tenderized by the movie “The Constant Gardener” it is really hard for me to read about these kinds of ethical decisions and not cringe in disgust and frustration.
The article points out that part of the problem is the “reticence” of Americans and other westerners to participate in clinical trials for experimental drugs. The bottom line is that we rely heavily on these drugs, and they have to be tested before they can be approved. If intelligent, well informed Americans won’t participate, then someone has to. And unfortunately those “someones” happen to be the poor of the world.
Indeed, in January last year the Indian government did away with a law that had previously restricted clinical trials to “drugs proven safe in trials conducted in the country of origin…India, the brilliant hub of outsourced labor, was positioning itself in a newly lucrative role: guinea pig to the world.”
Shouldn’t we be appalled by this? I know we can’t interfere in the way other countries run themselves, and India is free to do whatever they want, but this just seems to be so wrong to me. I don’t even know who to blame, because everyone is culpable – the Indian doctors running these trials, the Indian government who want the trials, the big pharmaceuticals for outsourcing the trials, the western patients who desire more and more drugs… the problem eventually comes all the way back to me. No-one is really innocent here. Except maybe the folks who are being experimented on…
Back in India Dr. Kalantri says:
To be fair to Dr. Kalantri, he expresses a lot of hesitation about the trials. But not everyone worries about potential ethical problems. The CEO of a New Delhi company that is in charge of clinical trials for pharmaceutical companies says: “Are patients here more reliable? Obviously. They’re poor. They’re illiterate.”
So, does that make it acceptable?
I say, absolutely not. We should never compromise the sanctity of human life in the name of science.
Never.
This has to stop.
The movie itself is very well made. It moves carefully and precisely, at a pace appropriate to the personality of the main character. The cinematography is excellent, the story is pretty good, and the acting is fantastic.
But movie-making skills to one side, the subject matter is disturbing. Over the course of the movie Justin learns that the British government has agreed to help a large Canadian pharmaceutical firm test an experimental new drug on native Kenyans. In exchange for the British government casting a blind eye to the pharmaceutical company’s lack of ethics, the company will invest millions of dollars into economically depressed areas of England. The Kenyan test subjects are not informed about the tests, do not consent to be a part of the trial, and many of them suffer fatal side effects that are suppressed from the official results. Justin learns that his wife uncovered this plot and told the British Government, who in turn had her “silenced.” Sounds like fantasy, right?
Well, I would have thought so to, had I not just read an article in Wired about the outsourcing of clinical trials to poverty-stricken areas of countries such as India. The article, titled “A Nation of Guinea Pigs”, won’t be available online until March 1st, so I can’t link to it here, but the gist is that major pharmaceutical companies are starting to do clinical medical trials for new drugs in the rural areas of countries such as China, India, and Brazil.
While not quite the same scenario as the movie, the article follows the impacts, both positive and negative, of such trials in a small hospital in rural India. In a region where medical care of any sort is scarce, doctors and hospitals are more than happy to enroll their patients in medical trials that will bring in significant amounts of cash:
”Patients in Sevagram are poor enough that the benefits of taking part in the study would amount to a health care windfall; among other things, Boehringer Ingelheim guaranteed participants two physicals during each of the three years [of the trial]… moreover, the hospital would receive about $665…Kalantri [the doctor in charge] talked the matter over with the chair of the hospital’s ethics committee, and the two concluded that the trial drug itself, with its possible side effects and limited efficacy, would provide little benefit to their patients. Then they went ahead and signed up.”(emphasis added)
This is pretty scary to me. I mean, I suppose this is not exactly an isolated case and possibly the same sorts of things happen everywhere, all the time. Life is all about compromises. But, I think that with a heart tenderized by the movie “The Constant Gardener” it is really hard for me to read about these kinds of ethical decisions and not cringe in disgust and frustration.
The article points out that part of the problem is the “reticence” of Americans and other westerners to participate in clinical trials for experimental drugs. The bottom line is that we rely heavily on these drugs, and they have to be tested before they can be approved. If intelligent, well informed Americans won’t participate, then someone has to. And unfortunately those “someones” happen to be the poor of the world.
“As many as half of all clinical trials are already conducted in locations far from the pharmaceutical companies’ home base, in countries like India, China, and Brazil. And many industry analysts expect the market to skyrocket…the market in India for outsourced trials will hit $1.5 billion by 2010… drug trial outsourcing is seen as the fast route to economic and scientific growth – a money train that the country can’t afford to miss.”
Indeed, in January last year the Indian government did away with a law that had previously restricted clinical trials to “drugs proven safe in trials conducted in the country of origin…India, the brilliant hub of outsourced labor, was positioning itself in a newly lucrative role: guinea pig to the world.”
Shouldn’t we be appalled by this? I know we can’t interfere in the way other countries run themselves, and India is free to do whatever they want, but this just seems to be so wrong to me. I don’t even know who to blame, because everyone is culpable – the Indian doctors running these trials, the Indian government who want the trials, the big pharmaceuticals for outsourcing the trials, the western patients who desire more and more drugs… the problem eventually comes all the way back to me. No-one is really innocent here. Except maybe the folks who are being experimented on…
Back in India Dr. Kalantri says:
“When I try to explain that a drug is experimental, that it might not work, the understanding is not there. One woman said to me, ‘What do you mean, the drug might not work? All drugs work!’ “
To be fair to Dr. Kalantri, he expresses a lot of hesitation about the trials. But not everyone worries about potential ethical problems. The CEO of a New Delhi company that is in charge of clinical trials for pharmaceutical companies says: “Are patients here more reliable? Obviously. They’re poor. They’re illiterate.”
So, does that make it acceptable?
I say, absolutely not. We should never compromise the sanctity of human life in the name of science.
Never.
This has to stop.
posted by Jonathan Ziman at
10:21 PM
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