I ought to write a proper review for this but its very deep and complex and requires a lot of thought. Whenever I think about a review too long I never write it though! I shall try this time.


Notes as I was reading.
It is quite a frightening exposé of the American drug industry and how the FDA and the Government all conspire to keep it as the highest profit industry in the country.

Three things I've learned so far:

1. If you ask your doctor for meds you've seen advertised on the tv and he happily prescribes them, you need to change your doctor. He should be doing the diagnosing and prescribing, not you. Drug advertising began because doctors didn't prescribe enough drugs to satisfy big Pharma, so they advertised them like any other consumer item.

2. Always ask for an older drug, especially a generic drug. Drugs are not tested to see if they are more efficient than existing ones only that they work better than nothing. Really dreadful side effects may well be ignored by the FDA (which is why you see so many drug recalls and class actions later).

3. If your doctor tries to suggest a new experimental drug or enroll you in a drug trial or in any way gives you a drug that is not freely available at a pharmacist - beware. He may have enrolled you in a drug trial without exactly full disclosure but then back in 2005 he would have got up to $12,000 a patient for that, probably a lot more now. ( )

The World Bank and International Monetary Fund (IMF), with their billions of dollars in strings-attached loans, lay heavy hands on the health care of the global poor. According to the bank, "improved water and sanitation," the very public works that lifted the West out of its infectious soup, were "not particularly cost effective as a health measure."

And so in Zaire, for example, World Bank and IMF "economic recovery" measures require the government to slash its spending on social services. In a single year the government fired more than eighty thousand teachers and clinicians. In Zambia, within just two years of such programs, the nutritional and health status of children had plummeted, canaries in a coal mine. Infant mortality rose by 25 percent while life expectancy dropped from fifty-four to forty years. In Argentina, polio and DPT immunizations fell by nearly 25 percent between 1992 and 1998, and throughout Latin America previously controlled diseases such as cholera and dengue fever re-emerged at epidemic levels.

If you find the above excerpt shocking, read on. Sonia Shah's well-researched and well-argued investigation into the global health economy generally, and the global conduct of clinical trials more specifically, is absolutely terrifying. I've never been able to say this about a non-fiction book before: it was gripping. The only reason I could ever force myself to put it down was because I would become too infuriated by what I was reading to think straight anymore.

Shah is a phenomenal investigator, and she doesn't hesitate to name names (and corporations) in this no-holds-barred exposé of the pharmaceutical industry and the way in which clinical trials are conducted at the expense of subjects in the global south, to the advantage of patients in the first world. Shah demonstrates a firm understanding of the clinical trials paradigm and the motivations behind the primary bias-reducing strategies she chooses to pick on. She goes deep into the controversies surrounding HIV vaccine trials, the use of placebos in third-world countries, the lack of access to proven therapies for subjects when the trials end, and the intentional overlooking of consent requirements in third-world trials. She paints a vivid (and accurate) picture of the incentive structure driving the world pharmaceutical industry, and the resulting mis-appropriation of research efforts into "me-too" drugs and the creation of markets and diseases which didn't exist before, rather than into the development and dissemination of important drugs which could treat the real problems and diseases plaguing the global south.

An excellent read, recommended for anyone who has interest in clinical trials broadly, medical research ethics, global justice, or the impact of robust conceptions of intellectual property rights. ( )

Just made it through Sonia Shah's The Body Hunters (indictment of Big Pharma's drug research on disempowered peoples); I think I would have been more impressed prior to reading Smith and Roberts.

Excellent discssion of the ethical issues surrounding contemporary drug-testing, focusing on (but not limiting itself to) the current pattern of exporting more and more drug trials to developing nations. Shah gives a comprehensible overview of the technical issues of conducting drug trials -- the desire for a population that has high incidence of the disease, has never been treated for the disease, and which is not getting treatment for any other disease; the desire to test against placebos instead of existing treatment; the all-important distinction between experimentation and treatment. Against that technical backdrop, she discusses the history of global health inequities (many of which have been caused or deepened by protectionist intervention from the Global North), the advent and erosion of U.S. regulation of the pharmaceutical industry, the ethical history of U.S.-based medical testing, the adoption and erosion of international ethical codes, and the financial conflicts of interest that entangle our ethical gatekeepers.

In the end, Shah is not so much against pharmaceutical testing as she is against the hypocrisy and mythologizing that often surrounds pharmaceutical testing. When a company says that an experimental protocol should be permitted because it is "for society's benefit," will the society that bears the burden of the experimentation also be one of the societies that benefits from the resultant drug? Is the societal good available in the here-and-now, or is it available in "some speculative future when prices fall, or poverty ends"? Will the new knowledge actually benefit a society-at-large (e.g. a treatment for a previously untreatable disease) or does it benefit only corporate shareholders (e.g. a replacement drug for a soon-to-expire patent)? Unfortunately, as Shah documents, the pretty rhetoric about societal benefits often doesn't match the observed realities.

We have two options, as Shah sees it. We could "mothball the mythology" that surrounds drug-testing, the mythology that frames the exploitation and human rights violations as "side-effects", and hold the drug industry to the same moral standards that we (try to) hold other self-serving industries to. Or we could demand that drug companies and medical researchers live up to the myths, and hold them accountable for actually doing the mythic work that they claim to do. The latter would require a political movement, Shah is well aware. In the meanwhile, she asserts, we need to find ways to do medical experimentation fairly.