Dying for Drugs. Channel 4, 27 April at 8 30 pm. Rating: ★★★
“They're not just pushing pills—they're pushing life or death.” Thus said Drummond Rennie, the editor of JAMA, during True Vision's documentary about Big Pharma (note the Orwellian echo). True Vision specialises in documentaries about social issues. Their work includes The Dying Rooms and Return to the Dying Rooms (about China's state orphanages) and Schoolgirl Killer (about bride abduction in Ethiopia). In Dying for Drugs their premise was that some pharmaceutical company activities in developing countries can cause deaths. Four stories made the point.
The first was about an outbreak of meningitis in Kano, Nigeria, in 1996. About 150 000 people were infected, and 15 000 died. Pfizer arrived several weeks after Médecins Sans Frontières and performed a trial of trovafloxacin, a new quinolone antibiotic. They are accused of not having obtained prior approval from an ethics committee nor informed consent from the 200 patients they studied.
In the second story we heard about Nancy Olivieri, whose tribulations have been well publicised in the medical press (BMJ 2002;325:985) and elsewhere (for example, the Economist 11 April 2002). When she discovered that deferiprone, an oral substitute for subcutaneous desferrioxamine in patients with thalassaemia, was perhaps less effective and possibly caused liver damage, she was horrified that the pharmaceutical company with which she was associated, Apotex, refused to let her tell her patients. One of her hospital colleagues sent poison pen letters to one of her supporters, and the university authorities in Toronto threatened to sack her, until David Weatherall and David Nathan intervened. Deferiprone has since been licensed in the European Union.
Meanwhile, South Koreans are demanding cheaper supplies of imatinib (Glivec) for chronic myeloid leukaemia associated with the Philadelphia chromosome after failure of interferon alfa or in accelerated phase or blast crisis. Novartis charge $19 (£12; €17) a capsule, but an Indian generics manufacturer claims that he could provide imatinib for about $1 a capsule. However, the Korean government, allegedly because of US government pressure, has not agreed to allow the drug to be supplied under a compensatory licensing agreement; under such an agreement Novartis would make a reasonable profit from the provision of a generic equivalent while they still hold the patent on the drug, but not (in India at least) on the method of its manufacture. But the bottom line was not mentioned—that, according to the summary of product characteristics, “There are no controlled trials demonstrating a clinical benefit or increased survival [with imatinib].”
Finally, a young boy dies of AIDS in Honduras because he cannot afford antiretroviral drugs nor, when he develops severe candidiasis, the fluconazole (Diflucan) that Pfizer sell at $29 a capsule. In neighbouring Guatemala fluconazole, we were told, is available at $0.30 a capsule. But we were not told that two years ago GlaxoSmithKline, under pressure from competitive generics companies, announced reductions in the prices of some antiretroviral drugs in developing countries (BMJ 2001;322:1510). Honduras is one of the lowest income countries in the Western Hemisphere; was it not included?
The programme did not explore the reasons for the behaviour of the companies that it criticised, apart from a brief, out of context digression about “me too” drugs. The complex issues, which include the enormous costs of drug development, greed (both individual and corporate), and fear of failure, would take a lot of dissection to give a balanced account, and that is not what crusading prime time television is about. I would like to see a series of programmes about the discovery, development, marketing, and monitoring of medicines, in which stories such as those we saw in this programme would be juxtaposed with some basic facts. The emotional debate that took place on Channel 4's website after the programme showed how much this is needed (www.channel4.com/health).
“Nobody seems to want to discuss these issues,” said David Weatherall, commenting in the programme on the Olivieri case, “The universities don't want to . . . governments don't want to. I think there's so much money involved, and particularly with the universities being bankrupt and looking upon this as such a valuable source, they don't want to rock the boat. But the boat really does need rocking.” This programme tried to rock the boat but didn't give us a clear view of which boat it was rocking.
Figure.
CHANNEL 4
Inability to pay for AIDS medication meant this 12 year old Honduran boy was unable to continue treatment