In Place of Nations
by John le Carre
The Nation magazine, April 9, 2001
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 Southeast 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 makes Siamese twins of
Tony Blair, Margaret Thatcher, Ronald Reagan, Bill Clinton and
George W. Bush. It holds to its bosom the conviction that, whatever
vast commercial corporations do in the short term, they are ultimately
motivated by ethical concerns, and their influence upon the world
is therefore beneficial. And anyone who thinks otherwise is a
In the name of this theory, we look on apparently helpless
while rainforests 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 world are invaded
and desecrated, and tropical paradises are turned into rotting
wastelands with sprawling, disease-ridden megacities at their
And of all these crimes of unbridled capitalism, it seemed
to me, as I began to cast round for a story to illustrate this
argument in my most recent novel, that the pharmaceutical industry
offered me the most eloquent example. I might have gone for the
scandal of spiked tobacco, designed by Western manufacturers to
cause addiction and incidentally cancer in Third World 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 by a wicked and corrupt totalitarian
But the multinational pharmaceutical world, once I entered
it, got me by the throat and wouldn't let me go. Big Pharma, as
it is known, offered everything: the hopes and dreams we have
of it; its vast, partly realized potential for good; and its pitch-dark
underside, sustained by huge wealth, pathological secrecy, corruption
I learned, for instance, of how Big Pharma in the United States
had persuaded the State Department to threaten poor countries'
governments with trade sanctions in order to prevent them from
making their own cheap forms of the patented lifesaving drugs
that could ease the agony of 35 million men, women and children
in the Third World who are HIV-positive, 80 percent of them in
sub-Saharan Africa. In pharma jargon, these patent-free copycat
drugs are called generic. Big Pharma likes to trash them, insisting
they are unsafe and carelessly administered. Practice shows that
they are neither. They simply save the same lives that Big Pharma
could save, but at a fraction of the cost.
Big Pharma did not invent these lifesaving drugs that they
have patented and arbitrarily overpriced, incidentally. Anti-retrovirals
were for the most part discovered by publicly funded US research
projects into other diseases, and only later entrusted to pharmaceutical
companies for marketing and exploitation. Once the pharmas had
the patent, they charged whatever they thought an AIDS-desperate
Western market would stand: $12,000 to $15,000 a year for compounds
that cost a few hundred to run up. Thus a price tag was attached,
and the Western world, by and large, fell for it. Nobody said
it was a massive confidence trick. Nobody remarked that, while
Africa has 80 percent of the world's AIDS patients, it comprises
1 percent of Big Pharma's market.
Do I hear you offering the drug companies' time-worn excuse
that they need to make huge profits on one drug in order to finance
the research and development of others? Then kindly tell me, please,
how come they spend twice as much on marketing as they do on research
I was also told about the dumping of inappropriate or out-of-
date medicines by means of "charitable donations" in
order to get rid of unsalable stock, avoid destruction costs and
earn a tax break. And about the deliberate widening of a drug's
specifications in order to broaden its sales base in the Third
World. Thus, for instance, a drug that in Western Europe or the
States would be licensed only for extreme cancer pain might be
sold in Nairobi as a simple headache cure-and at several times
the cost of buying it in Paris or New York. And in all probability
no contraindications would be provided.
And then of course there is the patent game itself. One compound
can carry a dozen or more patents. You patent the manufacturing
process. You patent the delivery system, pills, medicine or serum.
You patent the dosage, now daily, now weekly, now twice weekly.
You patent, if you can, every footling event in the drug's life
from research lab to patient. And for every day that you fend
off the generic manufacturer, you earn yourself another fortune,
because markup, for as long as you own the patent, is astronomic.
But Big Pharma is also engaged in the deliberate seduction
of the medical profession, country by country, worldwide. It is
spending a fortune on influencing, hiring and purchasing academic
judgment to a point where, in a few years' time, if Big Pharma
continues unchecked on its present happy path, unbought medical
opinion will be hard to find.
And consider 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 flow 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.
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, America's most prestigious, recently confessed to its
chagrin that some of its contributors have turned out to have
had undeclared connections with the pharmaceutical industry. As
to 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 And more than one "opinion leader"-i.e., research
professor has been known to add his name to an article that has
helpful been written for him back at the shop.
The general press, by contrast, has started to serve the public
a great deal better than it used to, particularly in the United
States. Perhaps they are a little less worried about their advertisers.
A Washington Post eleven-month investigation last year into the
malpractices of US and multinational pharmas in poor countries
culminated in a series of devastating articles that should earn
the writers a Pulitzer Prize, the thanks of all decent people
and the naked loathing of the industry.
A recent, equally splendid article by Tina Rosenberg in The
New York Times Magazine held up Brazil as the way forward, and
showed us the limitations, in law, of the pharmaceutical companies'
grip on their own patents. Brazil has put the survival of its
own people above the huffing and puffing of Big Pharma. It has
produced its own generic anti-retrovirals at a fraction of the
cost of the patented equivalent and it is dishing them out to
every Brazilian who needs them. At first, instead of rushing screaming
to its lawyers and lobbyists and the US State Department, Big
Pharma bit the bullet and dropped its prices to compete. But for
how long? Under George W. Bush, it is already preparing to put
back the clock to day zero.
George W. Bush came to power on the back of a lot of very
greedy people, not least Big Pharma, which poured millions into
his campaign, more than twice the sums it gave the Democrats.
Several of the godfathers and grandfathers who packaged and promoted
George W. have more than close connections with the pharma industry.
Clinton, by the end of his second term, had started to resist
Big Pharma's draconian Washington lobby and was even timidly advocating
the release of generic AIDS drugs to people who were dying by
the million for want of them. But a huge court case, brought by
Big Pharma in South Africa and now imminent, proposes to entrench
patent law at any price. The price, of course, is the lives of
millions of the Third World's citizens.
Do governments run countries anymore? Do presidents run governments?
In the cold war, the right side lost but the wrong side won, said
a Berlin wit. For the blink of a star, back there in the early
nineties, something wonderful might have happened: a Marshall
Plan, a generous reconciliation of old enemies, a remaking of
alliances and, for the Third and Fourth Worlds, a commitment to
take on the world's real enemies: starvation, plague, poverty,
ecological devastation, despotism and colonialism by all its other
But that wishful dream supposed that enlightened nations spoke
as enlightened nations, not as the hired mouthpieces of multi-billion-dollar
multinational corporations that view the exploitation of the world's
sick and dying as a sacred duty to their shareholders.
Tina Rosenberg in her New York Times piece offers one of those
very rare simple solutions that are, of course, too obvious and
clearheaded to be acceptable to the health bureaucrats of the
world community: Let the World Health Organization treat global
AIDS in the same way that UNICEF has treated global vaccination,
which saves 3 million lives a year and prevents crippling diseases
in tens of millions more. She calculates the cost at around $3
billion, which she suggests isn't too bad a number if you're heading
off the collapse of a continent.
She might have added-and perhaps in her mind she did- that
the sales of just one pharma giant, Pfizer, amounted last year
to $29.6 billion and its profits to $3.7 billion. GlaxoSmithKline
did even better, with lower sales of $27.5 billion and greater
profits of $5.6 billion. And it's all for love of mankind.
Copyright David Cornwell 2001. John le Carre s most recent
novel, The Constant Gardener (Scribners), begins with the murder
of a woman who had been about to expose misdeeds by a pharmaceutical
company. The fee for this article is being donated to the activist
group BUKO Pharma-Kampagne (www.epo.de/bukopharma), whose address
is. August-Bebel-Str. 62, D-33602, Bielefeld, Germany.