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 neo-Communist heretic.

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 center.

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 regime.

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 and greed.

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 and development?

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 names.

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 (, whose address is. August-Bebel-Str. 62, D-33602, Bielefeld, Germany.

Corporate watch

Index of Website

Home Page