October 26

THE CONSTANT GARDENER–John le Carre’s novel about Big Pharma gets rave reviews

THE CONSTANT GARDENER–John le Carre’s novel about Big Pharma gets rave reviews

Sat, 3 Sep 2005

Constant Gardener, the movie based on the novel by John le Carre, about the pharmaceutical industry’s immoral and even criminal activities,  opened nationwide.  

It has already received rave reviews. Below are two reviews from The New Republic and The Chicago Tribune. Given the high marks the film has received, we can expect a blitz of protests by PhaRMA and its consultant doctors who are sure to say, it’s fiction, not reality. In fact, the film provides a glimpse into the fraudulent practices in clinical trials outsourced to the sub-standard hospitals in underdeveloped countries.  

A whistleblower’s expose about the fraudulent documentation in AIDS drug trials conducted in Uganda‹as reported by the Associated Press, validates Le Carre’s fictionalized description of pharmaceutical industry practices shielded by government.  See: https://ahrp.org/infomail/04/12/15b.php  and documents obtained by AP:http://wid.ap.org/documents/nevirapine2.html

“The Constant Gardener” begins with a strong, angry story, and peoples it with actors who let it happen to them, instead of rushing ahead to check off the surprises. It seems solidly grounded in its Kenyan locations; like “City of God,” it feels organically rooted. Like many Le Carre stories, it begins with grief and proceeds with sadness toward horror. Its closing scenes are as cynical about international politics and commerce as I can imagine. I would like to believe they are an exaggeration, but I fear they are not. This is one of the year’s best films.”

Contact: Vera Hassner Sharav



Drug Abuse
by Adam Graham-Silverman
Only at TNR Online
Post date: 09.02.05


In a crowded Kenyan hospital, diplomat Justin Quayle catches sight of a dying woman undergoing mysterious tests administered by a mysterious doctor. When he returns to get more information, a nurse insists the woman and the doctor never existed. After more investigation, Quayle learns that a British drug testing company is using the hospital to fudge results for a deadly new drug to treat tuberculosis. When a patient comes along whose side effects would skew the drug trials unfavorably, her records are destroyed and her body is dumped in a mass grave.

In a Nigerian metropolis, an American drug company drops into a horribly filthy, understaffed hospital and sets up a clinic to treat children afflicted with meningitis. While half of the patients get a proven treatment, the other half get the company’s latest antibiotic, which has yet to be tested on children. At first, the drug company plucks the most treatable children from the epidemic. Soon it offers treatment to all, though few realize they are consenting to be part of an experiment. After gathering enough data in three weeks for its approval studies, the drug company picks up and jets out.

The first scenario is the plot of The Constant Gardener, the new political thriller based on the book by John Le Carré. The second is the plot of an investigative story that ran in The Washington Post in late 2000, demonstrating once again, but not solving, that old question of art imitating life, or vice versa: As drug companies emerge as bad guys on screen, they are playing the same roles in the real-life developing world. Unlike a fantastical spy film, The Constant Gardener needs no special effects to paint this picture. Director Fernando Meirelles just turns the camera on the harsh realities of modern Africa.

Meirelles directed the Oscar-nominated City of God, which told gritty-yet-beautiful stories of growing up amid gang and drug violence in the slums of Rio de Janeiro. He brings that same aesthetic to this more straightforward tale: While the book tells the story from the perspective of the British diplomat Quayle, the movie’s point of view feels much more African. The rusted, corrugated iron roofs of Kibera, Nairobi’s largest slum, and lava-flow desert scenes shot in northern Kenya blaze an overexposed red. Meirelles does not hide the poverty and beauty of Kenya’s open-air markets or crumbling hospitals and roads. The movie’s cameras don’t fear bouncing around up close with its characters. Also to his credit, Meirelles shows AIDS’s reach into a small, rural settlement, a scene shot in Kenya but set in Sudan. (The producers took great pride in tapping local actors and workers, and they left behind an AIDS charitable trust and several public works projects. The Kenyan and British governments both aided shooting despite the fact that the movie indicts both for corruption.)

The brutal death of Quayle’s wife, Tessa, an activist played by Rachel Weisz, sets the plot in motion. The kind but detached Quayle, played empathetically by Ralph Fiennes, slowly picks up the trail his wife had been following, tracking the ties between a drug company, its agents in Kenya, and the British government. Unlike Mission Impossible II, in which terrorists threaten to infect the world, or the remake of the Manchurian Candidate, in which an international drug cartel is among those seeking to install a puppet president, Meirelles makes this movie feel real. So while there’s a car chase on a dusty plateau, no one plunges off the cliff to a fiery end or defies death with high-tech gadgets.

The film’s case against the drug companies is a less subtle affair. Even though Meirelles said he cut out a sequence of monologues lecturing about the evils of the industry, the information still comes across as didactic and Manichean, conveyed via e-mail and grainy video clips. A couple living in Kibera pop into the movie long enough for Tessa to lecture the man about his need for an AIDS test. Later, when Tessa and a local doctor see him in line for a free test sponsored by the drug company, the doctor declares: “No drug company does something for nothing.” (Meanwhile, he gives the anti-HIV drug nevirapine willy-nilly to the man’s wife when the local clinic runs out, a definite no-no that builds resistance to the drug.) This is heavy enough material to sink a summer thriller, especially given its efforts to make the people and places so believable. There’s no suspense in black-and-white morality.

It seems hard to reconcile the realist elements of the film with its fantastic-seeming tale of international intrigue. But real life is not so different. In 1996, drug giant Pfizer tested its antibiotic Trovan on children in Kano, Nigeria, during a meningitis outbreak there. According to The Washington Post, the company never produced any signed consent forms, and standard practices such as follow-up exams were declared optional. Sometimes dosages of antibiotics were reduced, undermining the science behind the study. Nigerian regulators signed off on the project in a backdated letter drafted as much as a year after the testing was finished.

Such studies do not require U.S. Food and Drug Administration approval, but the data can be used to get drugs certified at home. The FDA has accepted foreign research since 1980, but the late 1990s saw a huge boom in the practice. A six-part series in the Post in 2000 detailed how companies and governments took advantage of lax oversight or lower standards in Latin America; failed to deliver on promises of medical care in exchange for testing in China; gave placebos to patients in Thailand more often than in the United States; and offered perks and omitted mention of risks for studies in Switzerland. Point being: It’s a widespread problem, and it has only continued in recent years.

In 2001, Johnson & Johnson subsidiary Discovery Labs prepared a Latin American trial of a respiratory drug for children that would have used a placebo instead of a proven treatment–a method that would not be allowed in the United States. When the activist group Public Citizen pointed out that it would lead to deaths that could be prevented, the company redesigned the study. Ongoing tests of AIDS drug tenofovir for use as a preventive medicine have raised ethical questions in at least five countries. Again, some patients at risk for contracting HIV get placebos instead of the drug, which researchers must do to study its new use. But some of the tests may fail to address the long-term costs of this approach: If patients are infected in the course of the study, will their treatment be covered? Will the testing companies provide risk reductions such as condoms or syringes? And once this cheap and available population is used for the study, will the drug be marketed only to the developed world, where companies can charge far more?

Protests recently forced suspension of tenofovir tests in Cambodia and Cameroon. But disturbingly, in 2004 the FDA proposed that internationally accepted ethics guidelines on new drug research conducted overseas be replaced with less stringent procedural requirements. A decision on that move is still pending.

Though it’s difficult to convey in narrative drama, brand-name drug companies are using many other tactics that keep drugs from those in the developing world who need them. They have maneuvered new protections from generic competition into trade deals such as the recently completed Central American Free Trade Agreement. And despite pressure from activists, companies have done little to voluntarily lower prices of essential medicines in developing countries.

Meirelles hails from Brazil, a hot spot in the global fight against AIDS because it provides free antiretroviral drugs to its large number of infected people. Its threats to produce generic drugs have forced brand-name companies to lower their prices. The country’s struggles, along with what Meirelles saw in Africa, were among the issues that drew him to this movie. Despite its realistic depictions, the film’s difficulty in making drug company abuses compelling underscores the fact that these are very unsexy issues. But while they lack drama, it’s important to remember that exploitative drug testing isn’t always fiction, either.

Adam Graham-Silverman is a writer living in New York. This spring, he was a fellow with the International Reporting Project at Johns Hopkins University’s School of Advanced International Studies.  

The Constant Gardener
BY ROGER EBERT /September 1, 2005

 They meet as strangers who plunge at once into sudden sex. They catch their breath, marry, and begin to learn about each other. Justin is an official in the British government. Tessa is an activist. She goes to Africa without Justin, her motives unclear in his mind, and witnesses what she thinks is murder in an African hospital. Then she is murdered at a crossroads, along with Arnold, her African driver.

But who was this driver? And why, Justin needs to know, did Tessa receive an e-mail asking her, “What were you and Arnold doing in the Nairobi Hilton Friday night? Does Justin know?”

The murder of Tessa takes place right at the start of “The Constant Gardener,” so it is not revealing too much to mention it. The movie is a progress back into her life, and a journey of discovery for Justin, who discovers a woman he never really knew. The flashback structure, told in remembered moments, passages of dialogue, scenes that are interrupted and completed later, is typical of John Le Carre, whose novels resemble chess problems in which one solution is elegant and all of the others take too many moves. It is a style suited to the gifts of the Brazilian director Fernando Meirelles, whose great “City of God” (2002) told a story that was composed of countless tributaries that all flowed together into a mighty narrative stream.

 The fragmented style is the best way to tell this story, both for the novel and the movie. “The Constant Gardener” is not a logical exercise beginning with mystery and ending at truth, but a circling around an elusive conspiracy. Understand who the players are and how they are willing to compromise themselves, and you can glimpse cruel outlines beneath the public relations facade. As the drug companies pour AIDS drugs into Africa, are they using their programs to mask the testing of other drugs? “No drug company does something for nothing,” Le Carre has a character observe.

“The Constant Gardener” may be the angriest story Le Carre has ever told. Certainly his elegant prose and the oblique shorthand of the dialogue shows the writer forcing himself to turn fury into style. His novel involves drug companies who test their products on the poor of the Third World and are willing to accept the deaths that may occur because, after all, those people don’t count. Why not? Because no one is there to count them.

 Do drug companies really do this? The recent verdict against the makers of Vioxx indicates that a jury thought Merck sold a drug it knew was dangerous. Facts are the bones beneath the skin of a Le Carre novel. Either he knows what he’s talking about, or he is uncommonly persuasive in seeming to. “The Constant Gardener” plays at times like a movie that will result in indictments. What makes the film extraordinary is that it also plays as a love story, and as an examination of the mysteries of the heart.

 The performances need to be very good to carry us through sequences in which nobody, good or evil, seems very sure of the total picture. Ralph Fiennes plays Justin as a bureaucrat who seems detached from issues; he’s the opposite of Tessa. As he tries to get to the bottom of her death, he sifts through his discoveries like an accountant unwilling to go home for the day until the books are balanced.

One way of looking at Tessa’s death is that she was a hothead who had an affair with a handsome African man, went where she shouldn’t have and got caught in one of those African border killings where toll-collecting soldiers with AK-47s enforce whatever they think is the law. Another way to look at it is to give her the benefit of the doubt. To wonder what was behind the embarrassing questions she asked at a press conference. To ask why statistics seem to be missing, if a drug study is designed to generate them.

 As he probes through the wreckage of his wife’s life, Justin encounters an array of characters who could have been airlifted in from Graham Greene — or from other Le Carre novels, of course. Hubert Kounde plays Arnold Bluhm, the African who is not, in fact, Tessa’s driver, but a doctor who is her colleague. Danny Huston, tall and courtly like his father, John, and like John often smiling at a private joke, plays Sandy Woodrow, the British high commissioner on the scene. Bill Nighy, that actor who often seems to be frowning through a migraine, is Sir Bernard Pellegrin, head of the Foreign Office, and thus Justin and Sandy’s boss. And Pete Postlethwaite, looking as if he has been left out too long in the weather, is Lorbeer, a drug company man who works in the field — at what, it is dangerous to say.

“The Constant Gardener” begins with a strong, angry story, and peoples it with actors who let it happen to them, instead of rushing ahead to check off the surprises. It seems solidly grounded in its Kenyan locations; like “City of God,” it feels organically rooted. Like many Le Carre stories, it begins with grief and proceeds with sadness toward horror. Its closing scenes are as cynical about international politics and commerce as I can imagine. I would like to believe they are an exaggeration, but I fear they are not. This is one of the year’s best films.

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