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March 2001
Vol. 4, No. 3, p
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Tinker, Tailor . . .
John Le Carré is one of the best fiction writers of our time. His books examine the post-World War II world with a discerning eye for the impact of global conflict on the individual. His classic 1975 novel, Tinker, Tailor, Soldier, Spy, is a masterful portrait of the personal price paid by his protagonist, George Smiley, as he dueled with the Soviet Union to ferret out spies in London and Berlin, and eventually spymasters in Moscow. Loss of friendship and dissolution of marriage were but two of the burdens borne by Smiley as he labored in the service of his British government ministers.

Now, Mr. Le Carré has a new book, his 18th. Entitled The Constant Gardener, it details the personal price paid by British career diplomat Justin Quayle, who is searching not for spies in Europe, but for executives of global pharmaceutical conglomerates that exploit the African population in a quest to find the next blockbuster drug, in this case one to treat tuberculosis. Quayle pays a high price in blood—first his wife’s and eventually his own. If you accept the premise that Mr. Le Carré’s novels are a reflection of the times in which they are written, then how did we get from the 1970s villain, Karla the communist spymaster, to 2001’s villain, Sir Kenneth Curtiss, pharmaceutical company president?

Maybe there is some fact along with this fiction. Consider that last December, The Washington Post published a six-part series on clinical drug trials in Africa entitled “The Body Hunters” (available at http://washingtonpost.com/wp-dyn/world/issues/bodyhunters). This series documents the way overseas drug experiments are changing the manner in which new drugs are tested and approved. The series also gives some unsettling examples of how the quest for clinical data “raises questions about corporate ethics and profits on a frontier of globalization where drug companies wield enormous influence, and where doctors paid by U.S.-based corporations sometimes perform experiments on ill-informed patients in authoritarian societies.” Partly in response to this series, the U.S. Department of Health and Human Services has established a new program to educate researchers and monitor international ethical concerns raised by clinical trial experiments in Third World countries.

Another problem in this mix of profit and sometime corporate mendacity is the fact that most of the people on whom these drugs are tested will never be able to afford them when approved. For example, consider that eflornithine—known colloquially as “the resurrection drug” for its ability to bring people back from a coma caused by trypanosomiasis, or sleeping sickness—is about to be made available in Africa primarily because the drug has a second, much more profitable use: It eliminates facial hair in women. Were it not for this effect, it is doubtful that development and production of eflornithine would proceed.

It’s a strange business, this mixing of medicine and economics—and one that we explore in this issue of Modern Drug Discovery. In particular, financial expert Milton Zall delineates the dilemma companies face in pricing drugs. On page 25, Assistant Editor Cullen Vogelson details the economics of getting a clinical trial off to a good start. Also in this issue, Staff Editor Michael Felton describes the latest Web wrinkle in the always expensive process of gaining—and keeping—patents.

The pharmaceutical industry is not like any other. We would all like to believe that the work we do will have influence beyond the small sphere of our friends and colleagues, but those who work in drug discovery really can change the world. These changes should not be only for rich and developed countries, and they should not be based on exploitation of the uneducated. Else Mr. Le Carré’s fiction becomes evermore fact.

James Ryan

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