'The Constant Gardener' - Film of John Le Carre's book on Big Pharma

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'The Constant Gardener' - Film of John Le Carre's book on Big

Pharma and Drug Trials in Kenya

Mon, 5 Sep 2005 11:22:26 +0100

 

 

 

 

ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)

Promoting Openness, Full Disclosure, and Accountability

2/9/05

 

www.ahrp.org

 

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 Kenya —as reported by the Associated Press,

validates Le Carre's fictionalized description of pharmaceutical

industry practices shielded by government. See:

http://www.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

 

212-595-8974

 

veracare

 

 

THE NEW REPUBLIC ONLINE

 

THE CONSTANT GARDENER AND DRUG COMPANIES.

 

Drug Abuse

by Adam Graham-Silverman

Only at TNR Online

Post date: 09.02.05

 

 

 

http://www.tnr.com/docprint.mhtml?i=w050829 & s=grahamsilverman090205

 

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. 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 ®

 

Ebert: Users:

 

 

Rachel Weisz and Ralph Fiennes know how to inhabit a landscape in " The

Constant Gardener. "

 

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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