The Mild Torture Economy

Carl Elliott

  • Medical Research for Hire: The Political Economy of Pharmaceutical Clinical Trials by Jill Fisher
    Rutgers, 257 pp, £23.50, January 2009, ISBN 978 0 8135 4410 6
  • When Experiments Travel: Clinical Trials and the Global Search for Human Subjects by Adriana Petryna
    Princeton, 258 pp, £18.95, June 2009, ISBN 978 0 691 12657 9
  • The Professional Guinea Pig: Big Pharma and the Risky World of Human Subjects by Roberto Abadie
    Duke, 184 pp, £15.99, October 2010, ISBN 978 0 8223 4823 8

The last few years haven’t been the best for the business of medical research. There was the Sanofi-Aventis researcher in California who was arrested waving a loaded handgun; police found a package of cocaine stuffed in his underwear. There was the psychiatric researcher in Oklahoma City whose medical licence was suspended after he infected two patients with genital herpes, and who was investigated by the FDA after he barred a research subject from leaving his clinical trial facility. In Miami, investigative reporters for Bloomberg Markets magazine discovered that a contract research organisation called SFBC International was testing drugs on undocumented immigrants in a rundown motel; since that report, the motel has been demolished for fire and safety violations. Several pharmaceutical companies have been caught up in controversial cases of suicide, such as that of Dan Markingson, a young man who stabbed himself to death while taking Seroquel in an AstraZeneca trial at the University of Minnesota, and Traci Johnson, who hanged herself in a study of Cymbalta at the Eli Lilly trial site in Indianapolis. Britain had its own disaster at Northwick Park Hospital in north-west London, where six healthy subjects nearly died in a ‘first in man’ study of a monoclonal antibody. And Pfizer has spent longer than a decade dealing with the fallout of a study in Kano, Nigeria, in which 11 children died during a meningitis trial allegedly rigged to show that the antibiotic Trovan was superior to a competitor’s drug. The Trovan case has wound its way through various courts for years, generating millions of dollars in damages and a stubborn public relations problem for Pfizer.

It is time for a ‘rebranding’ campaign, according to the Center for Information and Study on Clinical Research Participation. CISCRP is a non-profit group funded by pharmaceutical companies, academic health centres and contract research organisations. According to CISCRP, the public image of the pharmaceutical industry ranks alongside that of used-car dealerships and tobacco companies, and too often the media portray pharmaceutical research as ‘deceptive and evil’. So CISCRP has launched a new public relations initiative, called ‘Medical heroes can be found in everyday places.’ Funded by the pharmaceutical company Eli Lilly and orchestrated by Ogilvy Healthworld, the purpose of the initiative is to transform the image of the clinical trial volunteer from ‘guinea pig’ to ‘medical hero’. CISCRP has produced a slick public service announcement; it is sponsoring ‘clinical research education days’ all over America; and it is distributing posters, DVDs and shiny ‘Medical Hero’ badges to research subjects. Apparently the strategy is working: subject recruitment is up in areas where the campaign has run. Even bioethicists are pitching in. A team from the Department of Clinical Bioethics at the National Institutes of Health recently argued in the Journal of the American Medical Association that signing up for clinical trials is a prima facie moral duty owed by every citizen.

Over the past 20 years or so, without much fanfare, clinical research has undergone a remarkable free-market conversion. Until the early 1990s, most pharmaceutical research on human subjects was conducted by physicians in universities and teaching hospitals. (The FDA, which must approve drugs before they can be marketed, doesn’t conduct clinical trials itself.) However, pharmaceutical companies have been in search of cheaper, more efficient venues and today about 70 per cent of clinical trials take place in the private sector, often in the offices of private physicians or at dedicated sites. Clinical research has become a multibillion-dollar global industry, spawning spin-off businesses that barely existed 25 years ago, from patient recruitment firms and medical communication agencies to for-profit research ethics boards. The most important new players are contract research organisations (CROs) such as Parexel, Quintiles, PPD and Covance, which have built themselves into corporate giants by taking up the management of clinical trials. The research that many of us used to imagine as a humanitarian enterprise, carried out by selfless scientists and funded by Pink Ribbon campaigns and ‘Race for the Cure’ marathons, is actually a thoroughly Taylorised corporate system, outsourced and streamlined for maximum efficiency.

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