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Shah, Sonia - The Body Hunters: Testing New Drugs on the World's Poorest Patients
I picked this up after reading ![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
sanguinity's write up and after becoming more aware of the subject after reading Conquest and Killing the Black Body, particularly the chapters about the forced sterilization of Native and Black women (and I am sure of other women of color) and the unethical means of getting those women to agree to Norplant or Depo-Provera.
Shah's book focuses less on reproductive health and more on Big Pharma and the drug testing industry. She goes through recent history, from the rise of testing with the Salk vaccine to the Nazi and WWII-Japanese experiments on human subject to the Tuskegee Syphilis Study to testing nowadays in "third-world" countries.
She explains the many factors that led to this: the more and more stringent requirements for drug companies to first prove that their medicines do not harm and then to prove that they actually do what they say they do and the growing protection of patients. But only patients in the right countries, only patients with money, only patients with power. Points she especially emphasizes are testing experimental drugs against placebos versus testing them against the best proven treatment, as companies have found ways to worm their way around "best proven treatment." After all, if they're testing in Africa or India, those people couldn't access the best treatment anyway, so a placebo really is their best treatment. And it would be unethical to provide access to good drugs during the trial and then to take them away afterward.
I agree with her analysis, particularly the way companies take advantage of the ravages of colonialism to subject even more testing and experimentation upon the very people hurt most by colonization. However, I think at times her argument gets a little confusing, particularly when she first argues against siccing experimental drugs that may or may not hurt patients on test subjects, and then argues that a drug study was unethical because they did not provide experimental drugs they thought might or might not help, as opposed to a placebo. I think I needed a little more data and a clearer picture of what counted as "known to help" and what didn't before I could quite figure out what was going on.
The other problem I had with the book was the lack of individuality of the people submitted to drug tests. She has several portrayals of individuals within the drug industry (none flattering), a few of people protesting the lack of ethical standards, Peter Lurie in particular, and a few of regulators and doctors in assorted countries. I wanted portraits of the individuals hurt by the drug tests as well, because although I do not think it is at all her intention to do the "third world as teeming masses of oppressed people who need to be saaaaved!" some of that still came out in the book. There is a lot of contempt for the people being tested on from the drug companies and the regulators, and it would have been nice to see the people as people, with their own stories and pain and difficulty. That said, they are in the book and they are quoted, but I still felt they were less individualistic.
I also wish her portion on drug testing in the US had focused more on things like testing on the poor, on women of color, on populations least equipped to say no. She does mention testing in prisons and on the homeless, but much of that chapter is on university students taking up drug testing for money. While it does prove her point about how someone can make an informed decision when there is money involved and that person needs the money, I think the argument would have been much, much stronger had she focused on populations that not only need the money, but are also caged by issues of social justice. I was thinking mostly about forced sterilization on the mentally ill and the differently abled, drug testing and monetary compensation on the lower class, Norplant and women of color (and how frequently the categories overlap and are the same).
Still, a good read, and I think I need to find more books on this subject.
Links:
-sanguinity's review
sanguinity's write up and after becoming more aware of the subject after reading Conquest and Killing the Black Body, particularly the chapters about the forced sterilization of Native and Black women (and I am sure of other women of color) and the unethical means of getting those women to agree to Norplant or Depo-Provera. Shah's book focuses less on reproductive health and more on Big Pharma and the drug testing industry. She goes through recent history, from the rise of testing with the Salk vaccine to the Nazi and WWII-Japanese experiments on human subject to the Tuskegee Syphilis Study to testing nowadays in "third-world" countries.
She explains the many factors that led to this: the more and more stringent requirements for drug companies to first prove that their medicines do not harm and then to prove that they actually do what they say they do and the growing protection of patients. But only patients in the right countries, only patients with money, only patients with power. Points she especially emphasizes are testing experimental drugs against placebos versus testing them against the best proven treatment, as companies have found ways to worm their way around "best proven treatment." After all, if they're testing in Africa or India, those people couldn't access the best treatment anyway, so a placebo really is their best treatment. And it would be unethical to provide access to good drugs during the trial and then to take them away afterward.
I agree with her analysis, particularly the way companies take advantage of the ravages of colonialism to subject even more testing and experimentation upon the very people hurt most by colonization. However, I think at times her argument gets a little confusing, particularly when she first argues against siccing experimental drugs that may or may not hurt patients on test subjects, and then argues that a drug study was unethical because they did not provide experimental drugs they thought might or might not help, as opposed to a placebo. I think I needed a little more data and a clearer picture of what counted as "known to help" and what didn't before I could quite figure out what was going on.
The other problem I had with the book was the lack of individuality of the people submitted to drug tests. She has several portrayals of individuals within the drug industry (none flattering), a few of people protesting the lack of ethical standards, Peter Lurie in particular, and a few of regulators and doctors in assorted countries. I wanted portraits of the individuals hurt by the drug tests as well, because although I do not think it is at all her intention to do the "third world as teeming masses of oppressed people who need to be saaaaved!" some of that still came out in the book. There is a lot of contempt for the people being tested on from the drug companies and the regulators, and it would have been nice to see the people as people, with their own stories and pain and difficulty. That said, they are in the book and they are quoted, but I still felt they were less individualistic.
I also wish her portion on drug testing in the US had focused more on things like testing on the poor, on women of color, on populations least equipped to say no. She does mention testing in prisons and on the homeless, but much of that chapter is on university students taking up drug testing for money. While it does prove her point about how someone can make an informed decision when there is money involved and that person needs the money, I think the argument would have been much, much stronger had she focused on populations that not only need the money, but are also caged by issues of social justice. I was thinking mostly about forced sterilization on the mentally ill and the differently abled, drug testing and monetary compensation on the lower class, Norplant and women of color (and how frequently the categories overlap and are the same).
Still, a good read, and I think I need to find more books on this subject.
Links:
-
sanguinity's review
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Have not read the book, but it may be a matter of Phase I versus Phase II studies. Phase I studies test drugs on healthy people to make sure that they are not so toxic as to make them unacceptably dangerous or unpleasant to use no matter how serious the condition they treat is. Phase II studies are then carried out on people with the target condition to see if the drugs actually work.
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It would seem to me to be most ethical to use the good stuff for the trial, and keep supplying it afterwards. I wonder how expensive that would be, compared to the marketing and advertising budgets of some of these companies...
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