A lush, atmospheric drama, The Constant Gardener brings unprecedented exposure to crucial issues facing the Western pharmaceutical industry and all those who partake of it. Set mostly in a sun-dappled Kenya and based on a John le Carré thriller, the film is a fierce but flawed indictment of Big Pharma’s complicity in African illness and poverty.
The film revolves around the transformation of mild-mannered career diplomat Justin Quayle, played by Ralph Fiennes. Quayle’s wife, Tessa, played by Rachel Weisz, has exposed a botched experimental trial conducted by a Western drug company upon unsuspecting African villagers. After she is found mysteriously murdered, Justin is infected with his firebrand wife’s righteous indignation.
The plot couldn’t be more timely. According to a May 16 report in USA Today, giant drug outfits are outsourcing increasing numbers of drug trials outside the United States and Europe. Merck is now conducting 50 percent of its trials outside the United States. By 2006, 70 percent of Wyeth Pharmaceuticals trials are expected to occur offshore. Across Latin America, Eastern Europe, Asia and Africa, the sick are abundant, desperate and doc-trusting, and so recruitment into clinical trials is rapid. As one executive from an outfit specializing in running drug trials in Asia put it, patients in developing countries are “more willing to be guinea pigs.”
As the film makes all too clear, Big Pharma’s new experimental bodies in the developing world only rarely enjoy the benefits of the research they participate in. Sometimes the new drugs are unlicensed in their countries or priced out of reach, but more often the drugs are irrelevant to the medical needs of their communities. After all, 90 percent of the global medical research budget takes aim at illnesses that cause just 10 percent of the world’s disease burden. And so, while 500 million cases of malaria rage across the developing world, the working poor of India, South Africa and elsewhere, desperate for the kind of high-tech care available to them almost solely through clinical research, line up for experimental doses of the latest arthritis, heart disease and obesity drugs.
Not surprisingly, ethical lapses are strikingly common. In one inquiry, out of thirty-three subjects enrolled in an experiment trial in Thailand, all of whom had signed forms stating their informed consent, thirty were found to be dangerously misinformed. The experimental HIV vaccine they were about to receive had no known protective value, but, according to the subjects, it would, in fact, protect them from the deadly virus. “Informed consent is a joke,” said one industry researcher in an anonymous survey sponsored by the National Bioethics Advisory Commission.
But challenging these practices is not nearly as black-and-white as this film would have it. Tessa Quayle, the martyred activist, stands up to yell “bullshit” at public lectures, shaking her lovely dark mane while she’s at it. At cocktail parties, she loudly embarrasses the health minister, who marches off in a huff. Good stuff, but the reality is that uncompromising activists–even if they look like Rachel Weisz–rarely enjoy this kind of privileged access to power so effortlessly. Tessa has it too good and too bad, too. She ends up paying with her life for her exposure of the botched trial; in real life, bad drugs and unethical research practices often continue unhindered despite mountains of data and reports detailing their defects.