Hailed by John le Carré as "an act of courage on the part of its author" and singled out for praise by the leading medical journals in the United States and the United Kingdom, The Body Hunters uncovers the real-life story behind le Carré's acclaimed novel The Constant Gardener and the feature film based on it.
"A trenchant exposé . . . meticulously researched and packed with documentary evidence" ( Publishers Weekly ), Sonia Shah's riveting journalistic account shines a much-needed spotlight on a disturbing new global trend. Drawing on years of original research and reporting in Africa and Asia, Shah examines how the multinational pharmaceutical industry, in its quest to develop lucrative drugs, has begun exporting its clinical research trials to the developing world, where ethical oversight is minimal and desperate patients abound. As the New England Journal of Medicine notes, "it is critical that those engaged in drug development, clinical research and its oversight, research ethics, and policy know about these stories," which tell of an impossible choice being faced by many of the world's poorest patients―be experimented upon or die for lack of medicine.
Sonia Shah is a science journalist and prize-winning author. Her writing on science, politics, and human rights has appeared in the New York Times, the Wall Street Journal, Foreign Affairs, Scientific American and elsewhere. Her work has been featured on RadioLab, Fresh Air, and TED, where her talk, “Three Reasons We Still Haven’t Gotten Rid of Malaria” has been viewed by over 1,000,000 people around the world. Her 2010 book, The Fever, which was called a “tour-de-force history of malaria” (New York Times), “rollicking” (Time), and “brilliant” (Wall Street Journal) was long-listed for the Royal Society’s Winton Prize. Her new book, Pandemic: Tracking Contagions from Cholera to Ebola and Beyond, is forthcoming from Sarah Crichton Books/Farrar, Straus & Giroux in February 2016.
This book is quite a frightening exposé of the American drug industry and how the FDA and the Government all conspire to keep it as the highest profit industry in the country.
Three things I've learned:
1. If you ask your doctor for meds you've seen advertised on the tv and he happily prescribes them, you need to change your doctor. He should be doing the diagnosing and prescribing, not you. Drug advertising began because doctors didn't prescribe enough drugs to satisfy big Pharma, so they advertised them like any other consumer item.
2. Always ask for an older drug, especially a generic drug. Drugs are not tested to see if they are more efficient than existing ones only that they work better than nothing. Really dreadful side effects may well be ignored by the FDA (which is why you see so many drug recalls and class actions later).
3. If your doctor tries to suggest a new experimental drug or enroll you in a drug trial or in any way gives you a drug that is not freely available at a pharmacist - beware. He may have enrolled you in a drug trial without exactly full disclosure but then back in 2005 he would have got up to $12,000 a patient for that, probably a lot more now.
Somebody recommended The Body Hunters when I reviewed Bad Pharma earlier this year, and I’m pleased that I was able to get and read it so soon! The author, an investigative journalist, here examines the ethics of biomedical research — specifically, of American drug companies outsourcing clinical trials to companies with laxer ethical requirements than the US and large populations of sick patients to run tests on. It’s a fairly widespread practice that only gets wider-spread with each passing year.
I am an inveterate note-checker in my nonfiction. I already sort of was to begin with, and then I read Cordelia Fine’s book Delusions of Gender, which talks about how citations can be slapdash to the point of misleading. These days, if you hand me a nonfiction book and a computer, I’ll check endnotes until my fingers cramp (or until I decide the author’s reliable). That sort of fact-checking is exactly the level of tedium that pleases me, and anyway I like to know that my sources are dependable before I go quoting them hither and yon like I’m some sort of science expert.
(I mean, ideally. In my own life, I repeat things willy-nilly that I think are interesting, and then disclaim responsibility for them by forgetting where I read them. It’s the magpie approach to knowledge.)
The Body Hunters doesn’t do the thing Cordelia Fine rages over, of citing studies that say green in support of a statement that says red, but it also doesn’t adequately back up all of its points. In the third chapter, for instance, Shah says, “Shigella is a disease-inducing bacterium that kills one million people around the world every year.” The citation for this claim is a press release from a pharmaceutical company. The press release was most likely getting its information from a 1999 study published in the Bulletin of the World Health Organization, but still, I’d rather let’s cite the study itself than cite somebody citing the study, particularly since I can easily look up the study if I know where to look for it and care enough to bother. (If you’re concerned about shigellosis, the happy news is that a WHO study published in 2010, after The Body Hunters‘s publication, found that only about 14,000 people die from shigellosis-related causes every year. Deaths caused by this bacterium are still disproportionately likely to happen in Asia rather than anywhere else.)
It took me five minutes to find the original study and the updated study and add that information to this post for your delectation and delight; but Sonia Shah cited a press release from a pharmaceutical company. That is lazy.
Or here’s another one: “In 1985, a long-running government study on cardiovascular risk — the Framingham Heart Study — reported a correlation between low cholesterol levels and increased longevity.” The citation for this is a 1985 Washington Post article. It’s not hugely important here to cite the primary source, but since we’re citing things, why not cite a primary source? They’re easy to find. The Framingham Heart Study has a website. Or if it’s something that’s just known, like the dates of the Civil War, then don’t cite anything. That is also okay sometimes.
It feels churlish to complain about a book like The Body Hunters, which is a friendly and easy-to-digest account of some of the ethical problems plaguing pharmaceutical research. It’s important to have such an account available, and I truly do understand that there are times when you have to cite secondary sources, even though you’d prefer to cite primary ones. And speaking generally, these lazy citations showed up in support of background information rather than in support of the main points Shah was making. But having them at all leads to this thing, you know, where I got done with The Body Hunters and felt that I had gained a broad, vague sense of the story of testing drugs in third-world nations, but that I couldn’t depend on any specific piece of information I had been given (particularly scientific information).
Perhaps not surprisingly, Shah is at her best when she’s talking about the sociology of science, rather than the science itself. The chapter about the hunt for a cheaper AIDS treatment for patients in countries poorer than the US is both fascinating and well-documented, as is the one about AIDS denialism in South Africa under Thabo Mbeki. (Which, look. That was bad and he was wrong, but it is not insane to mistrust Western scientists when it comes to ethical and accurate research in Africa.)
Given that almost a decade has passed since the publication of The Body Hunters, I’d love to read another book on the same topic that takes on the last ten years. Has drug testing on third-world patients expanded wildly, as Shah grimly predicted it would? Have ethical standards been modified and improved? If you know of any recentish books that address this, let me know in the comments! I am interested in ethical quandaries and would gladly read many more books about this one in particular!
American drug companies more than other countries test their drugs on the poor from other countries. They do not fully inform patients what they are doing and the people are so in need of proper healthcare they really can’t refuse. Often if patients are harmed by the experiments, the drug companies do not cover their care afterwards. The interest is in data and Americans rarely care about how a drug was tested before it came to market. A big problem in the United States and the poor countries is a lack of public health care. It causes drug companies to be used in cures and nit prevention. An example given is Nixon’s War on Cancer which searched for remedies to cure cancer but overlooked programs on decreasing smoking and pollutants that cause cancer.
I read this book in preparation for a PRIMR book conference on ethics--well, this is kind of irritatingly over the top, with an axe to grind that makes it hard to focus on the reall issues that are here--doing ethical trials in the third world. I think the author's heart is in the right place, but she is so biased that it dilutes the argument (for me) which is that we need to hold the same standards for trials in the third world that we do here.
This book provides a fairly honest, interesting look at the world of clinical trials, with a focus on the research done in developing countries. Personally, my feeling is that when done right, the benefits can be felt on all sides, and this book hasn't changed that opinion. Exactly where the line should be drawn to ensure people are properly taken care of while still allowing game changing research to take place is certainly subjective.
There are shameful examples of drug companies taking advantage of patients that are highlighted in this book, and any rules to prevent such events would be a step in the right direction. With that said, any rules that go so far as to take away the feasibility of running trials in developing countries would do a monumental disservice.
The author spends a fair amount of time discussing "me-too" drugs, but seems to only partially understand the effects of these developments. While there are too many examples of research done to create drugs similar to what is already succeeding in the market, many times these drugs can help lower prices or provide an alternative when a similar medication is not working. The author poorly chose a class of medications that help with depression to highlight the issue of "me-too" drugs, as often when one of these medications doesn't work for a patient, trying another will have beneficial effects.
Overall, the author did a nice job exposing an important topic. While the author clearly has a strong opinion, she didn't let it completely take over her narrative. She impressively displayed both sides of the story in a way that (usually) felt fair and appropriate.
This book makes some excellent points, so it bugs me that I have to rate it lower. The problem is that it pursues its central point too aggressively: there's a frustrating tendency to slide between ethical violations with clear solutions and knotty situations where it's argued that researchers aren't doing enough good. Both are worth discussing, but the book uses both for outrage instead of delving into either. Overall, the book has a strong anti-placebo bias. There are legitimate grounds for this argument, but I felt like it generally ignored those in favor of more emotional appeals.
That said, it's a good chronicle of unethical practices, and it points to a serious problem with medical testing when all corporations are global.
This book was a pleasant surprise. It details the growth in the testing of prescription medicines on persons living in poor nations, and how the medical community has justified the lowered standard of safety and informed consent that is often used. An upsetting book, since essentially what it documents is how drug companies test medicines for wealthy, rich nations on the poorest people in the world, even though they'll likely never get access to these drugs. The twisting of ethics is fairly horrifying. I liked the book because it was well documented, easy to read, and did a good job of presenting all sides of the issue. Highly recommended.
Informative analysis of the history of clinical trials in the USA and in the developing world. It raise serious questions about the ethics and effectiveness of human trials, no matter where they are carried out. She also questions the conflicts between creating drugs to treat disease and creating drugs to sell (lifestyle drugs). Everyone gets attacked: the FDA, the NIH, doctors, researchers, drug companies, academic researchers, advertisers, advertising, developing countries. It's all a mess. It is an interesting worthwhile book to read but leaves you wondering where it all leads.
Educational. Clear. Informative. Eye-opening. I really learned a lot about the pharmaceutical companies role and drug testing in developing nations. It gave a brand new perspective on this industry. This was an industry that I used to work in and never even knew that something like this was happening and the horrible impact of it on peoples of developing nations. A great book for activists.
Long Story Short: I believe every word in this book about the ethical perils and injustices of medical testing, but I’m not sure at all what to do about it.
Why I Chose This Book: I’m not really tuned in to the new releases, and a lot of what I find to read crosses my path indirectly. This time, however, I crossed this book’s path directly: I was wandering through the library seeing if something would catch my fancy, and this book was one of the ones placed on a library shelf, propped on a bracket facing outward. It was about a topic I could read with a critical eye. It was about a topic that seemed rife with controversy and might teacher me something. It was written by a woman, and then had this unexpected “Foreword by John Le Carre,” which was intriguing enough (by seeming completely out of the blue) to seal the deal.* And we were in a hurry to go, so I just grabbed it and checked it out and didn’t pick it up again until a few days after I’d brought it home (a detail that becomes important somewhere around the 950th word of this book review).
*I really scratched my head about this one, but some Internet searching revealed that he’d written a novel more or less about the same thing–The Constant Gardener–so there you have it. Also, it’s mentioned on the very first page of the preface, which I had forgotten about until I was flipping through the book today to write this review.
The Book’s Strengths: I thought this book really covered its material well. It analyzes the process whereby drug manufacturers identify and test drugs on human subjects, how it chooses which populations to test them on, the history of the drug-testing industry, the government regulations that enable and hamper (different regulations) the process, the ways pharmaceutical companies “spin” results, the cavalier attitudes towards “informed consent,” and international efforts to establish and protect test subjects’ rights. It covered all this information in an efficient, readable way, and each of ten chapters covered a distinct topic within the broader themes. There were lots of interviews, lots of documented research, and plenty of end notes and a long bibliography. I learned a lot and probably had the exact emotional reaction I was supposed to have; set against what I’ve picked up over recent years about marketing drugs right to patients and the revelations about how things like, say, statins are not really benefiting many people and may be harming more (and other things about Viagara, and all the different allergy medicines, et cetera), and the context of corporate greed and abuses that also make the news, Shah makes plenty of sense to me.
The Book’s Weaknesses: I always appreciate a good political screed, and this book has more than one scattered throughout–always well-placed and timely, too–but in the end I’m not sure what exactly to do with the information that I now have. Shah points to ways that too much government intervention AND not enough government intervention have combined to cause many of the problems she identifies (and no, it’s not a contradiction; different agencies of governments have their own regulations, like the FDA and the FCC), but she provides no suggestions for what anyone at any level of politics can do about it. It’s everyone’s responsibility to fix things, yes, but in a way that it becomes no one’s responsibility. And I agree there are some serious changes that need to be made in the culture of medical care, and that probably whatever decisions led to advertising drugs on TV and then allowing the worst side effects to be relegated to some website flashed in the commercial instead of being listed in the commercial should be rescinded, and that respecting a person’s agency is more important than testing a drug, and a bunch of stuff like that, but I have no idea how to begin. I don’t think my state senator knows how to begin, and I have no idea how to even track down–much less communicate–with the people who are likely to be sent to the sorts of international summits that make recommendations and set agendas for global overhauls of drug development. And it’s not like the author made any promise that she was providing a solution as well as exposing problems, but I feel sort of adrift. It’s as depressing as hell to think about, and I feel a little sick about how I’ve benefited from what kinds of abuses, but I don’t feel empowered to make changes. It sort of seems hopeless.
What Should Have Happened: I really think that the highly sensational, basically paranoid foreword by John Le Carre should have been dropped. I’m sure he did lots and lots of research for his novel about the same thing, but looking around online he doesn’t appear to be any kind of medical activist and he doesn’t seem to have any medical background. And I honestly can’t believe that this topic was considered “too risky” for mainstream publishers to touch until the brave, brave (I’m projecting here, just so you know) New Press stepped up to the plate.** I did roll my eyes when Le Carre dropped the term (twice!) “Big Pharma” in the third paragraph, and it’s just littered with scare words like “stranglehold,” “unrestricted corporate power,” “gunslinging,” “corrupt,” “supposed integrity,” “moral blackmail,” and such made me cringe. It predisposed me against the book, and I spent many, many pages distanced from the author because of its ludicrous introduction. Interestingly, the author’s own preface says basically the same thing without the shocking rhetoric, with sober language that makes you take the problem much more seriously. Le Carre’s foreword is completely dispensable and adds nothing positive, and I think is a turn off. If I were flipping through the book with no particular motivation to read it (which I did have), I would have put it back on the shelf.
**On the copyright page, New Press describes itself thus: The New Press was established in 1990 as a not-for-profit alternative to the large, commercial publishing houses currently dominating the book publishing industry. The New Press operates in the public interest rather than for private gain, and is committed to publishing in innovative ways, works of educational, cultural, and community value that are often deemed insufficiently profitable. Now that’s interesting. There has to be a lot of juicy gossip bubbling behind that I’d read a book-length expose’ about! And not along the lines of Kindle and Independent Book Sellers, either. I’ll definitely be browsing their catalog for something to read next.
I don’t know if the literary genre of Expose’ typically includes Strategies for Change vs. Calls for Change, so I don’t know if it’s appropriate to suggest such things in this book. And I don’t know how I’d fix the problem, either, so I have nothing to offer to fix the one weakness that I found. Sorry.
Short Story Shorter: Definitely a book worth reading.
I really enjoyed The Body Hunters, because it was a nuanced look into how pharmacological testing is shaped - how the parameters of the testing are set up to sell us more expensive drugs, how there isn't nearly enough funding for less profitable drugs, and how poor communities are used for testing in a way that isn't always ethical. I liked that Shah didn't make it a series of terrible stories without context - she clearly shows that we need medical testing, but also did a great job showing how the corruption of the IMF/World Bank, pharmaceutical industries and the medical industry support testing that is less than ethical. I also thought it was great to underline that we are often investing in new drugs, in developing countries, where the thing that eliminated the diseases in developed countries was investments in infrastructure etc. So why keep investing in untested medicines, when we know what might actually work?
A well researched and interesting read, with a real slant towards social justice. I really enjoyed reading this and am a bit sad that I've now read all her books besides Crude! I hope she comes out with another awesome one soon!
As someone who works in health care in low- and middle-income countries, I felt like this was an important read. My workplace doesn’t do clinical trials, but reading about how white researchers talked about their non-white test subjects showed the kind of bias and double standards people in the developing world encounter trying to access healthcare. Beyond that, the book showed a wide range of terrible things about the pharmaceutical industry. Every chapter had dozens of new things to feel angry about. The author’s proposed solutions were both ambitious and common-sense, and I hope at least the easier ones are implemented someday.
After "Crude: the story of oil" came a masterpiece about tracking pandemics, but the powerful book sitting before you is one level above: it's startling, shocking, and it's all true. Very few works of scientific journalism can rise to such a height, and this is the one that I would nominate for the highest acclaim, if it were up to me. Even Carl Zimmer would take second place to this book, and you need to read it.
The subtitle says it all - "Testing New drugs on the World's poorest Patients"
This is a well written, brilliantly investigated expose of drug companies, the FDA, and contract research organizations (CROs) and how they conspire to seek out the most underprivileged among us to test new drugs for their markets, which are mostly developed nations where patients and/or their insurers will pay inflated prices for them. In developing these drug trials, short shrift is given to informed consent, excuses ranging from language issues to time issues to just plain "it doesn't matter because they wouldn't understand anyway". Control groups are generally given placebos - even though effective treatments are available, leaving them to suffer, sometimes from very serious illnesses. This is so the new drugs can be determined to be better than nothing, rather than being better than current treatments, a very low bar for big Pharma to jump over. Most of the drugs tested are "me too" or copycat drugs, only slightly different from those already on the market, but developed to gain patent protection for the drug companies. Some are drugs for minor conditions that are more or less "manufactured" by the drug companies, for which they already have a remedy, often discovered as a side effect of other test drugs. Most of the drugs tested and shown to be effective are not provided for the test subjects after the testing is complete, despite the difficulty and expense, and often the impossibility of the patients acquiring them for their continued treatment. Another egregious example was a study of an AIDS vaccine, where the control group which did not receive the vaccine, was denied information and access to other preventive measures like condoms. When it comes to risks and benefits, the poor of the world take all the risk and the wealthier among us reap the benefits. The stunning lack of ethics in these drug trials exemplifies the dangers of a barely regulated industry whose only goal is making huge profits for their management and shareholders, regardless of the platitudes they mouth about benefiting mankind.
Pharmaceutical companies are exposed in this book for their horrendous actions upon human beings in developing countries (South Africa, Thailand, India, and etc). Similar deceitful “medical research” tactics that occurred during the Tuskegee Syphilis Study are occurring in other nations in this present day and age. The reason why the average American doesn’t know about these types of studies is because the pharmaceutical companies do not want anyone to know and are hiding it fairly well among the world’s most poor and destitute of nations. Not only are these pharmaceutical companies performing such horrendous experiments on people but they are not committed to improving the plight of these poor nations over the long-term. These companies lack ethics, moral values, and humane behavior. A very well researched and very informative read!
Working at a hospital that offers hundreds of clinical trials, I have been introduced to all the major pharmaceutical and CRO companies that deal with trials, not just here but all over the world. This book interested me since I had that familiarity with trials but only see them in a domestic setting. After reading this book, I now have an understanding of just how far and low these companies will go to get their drugs out on the market and making money. I had no idea half of these scenarios were happening or even legal but it seems the Pharma companies have done their research to see what they could get away with. I thought it a well-research and highly enthralling read and recommend it to anyone who has ever taken a pill and what to know what it took to get it into your house.
Every so often you pick up a book or watch a movie/show that just opens your eyes. In this case it was the pharmaceutical industry, after reading The Body Hunters, written by journalist Sonia Shah in 2006. It’s been a couple of months or so since I finished reading it and I still feel angry at some issues I came across. There are so many that I came across, but I’ll try and touch on only a few. It’s definitely a book worth picking up.
Very interesting book. New alot of this stuff already from other classes, but very intersting to see the whole picture together. I think ACP did a good job by requiring this book to be read in HCHV. I would suggest this to any inquiring minds who are interested in ethical debates.
Way more information than I wanted to know, it was just too technical for me. I wanted to learn more about the people used in the testing than the pharmaceutical companies. It's a shame this goes on in our world.
5 stars for taking a bold stance and bringing to light the hidden cruelties of clinical trials. Let's promote public health over money grabbing and rote scientific progress when human lives are on the line.