The cynicism of television sometimes appals, but worse is the cynicism television induces in viewers. I can hardly bear to confess this, but when the documentary Dying for Drugs (8.30pm, Sunday 27 April, Channel 4) opened with its doomy voiceover about the unchecked power of the pharmaceutical industry and matched it with film of a black child lying despairingly on a bed, I found myself thinking: "They're cheating; they're using a generic image."
By the end of this 90-minute film, in which the term "generics" happened to be crucial, I had been cruelly punished. Its final segment revealed that the little boy was Jairo, a 12-year-old Honduran suffering from the end-stages of Aids. His mother had died from the disease several years ago and he was now looked after by an aunt, uncle and grandmother. Our sad privilege was to follow the last few weeks of his life. He died on the back seat of the family car on the way to hospital, one of 14,000 "Aids orphans" in Honduras.
The programme's case was that if Jairo had been born in a country or to a family that could afford the latest anti-retroviral drugs, he would today be enjoying a near-normal childhood. The specific drug he needed when we joined him was Pfizer's bestselling fluconazole, sold under the brand name Diflucan. The programme's co-director, Brian Woods, bought some at the pharmacy for the family and for $27 was handed a cardboard box containing, astonishingly, just one tablet. A week's supply would cost $189. Jairo's family earns $90 a week.
We talk of postcode lotteries when it comes to our own health system; but, for Jairo to have lived, he did not even have to be born in Europe. He needed only to live across the border with Guate- mala, where, as is not the case in Hon-duras, a generic drugs manufacturer is licensed to sell its own-brand fluconazole for 30 cents a pop.
In South Korea, meanwhile, a young father called Yung was dying from myeloid leukaemia or, as he saw it, for want of the drug Gleevec (imatinib mesylate), manufactured by the Swiss firm Novartis. At $19 a tablet, Yung would need to spend $55,000 a year to keep well, far beyond what his family could afford. Again, the frustration was that a cheap alternative exists. In India, the generic drugs company Cipla said it could sell an own-brand version for just 80 cents a capsule. Under Indian law, the drug multinationals can only patent the way they make a particular drug, not the drug itself. Yet its generic drugs industry is under threat. The World Trade Organisation has decided that from the end of next year India must bring in full patent protection for the drug companies.
Though these cases are, loosely speaking, scandalous, they are also how you would expect the global market to operate. But the programme led with two real scandals that made the drug companies look like gangsters. The first took us to the Nigerian town of Kano, where it alleged that in 1996 Pfizer took advantage of a local meningitis epidemic to rush in and test a drug whose side effects, it later transpired, included severe joint pains and liver damage. Victims suffering these claimed they were not told it was a trial, and Pfizer has been unable to produce a single consent form.
The second scandal concerned a doctor in Toronto, Nancy Olivieri, a world expert on the blood disease thalassaemia. She had been keen to try her patients on a new drug called L1, made by Apotex, which agreed to fund the trials. Later she became worried about its side effects on their livers. When she began to question things, she was sacked from the trial project and banned from telling anyone, even her patients, about her doubts. Apparently under pressure from Apotex, she was fired (and later reinstated) from her hospital job and now spends her time in the courts fighting what she believes is the premature licensing of the drug.
This was a disturbing programme, clearly argued, and I commend Brian Woods and his co-director Michael Simkin, as well as Channel 4's courage in transmitting it, given the legal risks. Yet Dying for Drugs posed another ethical question, a journalistic one. At no point were the drug companies' cases put. The film-makers did not even stage a Michael Moore-style confrontation with the companies. They simply were not there.
Yet it is obvious that without the profit motive, the drugs that people are dying for would not even exist, and that drug development, with its potential for failure, is expensive. We were told, en passant, that Novartis is now offering to pay one-third of the cost of Gleevec to patients in Korea. We were not told that Pfizer has committed itself to providing Diflucan free to 50 of the world's poorest countries. Nor was a distinction made between good and bad (or evil and more evil) companies. Pfizer, the creator of Viagra, has a stock market value of $180bn and is the drug company we all love to hate at the moment. But in this programme it was just one face of a Hydra-headed monster. The broad brush intentionally painted what it called "Big Pharma", ie the global players, as having a generic image problem. But it left some of my cynicism about television in place, too.
Andrew Billen is a staff writer on the Times
