Book Reviews

Drug companies- helping or harming the health of the Third World? This month we review a controversial study of the issue- and a round up of books on the Bomb. Editor: Anuradha Vittachi

The quick fix

The Health of Nations: a North-South Investigation
by by Mike Muller

Faber pbk £3.95

Illustration: Clive Offley

In August 1979 a woman living in Mozambique took a pain-killing drug. It was sold by a well-known transnational company, manufactured according to the latest hygienic methods and contained what the label described. The effects, however, were frightening. A painful infection erupted all over her face and spread to other parts of the body. Abscesses formed in her lungs. Her life was in danger and was saved only by emergency action when she was flown to a hospital in South Africa It was later discovered that the drug had been shown liable to cause such side-effects 58 years before.

In The Health of Nations, Mike Muller asks whether the positive contributions made by transnational drug companies are not ‘outweighed by, and incidental to, the damage they do and the bad health they promote: in economic terms, whether the resources they have captured would not generate more benefit to their consumers if applied in other ways'.

In the early 1970s there was only a handful of relevant studies of these companies; now there is a deluge. Issues like drug safety, efficacy, research, market power and drug use are discussed in the first half of Muller’s book. All are legitimate targets for critics of the large companies.

More pertinent, however, is questioning the nature of health itself. Now the fashionable catch-phrases are ‘Health by the People’ and ‘Health for all by the Year 2000’. The emphasis is changing from curative to preventative medicine and, thus, away from pharmaceuticals.

Not surprisingly, the drug companies are eager to find a role for themselves in this new environment or, better still, to control any change. The second half of the book discusses the position in the 1980s: the concerted attack by UN agencies on bad health — and the corporate response. Muller’s information is up to date and his references as diverse as the Dar es Salaam Daily News, and documents produced by the transnationals for internal use.

Muller is an excellent person to tackle this subject He writes very readably and is no stranger to health controversies: in the early 1970s he wrote the influential War on Want book, The Baby Killer Scandal, and followed it with Tomorrow’s Epidemic, an examination of tobacco marketing in the Third World.

Today he works as an engineer in Beira, Mozambique. He has seen at first hand the effects of drug usage in the Third World and has the ability to set the particular against an international background. The woman described in the first paragraph called on him for emergency help and the book is full of such incidents observed in several countries.

And the other end of the chain has not been ignored. Muller has interviewed the decision makers of the big companies in their headquarters and presents a fascinating account of the strategies they now adopt to meet their critics.

If there is a failing in this book, it is in the oversimplification of the political economy. Mention is made of the vested interests of medical doctors but in countries such as India, frequently praised for its capacity to produce pharmaceuticals, there are other issues. Local production is-promoted not so much for medical considerations as for the economic targets of import substitution and the elusive benefits of industrialisation. Recent studies of India suggest that such schizophrenic planning is, at best, irrelevant to the health of the general population.

Although Muller is able to describe some positive recent developments, the mood of the book is pessimistic. ‘The multinational companies have a positive contribution to make to Third World health care: of this there can be no doubt,’ he say-s. The problem is that they are not making that contribution. ‘After all,’ says a spokesman for the pharmaceutical transnationals, ‘you can’t expect us to support policies which run counter to our own interests.’

Andrew Stoker

Andrew Stoker has worked as a chemical engineer in a major
pharmaceutical company and is currently with the University
of Edinburgh, U.K.

Anti-nuclear roundup

The Politics of Uranium is an inadequate title for this book by Norman Moss (Andre Deutsch, £4.95). It does, to be sure, deal with the politics of nuclear power and nuclear weapons, and with the economics and trade that are linked with the politics. But it deals with so much else besides: the structure of matter; radioactivity; the invention of the fission and fusion processes; chain reactions and the manufacture of plutonium; efforts at control; where and how uranium is mined; the nuclear non-proliferation treaty; how the various types of nuclear reactor work; the disposal of nuclear waste; the dangers of radiation.

All these and more are dealt with in close packed, factual prose. The readers are left to pass their own judgement and to supply their own indignation.

But The Politics of Uranium stops short of discussing the possible use of The Bomb (it’s strange how everyone knows what is meant by ‘The Bomb’ and ‘The Pill’, as distinct from any other bombs or pills). For that, one needs to choose among the plethora of books and pamphlets that have appeared over the last couple of years, some with an international appeal, others primarily directed towards a readership in a particular country.

Among the best of the former is Nigel Calder’s Nuclear Nightmares; an Investigation into Possible Wars (Penguin £1.50, 53.95)— not a book to cheer one up. Calder says, ‘The risk of a holocaust is growing with every year that passes and whether we shall avoid it between now and 1990 is at least questionable.’

Of the many directed primarily towards British readers (slingstones of David against the Goliath of the official line and its supporters), my own preferences are How to Make up Your Mind about the Bomb by Robert Neild (Andre Deutsch, £2.95) and Nuclear Weapons: the Way Ahead by Ronald Gaskell (Menard Press, £1.20).

These serve to ‘educate our anger’, to take the Rev. Sloan Coffin’s phrase when addressing the World Council of Churches conference at Amsterdam last year. But first must come the anger that is to be educated. To that end I’ve recently reread John Hersey’ s Hiroshima* (Penguin Classics £1.10)— over thirty years old but nothing published since can match it.

David Pitt

(*For a fuller review of ‘Hiroshima’, see NI 113 classic)

Jupiter's Travels
...being the book that showed how travel broadens the heart.

LAST WEEK I met a glaciologist —correction: an ex-glaciologist. He had given up glaciology because he thought it was gently turning him nutty. It was the isolation that did it, he said. After months on end of looking at nothing but snow and ice, with no TV, no drinks at the bar, no family life — nothing to buffer the mind from the stark priorities of life and death— well, it was tough readjusting to the cottonwool banalities of ’normal’ life. When he heard people casually complaining about being ‘exhausted’ or ‘freezing’, he would grab them by the collar and tell them they had no idea.

His best anecdote was the one about toffee. The team lived on a strictly controlled diet, but every second day they were allowed a treat: one toffee. It became the high point of their lives, this toffee: their dependence on it was obsessive. Two hours before each toffee-time, their hands were shaking.

It hadn’t been a comfortable experience but he was grateful for what it taught him about himself and his basic needs, physical and emotional. I read out a bit of Jupiter’s Travels to him and he joyfully recognised a kindred spirit.

Jupiter, otherwise Ted Simon, hadn’t travelled to the polar regions — not very practical on a motorbicycle — but he had experienced almost every other environment. He’d been on the road for four years and covered 60,000 miles (that’s two and a half times around the world as the satellite flies), most of that in the Third World. He’d had more adventures in those four years than most people have in a lifetime — but it wasn’t just the quantity of experiences that makes his account so absorbing. Plenty of journalists flit between war zones and revolutions, deserts and carnivals; not all are equally enriched by their experience. Some, depressingly, seem to have their protective skins thickened, not loosened, by travel.

The beauty of Jupiter’s Travels is that Ted Simon sheds layer after layer of the bulky defence mechanisms that he had barricaded himself with to cope with Western society. It’s a kind of cultural fasting. As the habits, expectations and dependences begin to fall away, he finds himself able to ’tune in’ to the strangers and strange places around him with a new awareness and confidence. It’s a subtle process of atonement— in the special sense of ‘at one-ment’.

In a teahouse in the north African desert, for instance, he sits peacefully among four splendidly robed Beseharyin Arabs — the ‘Fuzzy-wuzzies’ whose forefathers fought Simon’s forefathers at Khartoum. ‘Imagine meeting these men in a London pub or American diner,’ he writes. ‘Impossible. They would be made small by the complexities, the paraphernalia that we have added to our lives, just as we are though we have learned to pretend otherwise.’ But here ‘the contact between us is instant and overwhelming.., here outside a grass hut, on a rough wooden bench, with no noise, no crowds, no appointments, no axe to grind, no secret to conceal, all the space and time in the world, and my heart as translucent as the glass of tea in my hand.’

The motorbike is a perfect form of transport for keeping the heart translucent, combining accessibility with independence. When Simon reaches Rhodesia (as it was then, in 1973) he realises just how much his Western world-view has faded and how far he has become unconsciously ’Africanised’, as he experiences Rhodesia as not just white but ‘Whiter-than-White’. In one of the funniest passages in a book that brims with sudden hilarity, Simon finds out that bigotry is both frightening and absurd.

The journey might have ended triumphantly as he leaves Africa, but he goes on to Latin America and disaster. He is mistaken for a spy and briefly becomes one of ‘the disappeared’ in a Brazilian gaol. He never really recovers from the deep shock and the rest of the book limps a little. Somehow he never gets his finger back on the pulse of the journey: he has begun to lose its meaning. He is attacked by anxieties about other people — what answers will the media demand from him when he gets home? His personal strength dwindles and is replaced by an obsessive need to get safely home.

Like the glaciologist, he had had his fill— too much, indeed, for one man to bear on one trip. But he has had an unforgettable double journey, one across the lonely terrain of the world and another into the lonelier terrain of his unconscious. Readers (like me) who are unlikely to make such a trip themselves are fortunate to have the chance to ride pillion.

Anuradha Vittachi

Jupiter’s Travels
by Ted Simon (1979)

Penguin (pbk) UK: £1.50 / Aus: $4.95 / Can: $3.95