New Books And A Classic

Is it true that drug companies have a worse record of law-breaking than any other industry? This month we review a criminologist’s investigation revealing bribery, smuggling and international law evasion - and also a campaigner’s manual on how to combat drug company crimes. Editor: Anuradha Vittachi

Caught in the act

Corporate Crime in the Pharmaceutical Industry
by John Braithwaite

Routledge & Kegan Paul (hbk) £25

Evidence of widespread drug marketing abuse - particularly in the Third World - is all too familiar. But when a criminologist sets out to investigate institutionalised white-collar crime in the drug industry, the perspective is new and his revelations startling.

In Corporate Crime in the Pharmaceutical Industry, John Braithwaite argues that the drug industry has a ‘worse record of international bribery and corruption than any other industry, a history of fraud in the safety testing of drugs, and a disturbing record of criminal negligence in the usage of drugs’. Amongst the evidence he has painstakingly amassed, Braithwaite cites a study of corporate crime in the USA which found that the drug companies had more than three times as many serious or moderately serious law violations per firm as other industries.

Braithwaite confronts his subject head on. As he points out, no one expects a criminologist to give a ‘balanced’ account of mugging or murder. But ‘balance’ is expected when corporate criminals are under investigation. Opening a chapter on ‘The corporation as pusher’, he exposes a double standard: ‘People who foster dependence on illicit drugs such as heroin

are regarded as among the most unscrupulous pariahs of modem civilisation. In contrast, pushers of licit drugs tend to be viewed as altruistically motivated purveyors of a social good.’ Yet, dependence on some psychotrophic drugs (i.e. drugs capable of affecting mental activity, like Valium) marketed by these companies can have consequences just as frightening as heroin addiction.

In scrutinising drug companies’ activities in the Third World, Braithwaite is scrupulously fair in emphasising that the transnationals tend to operate to higher standards than many local commercial producers. But he concludes that ‘the moral failure of the transnationals lies in their willingness to settle for much lower standards abroad than at home.

Campaigners expecting new evidence may be disappointed by the chapter on ‘Drug Companies and the Third World’. But for newcomers to the subject it provides a comprehensive review of earlier studies by Silverman, Yudkin, Medawar, Muller and others.

But the particular stength is that it delves into the corporate mind. In an appendix that is essential reading for consumer activists, Braithwaite explains the tactics used to arrange interviews with 31 drug industry executives in the USA, UK, Australia, Mexico and Guatemala. As a result, the book contains fascinating insights into the reality behind the monolithic image of the corporation: often there may be fierce

internal conflict - between, for example, medical and marketing people.

An important thesis of the book is that transnational corporations deal with legal constraints more through international law evasion strategies than outright legal violations. In most Third World countries such laws as do exist aren’t enforced anyway. An industry executive in Guatemala described the drug registration situation as ‘practical anarchy’.

The final chapter, ‘Strategies for controlling crime’, addresses the most complex and thorny issues of how to make national and international controls enforceable and affordable. Predictably, it fails to come up with a blue-print of what should be done. But it explores the different options that are open: sanctions, binding legislation, self-regulation and their shortcomings.

The obstacles are huge. Rule-breaking is habitual, as described by one managing director: ‘I don’t follow the corporate rules when it doesn’t suit me. No one does. That is, if you’re credible you can get away with it. We’re credible because we perform well. If we were running at a loss, I’d be fired for breaking the rules. But because we’re doing well, it’s a good management decision.’ When it comes to opposing controls from outside, opposition can be formidable. The book cites evidence of the organised industry lobby with influence over health regulatory authorities and amongst politicians.

One conclusion of the study will be particularly welcome to Health Action International (the network of health activists and public interest groups in developing countries, campaigning for an end to double standards Braithwaite states that, to stop global corporations playing off the regulatory standards of one country against those of another, standards must be harmonised. That is, strategic government action is needed to change lowest-common-denominator regulation into highest-common-denominator controls.

This makes the role of networking and exchange of information between health authorities and campaigners in developing and developed countries vital to stamp out corporate crime.

Dianna Meirose

Dianna Meirose is the author of Bitter Pills reviewed in NI 121.

Action against drug abuse

Prescription for Change
by Virginia Beardshaw

HAI/IOCU (pbk) £5.00

Available from Oxfam Campaigns Unit, 274 Banbury Rd, Oxford, UK.

The relationship between health and the medical supply industry is especially important in that it reflects the power wielded by private enterprise when it interacts with the public at large: with public industry, national authorities, health care services and individual consumers.

It seems that this power is misused. For this reason, the international pharmaceutical industry has recently become the target of campaigns by various critics. In the UK, for example, War on Want and OXFAM support a number of local groups which publicise examples of corporate malpractice and support rational health initiatives at home and in less developed countries. Prescription for Change is written for such groups.

Virginia Beardshaw writes on behalf of two well-known international bodies, Health Action International (HAI) and the International Organisation of Consumer Unions (IOCU). Her main concern is with reforming the existing system of drug supply and usage. ‘This guide,’ she says, is more about influencing policy makers than about academically correct research methods, since action is the key to progress.’

Since, unfortunately, many activists do not have much spare time, Beardshaw describes the key issues and principles for action in nine short chapters covering no more than 50 pages. These are packed with well-referenced summaries of the criticisms which are levelled against the large drug companies, together with helpful hints on how to campaign for more appropriate use of drugs. Many of the suggestions appear at first to be rather commonplace, but could easily be overlooked by groups that are inexperienced or less than fully alert. In any event, they form a convenient aidememoire, whilst the book as a whole is a useful introduction to the issue.

A couple of reservations: firstly, I would have liked more information about how some of the early campaigns fared. There are some references to Ciba-Geigy’s marketing of clioquinol, and the associated SMON scandal, but we are told little about the response of the company to its critics and nothing about its eventual decision to withdraw the drug. Similarly, there is little about how Searle reacted to the Social Audit campaign against the promotion of Lomotil.

Secondly, this is yet one more book which portrays malevolent drug companies linked up against a range of united and socially concerned consumers, medical professionals and government officials. I am convinced that this is an over-simplification, since some members at least of each of these groups may also have an interest in supporting the status quo.

That said, this book is a timely and useful tool for the many groups and individuals working for an appropriate use of drugs.

Andrew Stoker

Is anyone taking any notice?
...being the book that showed the truth the camera can tell

IF IT IS TRUE that books can change a person’svision, then Don McCullin’s book of photographs must surely qualify among them. One would have to be very hardened to look through Is Anyone Taking Any Notice? without experiencing a sudden shift of perspective, from the level of small personal worries and irritations to an overwhelming apprehension of universal pain. It doesn’t matter how many times one has seen the pictures: each time they go for the throat, they make the eyes widen in shock and pity.

John Le Carre said he would rather ‘watch any amount of television footage of battle than be forced to leaf through McCullin’s albums of human suffering’. Of course, because most television coverage skim ‘hurriedly over suffering; each flying image cancels out the impact of the one before.

The viewer is grateful for the rush: it means not having to connect, person to person, with each fellow human suffering on the screen. We can peer briefly at them and turn away, satisfied that we have done our duty by them, by watching the nine o’clock news and ‘knowing’ what’s going on in the world.

McCullin doesn’t allow his viewers to get away that cheaply. We owe more to the people he photographs, and we know it. However much we may long to hide, to distance ourselves, he involves us in their lives. How does he do it?

Part of the answer seems to lie in McCullin’s own involvement When he photographs moments in the Vietnam war, or Biafra, or northern Ireland, he is not there simply as a newshound, making war photogenic. McCullin is there to stop the war, by blazoning out the quality of its madness.

One of his pictures shows a Vietnamese captain bending over a soldier, lecturing him about war. The captain is crazed: for the soldier is dead. Another, in Northern Ireland, shows a man walking home, it seems, after work - looking down nonchalently at the pavement where a soldier lies full-length aiming his machine gun. It makes one blink, the ordinariness of the man in such an extraordinarily violent situation. But that is the bizarre nature of war, that we go about our daily business as though nothing were happening, when war is happening - injury, poverty, death are happening. McCullin’s pictures jolt us into realising the absurd coexistence.

And McCullin’s involvement goes still deeper. If he were only an objective recorder of tragic moments in other people’s lives, however sensitively he might take the photograph, and however import-. ant its social message might be, he would still be making objects of those people. The relationship is unavoidable, revealed in the very word ‘objective’.

But another - rare - relationship is possible, and McCullin can make it there. It happens when both photographer and subject find themselves in a dynamic relationship with one another. At that moment of affinity, taking the photograph becomes a mutual act - McCullin presses the button, but the other has requested him, silently and urgently, to take the picture. It must be taken, in order that the truth of that moment, experienced by them both, be understood and honoured and passed on. It’s not a moment in someone else’s life that McCullin records, but a moment also in his own.

The frisson that flickers in that naked meeting is stored like an electric current in the picture, to flicker out again towards the viewer. McCullin’s most moving photographs, therefore, go deeper than the single message of man’s inhumanity to man: they reach down into the heart of acceptance, of union, between one human being and another.

A photographer who was taking pictures in Honduras for a Sunday newspaper was asked how he got his best pictures. ‘I just walk up and snap them fast,’ he said, ‘before they know it.’ Just the opposite: ‘they’ as victims, picture-fodder; not ‘we’, as for McCullin.

Why all this scrupulosity? To find a clue, one needs to go back to McCullin’s childhood, which he refers to frequently and with eloquence. He was born into working class poverty in London, dropping out of school at a tender age to support his family. McCullin blames their poverty for his father’s chronic illness and early death. The most heartfelt line in an autobiographical sketch is: ‘My fear was his dying. My strength was in trying to play a part in his survival.’

But his father died, despite his best efforts. Fortunately for the rest of us, though painfully for McCullin, the injunction to stop the dying, stop the poverty and suffering, lived on.

Anuradha Vittachi

Is Anyone Taking Any Notice
by Don McCullin (1973)

MIT Press: currently out of print