Turkey: what now for dreams of regional leadership? – pages 2-3
JANUARY 2015 N o 1501
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FROM RESEARCH LABORATORY TO DOCTOR
The hard sell
Drug companies prioritise profit over patients, and they control their own clinical trials, which do the same
Michel Herreria – ‘Bascule’ (Tilt), 2014
Obama’s bold Cuban gesture
BY Serge halimi
Last November’s mid-term electoral defeat for the Democratic Party seems to have reinvigorated President Barack Obama. He was triumphantly elected in 2008 and had a comfortable Congressional majority in his first two years, but all he produced was a modest reform of the healthcare system, plus homilies urging compromise on Republican politicians determined to destroy him (1). Since the Democrats’ crushing defeat, Obama has been making bold decisions as his political career winds down: a decision to re-establish diplomatic relations with Cuba, announced after an important climate agreement with China, and an amnesty for 5 million illegal immigrants in the US. Perhaps, to enable sensible decisions, US democracy requires a president with no fanatical senators to manage or wealthy lobbies to bribe.
An end to the embargo that John F Kennedy imposed on Cuba in 1962 would rectify a violation of international law so indefensible that every state except Israel condemns the US stance each year (2). These states have probably grasped that, beyond the virtuous justifications claimed by the US (human rights and freedom of conscience, as respected by the US’s Saudi allies and at Guantanamo), the embargo was a way for the US to vent its frustration. Not 100 miles from Florida, a small country has long defied the US empire. In this battle for dignity and sovereignty, David has ultimately beaten Goliath.
But what condition is it in? Though the US embargo has not achieved its objective of regime change in Cuba, the Cuban model that it was intended to contain has been annihilated. “It no longer works even for us,” Fidel Castro admitted in 2010, speaking in support of his brother Raúl’s “liberal” reforms. After the
Serge Halimi is president of Le Monde diplomatique breakup of the Soviet bloc, on which Cuba depended, Cubans’ buying power collapsed. Most only survive in a broken economy through frugality and a strong instinct for getting by (3). For the moment, liberalisation in Cuba means allowing employees, most of them former civil servants, to become the owners of the small businesses that employ them.
Obama, justifying his historic decision, immediately welcomed by big US companies keen to develop their business in Cuba (including American Airlines, Hilton and PepsiCo), said: “It does not serve America’s interests, or the Cuban people, to try to push Cuba toward collapse. Even if that worked – and it hasn’t for 50 years – we know from hardearned experience that countries are more likely to enjoy lasting transformation if their people are not subjected to chaos.” Could the US, Germany, the UK and France apply the same lesson to Russia, without waiting 50 years?
TRANSLATED BY GEORGE MILLER (1) See Serge Halimi, “Obama, straight down the middle”, Le Monde diplomatique, English edition, January 2010. (2) In 2013 Palau, the Marshall Islands and Micronesia abstained from the annual vote on this issue. (3) See Renaud Lambert, “Cuba’s new socialism”, Le Monde diplomatique, English edition, May 2011.
Inside this issue Cameroon: rise and rise of Boko Haram rodrigue nana ngassam Pages 4-5 Darfur: the trouble with UN sanctions j tubiana and c gramizzi Pages 4-6 Central Asia’s shifting plates régis genté Pages 8-9 Is Iraq the new Vietnam? tom engelhardt Pages 10-11
BY QUENTIN RAVELLI
“I
realised I was being spied on, and the drug company knew exactly what I was prescribing,” said a doctor from a smart Parisian practice. “I was naive. I’d never realised. A drug company rep said to me: ‘You don’t prescribe much.’ And I thought – how would she know that?” Drug companies’ marketing departments coordinate such tactics, which shock many medics: the big pharmaceutical firms go to great lengths to maintain or grow their market share, and will change a drug’s indications to gain new business.
Pyostacine (“Pyo”) was long prescribed as an antibiotic for skin infections and considered by some medics the best for the job. It is now widely used to treat broncho-pulmonary and ear, nose and throat infections. This last use has been criticised by many doctors and public health authorities, as it may contribute to over-consumption of antibiotics and the wider problem of antimicrobial resistance, a major public health issue responsible for 700,000 deaths a year (see ‘Hit hard and hit fast’). Pyostacine is made by Sanofi, the fourth largest pharmaceutical company in the world (with a turnover of $40.3bn in 2013).
For four years, I followed the development of this drug, from the research laboratories through the manufacturing plant to doctors’ consulting rooms, to gain an understanding of the versatility of medical products (1). At every stage, the product had a different name: the biologists talked about Pristinae spiralis bacteria; the chemists referred to the pristinamycin produced by the bacteria; sales reps told doctors about the benefits of Pyo; and the factory workers nicknamed it “Pristina” or “the bug”. Over this process, there was a shifting dynamic between the patient’s needs and the company’s profits, and between the drug’s use value and its exchange value (2). This increased the tension between employees and managers, particularly strong in a company
Quentin Ravelli is a research fellow at the Centre National de la Recherche Scientifique and the author of La Stratégie de la bactérie, Le Seuil, Paris, 2015
Australia courts the Chinese dragon olivier zajec Page 12 India’s car workers fight for rights naïké desquesnes Page 13 Italy: the end of the asylums mathilde goanec Pages 14-15 Egypt’s tense state of the art peter schwartzstein Page 16
that was going through major restructuring, a process in which employees had little say.
Sanofi’s marketing department is on the third floor of the company’s offices, in a southern suburb of Paris. Members of this team have been promoting Pyostacine for respiratory infections since the 1990s. They increased sales for broncho-pulmonary infections over eight years by 112% (compared to growth of just 32.6% for skin infections). This is the result of commercial strategy, as the market for respiratory infections is by far the larger. “It turned out to work really well against germs that infect the bronchia, lungs and sinuses,” a company doctor said. “So that was the direction we developed its recommended uses in.”
The people who work this commercial magic are the product managers, who specialise in promoting a single drug or family of drugs. Celia Davos (3) is product manager for Pyostacine. She describes herself as “very business orientated”: “Your job [as a product manager] is to monitor your [drug’s] performance, monitor your product, to see where it’s going compared to its competitors, in the context of the market … and to do everything you can to maximise its turnover.” This role is central to the marketing department, which is the heart of the company, and acts like a career turntable. Employees may be appointed as product managers from various departments and subsequently redeployed to other managerial, marketing, PR and sales roles.
The product manager provides support materials to the drug reps who visit doctors to get them to prescribe their products. For Pyostacine there is a guide to help reps explain the product, using arguments set out by the marketing team; a short synthesis of the key points; and extracts from the medical journal Infectiologie, sponsored by Spilf, France’s professional body for the study of infections, describing the latest clinical trial successes for Pyostacine. The reps also carry Pyostacinebranded freebies: plastic torches with tongue depressors to allow the doctor to examine a patient’s throat, boxes of tissues for the consulting room, pens and USB thumb drives.
Some doctors are of more interest to the drug companies than others. Those deemed to have significant “prescribing potential” receive most attention. To identify them, the companies use information from the health sector economic interest group GERS (Groupement pour l’Elaboration et la Réalisation de Statistiques),
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