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 teach 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.