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November 22, 2007

Pfizer's Nigerian trials: Big Pharma is on trial in Nigeria - but this isn't The Constant Gardener, more "Carry On Corporation-bashing"

Posted by Richard D. North

Richard D. North looks at the evidence surrounding the case of Trovan, the 1996 drugs trial which may cost Pfizer billions.

Right now, one of the world's bigger claims for damages is rattling chaotically toward its end game. The case, hardly yet noticed in the West, may be the biggest single risk faced by Pfizer, the world's largest pharmaceutical company. The firm stands to lose as much as $8.5 billion dollars, though probably much less. But in any case the money may matter less than the unpleasant exposure the firm may endure.

To get a sense of what is going on as several Nigerian courts prepare to take on Pfizer, it's easiest to recall a 2005 movie which - coincidentally, I am fairly sure - looks a tad prescient. Remember The Constant Gardener? [for a forthright review, see: Kenneth Minogue asks, how can serious critics take such tosh seriously?]. It was based on John Le Carré's eponymous fictional account of how a big Western pharmaceutical firm trials a dangerous tuberculosis drug on the poor people of Africa. They die, international governments connive at it all, our investigative heroine - a feisty Anita Roddick-type - gets murdered, amongst others.

It was so over the top that most people concentrated on the gorgeous filming and the sexy characters and their personal stories rather than on the anti-corporate and anti-globalization and anti-government paranoia which provides its half-baked core. Even Sonia Shah, a seasoned critic of Big Pharma's Third World exploits, thought the film over did it. (It ought to be admitted that another critic, Marcia Angell - whom I think to be very intemperate though well-informed - thought it understated.

As Shah notes, it is certainly true that Big Pharma is increasingly testing drugs in the Third World, and Pfizer is no exception. Indeed, in 1996 it trialled a new drug, Trovan, on 100 young patients in Kano, a poor Muslim state in Nigeria. The children were suffering in a ferocious epidemic of a form of meningitis particularly acute in Africa. Some of the children involved in the trial died and others were ill, and some still are. In succeeding years, an anti-Pfizer campaign got going.

Eventually, it reached the ears of a serious American paper. The Washington Post has been running stories about the case since 2000, notably in 2006 and 2007.

Perhaps energised - shamed even - by the 2006 Post piece, state prosecutors in Kano and federal prosecutors in Lagos began to develop a massive damages case. Along the way, Babatunde Irukera, a Chicago-based Nigerian-born American lawyer got involved.

Cases like this have a special dynamic. The media and political classes in developing countries are schizophrenic about Western multinationals. They want the investment, taxes, employment and products that big firms bring. But bashing them plays well, too. The firms become latter day proxies for the colonialism which it is handy to blame for most of what's wrong. Besides, suing them is a distraction from more local ills, and holds out the promise of profits too.

Anyway, in Nigeria, and in Kano in particular, the plight of the Trovan "victims" has been trumpeted in almost every quarter and it is hard to see how Pfizer can escape a bloody encounter.

In fact, and contrary to most publicly-expressed Nigerian sentiment, Pfizer looks to be about 90 percent innocent of the charges levelled against it. It says, and can prove, that Trovan was in the late stages of testing and that the final stage of which the Nigerian trial was part was likely to be safe and quite safe enough, for instance, to have been undertaken anywhere in the world. Besides, amongst the drug's targets was the specifically African disease Trovan was deployed against in Kano.

Pfizer claim that all the relevant authorities and regulators in the US and in Nigeria were conscientiously and diligently involved. They further claim the drug was proved to be effective, and at least as effective as its nearest existing rival which was the control comparison drug in the trial. They also stick by their claim that Trovan was much easier to take. The firm claims - and think - they can prove that Trovan did not have the kind of side-effects claimed in Kano, and certainly wasn't fatal. Indeed, the drug went on to commercial production and was eventually withdrawn because it turned out to have side effects unrelated to those claimed for the Kano children. A paradoxical source of comfort you may think, but comfort anyway.

So far, so straightforward. Actually, however, it turns out that there is some evidence that the trial was not carried out in perfect accord with the rules ("protocols", they are called in the trade). Der Spiegel, the German magazine, in November 2007 supportively profiled Babatunde Irukera and his case. Beyond generalised assertions that Pfizer is wicked, it is that some children - maybe not more than a handful - may have been treated incompetently by some of the doctors during the trial.

Whether or not that incompetence was real and caused the problems for the children now claimed by anti-Pfizer campaigners and lawyers is pretty hard for an outsider to gauge. However, it does seem clear that the serious charges of large-scale exploitation, callousness and deviousness levelled at Pfizer are false.

Pfizer's public position is to claim that they were white knights on a humanitarian mission to donate free drugs to suffering children. This is, on the face of it, a rather silly claim. Pfizer are a commercial firm whose motives are never wholly philanthropic, and this was in any case a trial which was commercially valuable to them. Claiming chivalry rather detracts from the more credible claim that their enlightened self-interest did good. Why not admit it?

Well, one reason may be a lawyerly one. When there are court cases in the offing, it is often regarded as canny to stonewall for fear that small admissions of failure may be the thin end of negotiating wedges. Exxon played hardball over its liability in the 1989 Exxon Valdez oil spill case, and it is moot whether its reputation or its wallet would have been much enhanced if it had not.

More recently, Merck's $4.85bn settlement of 50,000 Vioxx claims is about a quarter of what had been predicted. It's a saving attributed to Merck's insisting that it was prepared to fight every compensation case if need be. Wyeth, by contrast had to pay out more than $20bn in its fen-phen saga [FT, 10/11 November, 2007].

Anyway, it may indeed be tactically difficult for Pfizer prematurely to admit some failings small and large by some of the people working for it or on its behalf in the midst of a crisis in the backwoods of a poor state in a difficult country.

What will happen next? Such situations anywhere are very unpredictable, and any Nigerian dealings can become murky quite quickly, so my guesses are doubly tentative. But one can suppose that Pfizer will aim to keep the case from going to trial, at least in Nigeria. In which case, presumably a deal will have to be struck. It will involve money and probably an admission of guilt, which Pfizer will fight hard to minimise. Perhaps any such admission can be limited to very localised wrong-doing. Pfizer will perhaps offer to crank up some pro bono assistance to Kano and Nigeria. The risk, so far as I can spot it, is that if this deal is delayed too long, more media outlets will make as much mischief as they can and that this may be quite bad for Pfizer.

The oddity is that Constant Gardener paranoia and its riffs about Big Pharma's exploitative tactics are the reverse of some big trends. Big Pharma is taking a serious commercial interest in developing countries - one that will make entrepreneurs, workers and patients in poor places part of the world wide health business. (For this case see this article in the pharmaceutical patents section of www.livingissues.com.)

So the Trovan case is most important for being a distraction from Nigeria's real future.

Nigeria is on the verge of being taken seriously as a good place to invest. It is beginning to fight corruption and earn relative economic success. It has great prospects in oil and gas and some chance to share with South Africa real economic leadership on its continent.

This all means that Nigeria stands to suffer much more than Pfizer. The more Pfizer is made to eat humble pie to buy off some of the more outrageous claims made by Nigerian interest groups, the more the country will reinforce its old reputation as an unreliable, dangerous, tin-pot sort of place.

It is in nearly everyone's interests to settle the case swiftly and decently with as much honesty as possible. Pfizer should abandon its patronising pose of infallible humanitarian benefactor. Nigerians should get past their erratic pose of victimhood. Then the two parties can move beyond Trovan and start to do proper business together.

[Richard D. North had no contact with either Pfizer or its opponents in the preparation of this piece. The research was conducted online using public domain documents. The author's conclusions are his own, not those of the Social Affairs Unit. Richard D. North has taken an interest in an earlier piece of Nigerian corporation-bashing. The Social Affairs Unit does not receive any funding from Pfizer.]

Richard D. North is the author of Rich is Beautiful: A Very Personal Defence of Mass Affluence and Scrap the BBC!: Ten Years to Set Broadcasters Free.


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