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Foreword
JOHN LE CARRÉ
    This book is an act of courage on the part of its author and its publishers. Ever since I wrote The Constant Gardener , I have received approaches, and sometimes complete typescripts, from investigative writers determined to lift the veil on the darker side of the world’s most profitable trade: the pharmaceutical industry. Where a proposed book seemed to have merit, and was not weighed down with mountains of medical jargon, I passed the word to literary agents and publishers’ readers. Yet not one of the authors, so far as I was ever aware, saw his project realized. And if, months later, I delicately inquired why not, the answer, however wrapped up, was always the same: too risky.
    And you might find it comic or outrageous or, if you are of my mind-set, illustrative of the stranglehold of unrestricted corporate power that the topic that is closest to all our lives, and closest to the concerns and responsibilities that we feel for one another, should be deemed too risky for public debate.
    You might also find it outrageous that our treasured legal system, originally designed to protect our freedoms, should be the instrument of their suppression. Yet such is the reputation of the gunslinging lawyers of Big Pharma, so unlimited the industry’s wealth, so vast its reach into politics, the media, and the very heart of the medical profession and the bureaucracy that sustainsit, that publishers have good reason to believe that, in picking a fight with Big Pharma, they are committing their company to a five-star lawsuit, countless hours of office time, disenchanted stockholders, and copies pulped before they reach the stores.
    Yet, little by little, the veil is indeed being lifted. The outsourcing of clinical trials to countries where sick people are so poor they are ready to sign up to anything, whether or not they can read what’s on the consent form, is now public knowledge. The tendency of Big Pharma to promote phantom, or at best speculative, maladies and then supply the cure for them, is now public knowledge.
    The corrupt recruitment of large numbers of doctors in general practice and teaching hospitals to prescribe a particular medical project is now public knowledge
    The corrupt recruitment of large numbers of doctors in general practice and teaching hospitals to prescribe a particular medical product is now public knowledge.
    The ever-growing list of dangerously under-tested products that have been wished upon the public by supposedly impartial government bodies is public knowledge, as are the links between members of such bodies and the pharmaceutical companies that manufactured them.
    It is also public knowledge, since they themselves have owned to it, that learned medical journals of supposed integrity have carried glowing accounts of this or that pharmaceutical product, only to discover they were written not by the august Professor of Something who has put his name to them but by their manufacturers.
    But perhaps the worst of Big Pharma’s many sins is its persistent encroachment, by means of a combination of lavish sponsorship and moral blackmail, on the integrity of biomedical research at every level, with the consequent ever-growing scarcity of unbought medical minds.
    Using clear, accessible language and carefully annotated case histories, Sonia Shah has struck a blow for all who dream of harnessingthe huge power for good that is invested in the pharmaceutical industry, of seeing its products made available to those who most need them, and of curtailing the greed that drives its worst practices.
    Â 
    Cornwall, England
February 2006

Preface
    â€œThe blood of those who will die if biomedical research is not pursued will be upon the hands of those who don’t do it.”
    â€”Joshua Lederberg, PhD, Nobel laureate 1
    â€œI mean, shit, we learn by climbing over the bodies of humans.”
    â€”Murray Gardner, MD, University of California
HIV researcher