Somebody recommended The Body Hunters when I reviewed Bad Pharma earlier this year, and I’m pleased that I was able to get and read it so soon! The author, an investigative journalist, here examines the ethics of biomedical research — specifically, of American drug companies outsourcing clinical trials to companies with laxer ethical requirements than the US and large populations of sick patients to run tests on. It’s a fairly widespread practice that only gets wider-spread with each passing year.
I am an inveterate note-checker in my nonfiction. I already sort of was to begin with, and then I read Cordelia Fine’s book Delusions of Gender, which talks about how citations can be slapdash to the point of misleading. These days, if you hand me a nonfiction book and a computer, I’ll check endnotes until my fingers cramp (or until I decide the author’s reliable). That sort of fact-checking is exactly the level of tedium that pleases me, and anyway I like to know that my sources are dependable before I go quoting them hither and yon like I’m some sort of science expert.
(I mean, ideally. In my own life, I repeat things willy-nilly that I think are interesting, and then disclaim responsibility for them by forgetting where I read them. It’s the magpie approach to knowledge.)
The Body Hunters doesn’t do the thing Cordelia Fine rages over, of citing studies that say green in support of a statement that says red, but it also doesn’t adequately back up all of its points. In the third chapter, for instance, Shah says, “Shigella is a disease-inducing bacterium that kills one million people around the world every year.” The citation for this claim is a press release from a pharmaceutical company. The press release was most likely getting its information from a 1999 study published in the Bulletin of the World Health Organization, but still, I’d rather let’s cite the study itself than cite somebody citing the study, particularly since I can easily look up the study if I know where to look for it and care enough to bother. (If you’re concerned about shigellosis, the happy news is that a WHO study published in 2010, after The Body Hunters‘s publication, found that only about 14,000 people die from shigellosis-related causes every year. Deaths caused by this bacterium are still disproportionately likely to happen in Asia rather than anywhere else.)
It took me five minutes to find the original study and the updated study and add that information to this post for your delectation and delight; but Sonia Shah cited a press release from a pharmaceutical company. That is lazy.
Or here’s another one: “In 1985, a long-running government study on cardiovascular risk — the Framingham Heart Study — reported a correlation between low cholesterol levels and increased longevity.” The citation for this is a 1985 Washington Post article. It’s not hugely important here to cite the primary source, but since we’re citing things, why not cite a primary source? They’re easy to find. The Framingham Heart Study has a website. Or if it’s something that’s just known, like the dates of the Civil War, then don’t cite anything. That is also okay sometimes.
It feels churlish to complain about a book like The Body Hunters, which is a friendly and easy-to-digest account of some of the ethical problems plaguing pharmaceutical research. It’s important to have such an account available, and I truly do understand that there are times when you have to cite secondary sources, even though you’d prefer to cite primary ones. And speaking generally, these lazy citations showed up in support of background information rather than in support of the main points Shah was making. But having them at all leads to this thing, you know, where I got done with The Body Hunters and felt that I had gained a broad, vague sense of the story of testing drugs in third-world nations, but that I couldn’t depend on any specific piece of information I had been given (particularly scientific information).
Perhaps not surprisingly, Shah is at her best when she’s talking about the sociology of science, rather than the science itself. The chapter about the hunt for a cheaper AIDS treatment for patients in countries poorer than the US is both fascinating and well-documented, as is the one about AIDS denialism in South Africa under Thabo Mbeki. (Which, look. That was bad and he was wrong, but it is not insane to mistrust Western scientists when it comes to ethical and accurate research in Africa.)
Given that almost a decade has passed since the publication of The Body Hunters, I’d love to read another book on the same topic that takes on the last ten years. Has drug testing on third-world patients expanded wildly, as Shah grimly predicted it would? Have ethical standards been modified and improved? If you know of any recentish books that address this, let me know in the comments! I am interested in ethical quandaries and would gladly read many more books about this one in particular!