Pfizer's Nigeria Scandal: Doctors Without Borders Stirs the Pot, to Little Effect

Last Updated Jan 5, 2011 12:59 PM EST

Pfizer's (PFE) long-running scandal in Nigeria just got murkier with accusations by Medecins Sans Frontiers -- a humanitarian group similar to the Red Cross and known in English as Doctors Without Borders -- that the company lied about clinical trials of the failed meningitis drug Trovan on Nigerian children.

But take the new complaint with a pinch of salt. The quote MSF uses in its press release is recycled from last year; the release omits information suggesting MSF used a less effective drug when it was in the region; and despite Pfizer's ethical problems, Trovan turned out to be more effective than the "gold-standard" meningitis drug of the time.

Regular Placebo Effect readers are familiar with the conflicted Trovan backstory and the Rashomon-like number of different explanations for what went down in the crowded, chaotic halls of a hospital in Kano, Nigeria almost 15 years ago (see related stories below).

The case involves Pfizer's test of a meningitis drug on 200 children in 1996. Pfizer failed to get proper consent for the trial. Eleven kids died and the drug was eventually nixed for meningitis because it had a risk of complications. The events may have inspired the book and film, The Constant Gardener. Pfizer has attempted to do the right thing in recent years by settling the case for $75 million, but it's been stymied by local bureaucracy and corruption.

Yesterday, MSF's statement said:
Pfizer falsely accused MSF in the US diplomatic cables of using Trovan. Documented evidence has shown that these accusations are patently false. MSF did not, at any time, administer Trovan to patients.
To be strict, Pfizer didn't accuse MSF of anything. Rather, the Wikileaks-leaked diplomatic cables say Pfizer said that. Nonetheless, MSF isn't being completely transparent here. It quotes its former Nigeria chief as saying:
"It was not a time for a drug trial," says Jean Hervé Bradol, former president of MSF France, to whom the Kano teams were reporting at the time. "They were panicking in the hospital, overrun by critically ill patients. The team were shocked that Pfizer continued the so-called scientific work in the middle of hell."
If that quote seems familiar, it's because it is. A near-identical quote was used in an article in The Guardian on Dec. 9, 2010:
"It was not a time for a drug trial at all," says Jean Hervé Bradol, former president of MSF France, to whom the Kano teams were reporting at the time. "They were panicking in the hospital, overrun by cases on the verge of dying. The team were shocked that Pfizer continued the so-called scientific work in the middle of hell."
Who got the best drugs?
The same Guardian story on which the MSF statement relies says that the meningitis drug that MSF was using to treat its patients in Kano was chloramphenicol:
MSF had helped set international treatment standards for African meningitis epidemics â€" a single intra-muscular injection of oil-based chloramphenicol will save a life if a child if treated in time.
But chloramphenicol may not be the best treatment for meningitis, the story says:
... the "gold-standard" treatment of the western world, [is] ceftriaxone ...
Ceftriaxone can be better because some strains of meningitis are resistant to chloramphenicol, according to this BMJ/Archives of Disease in Chldhood study of 346 children in Papua New Guinea. Chloramphenicol, however, is cheaper.

While MSF was using the cheaper, less effective drug on its patients, Pfizer was using the more expensive, more effective drug on the "control" group of patients not receiving Trovan. In the Trovan group of 100 patients, five patients died. In the ceftriaxone group, six people died. The usual overall mortality rate for the disease in the region among patients who presented themselves for treatment is about twice that rate, according to The Guardian.

So, to recap:
  • MSF is recycling its quotes to criticize Pfizer even though the criticism actually comes from the U.S. State Department via Wikileaks.
  • Pfizer probably cut some ethical corners in testing a meningitis vaccine during an epidemic.
  • Pfizer nonetheless saved lives during the experiment, and used a more effective drug than MSF as a control.
  • MSF used the less effective, cheaper drug.
  • Nobody in this case has clean hands.
MSF did not return a call for comment.

Related: Image by Flickr user kowitz, CC.

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