Film dares to show health in the real world

Film and journalists can uniquely reveal the drama and complexity of ensuring health breakthroughs reach the poor.  

Indian scientist Yusuf Hamied was a central character in the film Fire in the Blood. The film documents the battle to make AIDS drugs cheap enough for poor countries to afford them, and the story had a clear turning point. In 2001, Hamied, who then headed the Mumbai-based generic pharmaceuticals company Cipla, put the triple antiretroviral (ARV) therapy drug on the market for just under $1 a day.
 
The decision put life-saving medicine within reach of millions: it cost $350 per patient per year at a time when Western pharmaceutical companies sold the same drugs for around $10,000.
 
In the film, screened recently (30-31 October) at the Global Health Film Festival in London, Hamied says he acted on humanitarian grounds, and with the firm belief that India needs to be self-reliant when it comes to drugs. “We learned a very important lesson from Mahatma Gandhi … that every country has to decide for themselves their own destiny,” he says. I think it’s a message that applies to health and development more broadly.
 
The deadly consequences of expensive AIDS drugs and the fight leading up to that turning point were difficult to watch at times. Audiovisual stories are a powerful way to show the human face of topics that might otherwise appear dry — and the legal ins and outs of access to medicine is certainly one of those topics. But the film also made me reflect on the space where science, evidence and technology meet political realities; a space that is more often accepted and explored by journalists and filmmakers than it is by scientists.
 

Fight for survival

 
Fire in the Blood uses interviews with scientists, activists and political leaders to document how the tide turned against a system that kept the supply of AIDS drugs out of the reach of poor countries — contributing to millions of deaths in the global South, mainly in Sub-Saharan Africa. 
 
"The drugs are where the disease is not. And the disease is where the drugs are not,” Ugandan AIDS specialist Peter Mugyenyi says early on in the film, capturing the stark mismatch between maps of demand and supply. The film then takes us through what it means to change a system when those with power benefit from the status quo.
 
The patenting of drugs was, and remains, the central battleground. Economist Joseph Stiglitz points out in the film that, when properly designed, patents lead to innovation — otherwise, they suppress it. “AZT, the first antiretroviral drug invented in 1963, has been covered under monopoly for 54 years,” says Hamied. “Is that what patenting is all about?”
 
When Cipla put the generic version of antiretroviral treatment (ART) on the market in February 2001, the price difference between branded and generics began to decrease. The ART battle was won — but the war on generic drug access more broadly still rages. "Help prevent a sequel" is the last thing we see on the cinema screen.

Global health advocates such as MSF’s Access Campaign argue that international agreements — such as the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the Trans-Pacific Partnership Agreement (TPP) agreed last month, now up for approval by the US government — impose strict patent rules on developing countries which essentially block their ability to make low-cost versions of drugs.
 

Dig deep into politics

 
The complexities of trade agreements and the political wranglings around them make this a difficult story to tell in an engaging way. But, as newspaper article after article flashed on the screen during Fire in the Blood, it became clear that media coverage was an important part of the debate in the 1990s. 
 
New York Times world health reporter Donald McNeil, whose story on Cipla’s generics in 2001 made the front page, said in the film that publishing a profile of Hamied’s work a year earlier was probably the most important story of his career — because of the impact it had on countering the widespread perception that drugs produced in India would be substandard. What McNeil found on the ground was spotless factories; and he learned that the ingredients for many brand-name drugs were in fact sourced from India. 
 

“Good film is about using evidence and human stories to show how science lives in the real world and to untangle complex subjects that may touch any one of us.”

Anita Makri, SciDev.Net

On the second day of the festival John Pilger, renowned investigative journalist and documentary film-maker, took the audience through five decades of his career. In McNeil’s articles the politics of access to AIDS drugs were a backdrop, but Pilger spoke more strongly, and uncompromisingly, about how journalists should treat the political hand behind stories.
 
“What is important is to do the why, as well as the what, where and when — your responsibility is to explain why and give the political context,” he said.  
 
That context was plain to see in at least two other feature-length films at the festival. In That Sugar Film, Damon Gameau puts himself on the typical Australian’s diet for 60 days and shows how hidden sugar in foods marketed as ‘healthy’ can affect body and mind. The closer he looks at the foods and their impact, the more we see how cleverly designed labels distract consumers, and how companies might fund research that delinks evidence of harm from their products.
 
Every Last Child was more sober in style. It told how a polio vaccination team in Karachi, Pakistan handled the fallout from attacks on vaccinators following a ban against the vaccine issued by the Taliban. In this film, politics was the solution too: the campaign continued after the team got local politician Imran Khan on board to ‘rebrand’ the vaccination drive as being about broader health issues, not just polio .
 

Research is not enough

 
All three films are examples of how context matters in science. Research, development and technology to develop new medicines are not enough  to meet social needs equitably: health programmes also need to consider the mechanisms — logistical and political — that will deliver those innovations to those who need them, as well as make them economically viable.
 
Many health researchers will shift uncomfortably in their seats at the idea of engaging with these issues. They touch a politicised space that, more often than not, is outside the comfort zone of natural science — understandably so, considering core values such as objectivity and empiricism.
 
But in a social context truth is a messy business, and scientific evidence rarely exists in isolation from the places, people and reasons for which it is created.
 
Luckily, that is territory where journalists and filmmakers do dare to tread. The festival’s screenings were a reminder that good film is not just about creating an emotional response. It’s also about using evidence and human stories to show how science lives in the real world and to untangle complex subjects that may touch any one of us.
 
Anita Makri is opinion and special features editor at SciDev.Net. @anita_makri