In The Third Man, the hero, a guileless American, arrives in post-war Vienna to meet his friend, Harry Lime, who has offered him a job. He is told, first, that Lime is dead, and then, by a British military officer, that he was a criminal, a racketeer. Go home, says the officer.

The American doesn’t. He is convinced his friend was innocent, and stays in Vienna to clear his name. But Lime is still alive, and the American, at the end of the film, joins the chase and shoots him dead.

Something very serious is needed to account for this reversal, and something very serious is revealed. Harry Lime was not just a racketeer. He sold adulterated penicillin on the black market and children, as a result, suffered terrible brain damage. We are almost shown them, but not quite (this film was made in 1949): the camera tracks down the hospital ward and shows us the reactions of the other characters. We imagine. It is enough.

The cleverness of this element of the plot is how plausible it is made by the context. A black market is one of the products of civil chaos, and civil chaos is a product of war. In such an environment, everything becomes corrupted, starting with commerce and ending with conscience – or the other way round. And because it is a commercial transaction, the fact that it is evil is masked.   Commerce is just commerce, isn’t it? Caveat emptor.

Civil chaos also results from misrule. In Haiti, which has been misruled, often grossly, for most of two centuries, some cough medicine which did not do what it said on the label went on sale a few years ago in the poor districts of Port-au-Prince, and killed some of the children who took it. It wasn’t the first time this sort of thing had happened. Respiratory infections, along with many other ailments, are endemic in the slums; poverty is institutionalised by inequality of staggering proportions; with inequality comes contempt for the poor. The rich five per cent buy their drugs in Miami. Visiting Haiti, I was advised to look carefully at any medicinal products I bought.

We are accustomed, in this part of the world, to being able to trust a pharmaceutical product. It may not do all it’s claimed to do, but at least we can be sure that it is what it says it is. We may not like animal testing, but at least we know there has been testing, and some identifiable regulatory body has overseen it. We can assume, on the whole, that we – or the NHS – are not being monstrously overcharged for drugs we need, and that we will have access to them within a reasonable time of their reaching the market.

For ensuring the smooth running of this system we have been largely indebted, since 1995, to the European Medicines Agency (formerly the European Agency for the Evaluation of Medical Products). At its offices on Canary Wharf, this decentralised EU agency evaluates and regulates the safety of medical products across the EU, ensures universality of standards and that medicines are not duplicated (thus saving a lot of money). The British regulator, the Medical and Healthcare Products Regulatory Agency (MHRA), is fully integrated into it. Thanks to the efficiency of the EMA’s single market, patients in Europe are able to access new treatments and medications roughly six months to a year sooner than those in Canada and Australia.

John Major lobbied hard for the EMA to come to London, and since then it has played an important role in Britain’s participation in Europe-wide medical projects. It has been central to the UK’s reputation in scientific development. The wish to be physically close to the regulator has drawn research organisations and drugs manufacturing companies to settle in London. The EMA employs about 900 people, and receives a constant flow of professional visitors who account for 30,000 hotel bookings per year. It is one of the institutions that make London a world city.

And now it’s going, another victim of Brexit. As an EU agency, it has to be located in an EU member state. A decision as to which country will host it is expected in October. Member states have until the end of July to submit their bids. One of the main criteria is good transport links. The competition is keen. Ireland is one of the favourites.

If there is a perfect illustration of the own goal that is Brexit, the departure of the EMA is it. It is not simply that the UK will lose the revenue and prestige that is involved in hosting this important agency; it is also that, because it is subject to the European Court of Justice, British health services and manufacturers will lose access to it and the market it regulates. That market accounts for a quarter of all global pharmaceutical sales, and it is idle to pretend that British pharmaceutical companies will be not be seriously affected by being excluded from it.

The most important consideration, however, is the effect on the NHS, patient health and public safety. On 4 July the Government addressed this. It issued a statement of its desire to retain “a close working partnership” in respect of medicines regulation after Britain leaves the EU. It laid out three principles: that patients should not be disadvantaged, that innovators should be able to access the UK market as quickly and simply as possible, and that Britain would “continue to play a leading role in both Europe and the world in promoting public health” (MHRA website).

Informed readers of this announcement were not impressed. Perhaps they had noticed the lack of detail, a persistent feature of Government communications.   A letter of 12 July (, addressed to Michel Barnier and David Davis by representatives of the European and British pharmaceutical and life science industry, stressed the high degree of integration of the industry across Europe and the “sophisticated system of legal and regulatory arrangements between EU institutions, Member States and national competent authorities.”

“It is important,” the letter continued, “that there is as much certainty as possible, as early as possible, to enable the pharmaceutical and life science industry to transition smoothly into the new framework, ensuring there is no disruption to patient access to medicines.”

In a later paragraph it was more explicit: “In the case of an unorderly withdrawal there is a risk that all goods due to be moved between the UK and EU could be held either at border checks, in warehouses or manufacturing and/or subject to extensive retesting requirements… This would lead to a severe disruption of most companies’ supply chains, which would lead to potential supply disruptions of life-saving medicines.” (My italics.)

The authors of the letter pleaded for more time to prepare for the safe disentangling of the industry’s “sophisticated system of arrangements”. They fear they won’t get it, and with reason. The hard-line Brexiteers are suspicious of a transition period, and Theresa May will not allow a co-operation agreement that is subject to the loathed ECJ. And if the talks collapse because David Davis and his team are too dogmatic, unprepared or concerned with what is going on behind their backs in Westminster to carry them through successfully, then all bets are off.

It would be comforting to think that behind the scenes the Government is beavering away at making a success of our departure from the EMA, but the language it has employed in its statement is the same as the language it uses to talk about any aspect of Brexit – vague, bland, empty. It has talked of a “close working partnership” with the EU in relation to the Irish border, security and the European Arrest Warrant, Euratom, the single market… it knows only one note and untiringly sings it.

It appears ignorant of science and to regard it as secondary. In February, MPs from the House of Commons Science and Technology Committee called on David Davis’s Department for Exiting the European Union to hire a chief scientific adviser as a matter of urgency. The Department has still not done so. “The scientific community in the UK is frankly very worried about Brexit,” said Andrew Steele, chairman of the Science is Vital campaign group this week.

David Davis was photographed sitting at a table innocent, on his side, of any scrap of paper, at the negotiations on Monday. Michel Barnier, who had a sheaf of them, is acutely aware of the clock ticking: Davis seems not to know there’s a clock. He left the talks within an hour to return to London. If he is aware of the urgent need to make plans so that patients can get the right medicines, and don’t resort to unlicensed products because they’re all that’s available, he has given no indication of it.

We’re still a long way from Haiti. But the signs are ominous. Dereliction of duty in high office. Incompetence. Cynicism and a culture of lies. Indifference to poverty. The abomination of Grenfell Tower.

The road down which the signs point goes straight to Port-au-Prince.


One thought on “What exactly are these pills?

  1. I am Suzi Davies brother-in-law, married to Paddy’s sister Linda, and have been receiving your deeply interesting posts from Suzi. I would like to get them direct, please.

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