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Microsoft word - msf_review.docBOOK REVIEW
PIONEER IN PHARMA & IN CHINA
Dundee: Dundee University Press, 2008, 258 pp. (incl. appendices and bibliography), The history of Janssen Pharmaceutica and its evolvement in China is central to this homage to Paul Janssen, who set up the company in 1953; led it through a merger with Johnson & Johnson in 1961; built up relations with China from the 1960s onwards; and left clear footprints on its research agenda and company management style. The book owes its existence to Paul Janssen, who commissioned it to the author Geerdt Magiels. However, Janssen died shortly after their first meeting in 2003. The book aims to make known the scientific, business and human achievements of Paul Janssen. As such, there are scatterings of descriptions of major events in Janssen’s life; group photographs of important occasions and celebrations; and advice and adages on how to collaborate (for example, to have an open mind; to be creative; to allow local people to run the business; to work through friendship and compromise; to have patience; and to show mutual respect). The book gives corporate meaning to a global audience of the role of large pharmaceutical companies in developing countries. A role that involves the efforts made by such companies to advertise themselves as a bridge between rich and poor; their motivation by concerns for global health; and contributors to the well-being and development of people in developing countries. As a eulogy, this book can hardly be expected to meet academic standards. As belonging to the popular genre, the book is presented in chapters that are subdivided into small digestible bites. The many anecdotes of Janssen’s Chinese guests in Belgium and the Belgian experiences make it, in part, a very amusing and interesting read. Magiels based this company history on interviews with scientists, managers and other professionals that are, or have been, affiliated with Janssen. Nevertheless, parts of the book recount a narrative of scientific progress made by Janssen in the fields of biochemistry and medicine that may be hard to follow for laypersons (although an intelligent amateur, in principle, should be able to understand the main gist of it). The hybrid nature of the book makes it hard to judge the kind of audience the author had in mind when writing it: scientists, business managers, experts on China, development workers or, perhaps, admirers of Janssen. The book consists of nine chapters, of which chapters one, three and four contain long descriptions of the development of biochemistry in Janssen’s laboratories. Chapter one, for instance, explains how the synthesis of molecules can lead to chemical compounds that can be patented. This enables their licensing to pharmaceutical companies whose revenues can be used to finance further research. Janssen embodies both. The pharma use the compounds to develop new drugs. Examples are anticholinergic drugs, such as priamide and loperamide; anti-diarrhoeal drugs without the side effects of addiction, such as reasec (diphenoxylate); analgesics, such as fentanyl, sufentanil and lofentanil; antihistamines, such as cinnarizine; anti-psychotics, such as haldol (haloperidol); and anti-worm drugs (anthelmintic), such as levamisole and mebendazole. The other chapters are more concerned with recounting Janssen’s establishment in China and the evolution of its subsequent joint venture and collaborations. Chapter two is about beginnings. It explains the initial link between Paul Janssen and China – personified by George Hatem (who was originally Canadian) who travelled to Yan’an with Edgar Snow; worked as a skin and general doctor alongside Mao Zedong; knew Norman Bethune; and lived in China until he died in 1988 from pancreatic cancer. In 1976 Paul Janssen met Hatem at Xie He Hospital in Beijing where they ‘immediately felt a bond in working for the health of mankind’. Janssen continued to meet Hatem at various events and is said to have promised to help modernise China’s pharmaceutical industry. Janssen was especially keen on eradicating parasitic diseases in developing countries, yet he was told that this had already been achieved in China. Hatem, however, made clear that this was not the case, and so they decided to work on eradicating worm infections in earnest. Chapter three tells the story of how the first collaboration between Janssen and the Hanjiang factory in Hanzhong developed and culminated in the completion of the factory in 1984. It is told as a story of communication difficulties; misunderstandings and the building of friendship; and describing how, thanks to Janssen’s dream to produce medicine for the people of China, collaboration began with producing the medicine mebendazole – an anti-worm drug. In 1981 Janssen Pharmaceutica and the Chinese Government signed a Compensation Trade Agreement, from which Janssen provided the technology to manufacture mebendazole and for which the Chinese Government received payment in products at preferential prices. Janssen produced the design of the factory, supplied the machines, the technology (including China’s first water treatment works), the training and overall management. The Chinese financed it, provided staff, and were recognised as the owners of the factory. Chapter four explains how Janssen began to concentrate on ‘gastrointestinal motility’ with the synthesis of domperidone – a molecular compound that blocks the neutrotransmitter dopamine but does not cause vomiting. Janssen increasingly concentrated on marketing drugs that were based on bridging pharmacological theory and clinical practice. This chapter, most of all, sings the praises of Janssen: with its conceptual innovation, its ‘horizontal hierarchy’ (in which there is direct contact between boss and employees), its ‘intelligent serendipity’ and its emphasis on research rather than on marketing. Despite the increasingly stringent FDA demands on safety and efficacy; the increasing demands and costs of clinical research; and the increasing importance of market positioning, the author argues that Janssen emphasised research that served the goal of better therapy for the people rather than for market gain. Chapter 5 describes how a joint-venture company was established in Xi’an. Conflict occurred when Janssen wanted a 51% share of the equity and China would not allow it. In the end a face-saving compromise was reached by allocating 90% of the sales in China to the Xi’An based factory, leaving 80% of the international sales to Janssen. In the process, marketing had to be reinvented: many concepts, such as ‘profit’ and ‘cost-price’, were unknown or not understood and compromises had to be reached. In Chapter 6, the democracy movement in June 1989 is described as in ‘turmoil’ and regarded as ‘unfortunate in its timing’, as this is when Janssen, in Xi’an, was ready to market its first medicine. The book is not clear about these events, including the Tiananmen massacre, which shook the world. No doubt this strategy was chosen to maintain respect towards China. The events that led to the ‘Tiananmen incident’ are described as having come as a surprise to Janssen and to China, which makes it clear that Janssen had not been aware of the student demonstrations that had taken place earlier in the year and in 1987. Janssen was unhappy with the political situation. The unrest had thwarted the marketing plans of the company in China. Furthermore, the Xi’an plant had transgressed its budget to such an extent that the company considered pulling out. Reorganising the plant, and the growing economy, turned out to be the only way to save the joint venture. Finally, in 1991, the plant in Xi’an was opened. Chapter Seven describes the difficulties of the plant’s upkeep. For instance, if a part broke down the entire production line was stopped to take the machine apart. Havoc occurred when the Belgian technician had a part flown over from Germany, even though it could be ordered cheaply from elsewhere. It had to be explained that stopping the production line to wait for the missing part would be far more expensive. For instance, to prevent further difficulties in relation to price setting, management and marketing (over 10,000 distributors and managers, wholesalers and distributors) were sent abroad for training. In 2000, a Strategic Partnership Programme was signed between Xi’an-Janssen, the Chinese Ministry of Heath and China’s State Drug Administration to stimulate the development of healthcare in China. Chapter Eight explains how Janssen came to support Chinese public health. Thus, Janssen popularised the idea in China that psychotic patients should not be sedated. With the support of the Ministry of Health, lesson materials and training programmes were developed. Janssen helped ‘countless of other projects to get off the ground’: including a fund for emergency relief and natural disasters, a project for the protection of the terracotta warriors, and training programmes in hospitals. In my view the final chapter is the saving grace of the book: it discusses problems of healthcare, the gap between rich and poor, the widespread pollution and corruption, and the spreading of AIDS and TB. Although it emphasises the continuous improvements in the areas of human rights, the political system and economic growth, it also refers to some problems experienced by journalists, farmers and people in the West of China. Unfortunately, no references are made to the widespread occurrence of workers’ strikes, demonstrations, local oppression in the countryside, the situation of rural women, birth policies, and the revival of traditional beliefs and superstitions. Nevertheless, this book succeeds in conveying the challenges Janssen faced in China. It looks back into a history of difficult communication with foreigners in China during the economic reforms, and it becomes clear how China, for a long time, has been a society of fear: fear of foreigners and accusations of betrayal for going against Party rule. These fears had the effect of strict adherence to official procedures and instructions (even when they were clearly wrong); a suppression of initiative; and systematic self-censorship. Unfortunately, the nature of the book – a eulogy of Paul Janssen – does not make it possible to discuss more clearly the collapse of the healthcare system and the contributions that Janssen could have made to the wellbeing of the majority of the population, who will not profit from their drugs. It is ironic and tragic that with the eradication of free access to healthcare, welfare and education in large developing countries such as China, people have to rely on the handouts of transnational pharmaceutical giants to survive. The book pays little attention to bioethical regulation. The importance of animal models to the development of drugs is emphasised, but no space is dedicated to animal well-being. With regard to clinical trials, research regulation is criticised. The book relates how, after the Thalidomide (Softenon) scandal in the early 1960s, the regulation of medical research, in combination with an American litigious culture, became increasingly convoluted, expensive and lengthy – turning clinical studies into a millstone around the pharmaceutical industry’s neck. This millstone is made responsible for people dying (p. 23). No mention is made of the (sometimes) lethal problems that occur as a result of insufficient regulation or as a result of high price market strategies. In places there are some remarks on the translation, mistakes, and problems with the chronology and historiography of the book. Although the translation from the Dutch is good, there are some annoying mistakes: economical consequences (instead of economic); Mr Horsten was very interesting (instead of ‘interested’) (47); Ma Heide (instead of Haide) (42); multi-disciplined (instead of multi-disciplinary) (73). The sequence of events in the book is not always clear and in Chapter Three the quotes from many interviews seem to have been stuck together to tell the history of Janssen. One citation, referring to the situation at the first factory site in Hanzhong in 1983, mentioned that ‘[w]e couldn’t even send an e-mail home or have a spare part brought over’. Especially in Chapter Three, it was not always clear who was quoted and when. And, finally, Magiels adopts a ‘chatty’ style of history writing, which sometimes comes across as sloppy. For example, at page 47 Magiels explains how millions of Red Guards were transferred to the countryside to ‘take the Communist Message to the farmers’, while at page 52 Magiels explains that young students learned from the farmers how communism really works. As something for popular readership, however, I found it a very readable book. Margaret Sleeboom-Faulkner, Reader in Anthropology, University of Sussex Falmer, United Kingdom DOI: 10.2966/scrip.060109.530
Margaret Sleeboom-Faulkner 2009. This work is licensed under a Creative Commons Licence. Please click on the link to read the terms and conditions.
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