Fire in the Blood
Dylan Mohan Gray, director and writer
Dartmouth Films; 2013
All professions are conspiracies against the laity.
— George Bernard Shaw, The Doctor’s Dilemma (1906)
This famous Shavian aphorism could serve as the promotional tag line for Fire in the Blood. Instead, the feature documentary’s director, producer, writer and editor, Dylan Mohan Gray, selected the more dramatic and ominous “Medicine, monopoly, malice” to describe his exposé of the systematic withholding of affordable generic drugs from those with AIDS across the developing world. It is a startling portrait of cynicism, greed, racism, even borderline misanthropy on the part of multinational pharmaceutical companies, which used patent protection legislation to block the manufacture of inexpensive generic drugs. Millions in the developing world suffered and died as a result. Fire in the Blood is an impressive activist documentary that chronicles, ultimately, success over what health care advocate James Love called a “crisis of humanity.” It is a sprawling and thorough examination of the gnarled political, moral, ethical and economic dimensions of this crisis.
![Figure](https://www.cmaj.ca/content/cmaj/187/4/280/F1.medium.gif)
Image courtesy of Sparkwater India
The film details an astonishing story and a long-overdue tribute to those who made access to these drugs possible, people like former South African archbishop Desmond Tutu and former US president Bill Clinton. Narrated by acclaimed actor William Hurt, Fire in the Blood features interviews with physicians, researchers, activists and legislators. At its heart are the doctors and researchers in Africa and India who showed that they could produce and disseminate generic versions but were opposed by drug companies and Western governments. The cast of characters is remarkable: William F. Haddad, the “father of the American generic drug movement,” argues that affordable solutions are easily obtainable; Yusuf K. Hamied, the pioneering Indian scientist whose company, Cipla, offered to provide AIDS drugs for less than one dollar per patient per day, speaks of how his Gandhi-inspired approach was resisted by financial interests; and Peter Rost, a former Pfizer vice-president and physician, speaks of his experiences within the corporate machine and how he eventually decided to speak out against what he saw as the increasingly unconscionable practices of profiteering and blocking access to affordable medication for some of the poorest and most vulnerable people on the planet.
The film presents (and demolishes) myths used by drug companies to impede the production and dissemination of generic drugs: arguments that Africans would not use the drugs properly and fears that the virus would mutate, rendering nongeneric drugs ineffective. Confronting the oft-expressed theory that without patent protection, multinational pharmaceutical companies would lose revenue and therefore not invest in research, the film reports that worldwide, 84% of research into new drug regimens is state funded, with the major pharmaceutical companies accounting for just 12% of overall funding.
Admittedly, activist documentaries such as Fire in the Blood (other examples being Michael Moore’s Fahrenheit 9/11 and Davis Guggenheim’s An Inconvenient Truth) can have the effect of raising ire and indignation, but not much else. Their hortatory rhetoric and urgent pleas for reform, while convincing, often fade after the closing credits. One feels enlightened, perhaps, but is also left with a sense of the intractability of the problem and a lingering question: What can one actually do after the lights come up in the theatre? Although this concern does apply here, it is transcended by the fact that Fire in the Blood asks us to look beyond and to ponder the implications of the for-profit approach to health care. Similar situations could arise again, in fact may be arising as we speak. Are we all in this together, or is everyone on his or her own? This is an immediate and pressing question for every viewer, physician and patient alike. Gray’s film is a compelling and ongoing reminder of what’s at stake.
Fire in the Blood does not offer simple solutions; rather, it asks how the situation can be changed. As several people state on screen, the mere existence of this film is a sign that change is possible. A passage from Leonard Cohen’s Book of Mercy (1984) offers a useful, apposite summary: “Take heart, you who were born in the captivity of a fixed predicament; and tremble, you kings of certainty: your iron has become like glass, and the word has been uttered that will shatter it.” By telling this extraordinary story, Fire in the Blood may well have begun the process by which the “word has been uttered that will shatter” this lamentable inequity, but, as the film passionately argues, it is up to all of us to keep talking.