THE 1970 MERGER OF CIBA AND GEIGY, two Swiss pharmaceutical and chemical companies, created a massive corporation with operations in over 50 countries. Ciba Geigy is the third largest manufacturer of prescription drugs in the world, and the second largest producer of insecticides and fungicides. The company is the largest producer of dyes in the world. And it has a consistent record of disregarding the health and safety effects of the products it pushes throughout the world, bearing responsibility for one of the greatest drug disasters ever.
While Ciba Geigy has recently demonstrated some willingness to respond to pressure from public health and consumer advocates, it continues to market useless or harmful products in countries in which limited resources could be put to better and safer use.
The SMON tragedy
One of history's most horrifying cases of corporate negligence involved Ciba Geigy and its drug clioquinol. Ciba started marketing clioquinol in 1934 to fight amoebic dysentery. By the time the company entered the lucrative Japanese market in 1953, it was pushing clioquinol worldwide for all forms of dysentery. Ciba was permitted to market the drug in Japan for all types of abdominal trouble, with no limitation as to dosage or length of treatment. Ciba promoted the drug throughout the 1950s and 1960s as being safe and effective, even for children, and as having no adverse permanent side effects.
By 1970, 10,000 Japanese citizens, and hundreds of others worldwide, were afflicted with a little-known but devastating disease called subacute-myelo-optico- neuropathy (SMON). SMON victims suffered a tingling in the feet that eventually turned into total loss of sensation and then paralysis of the feet and legs. Others suffered from blindness and serious optic disorders. Almost 90 percent experienced sensory disturbances in the lower back and limbs. Japanese researchers did not identify clioquinol as the cause of SMON until 1970; until that discovery, patients suspected of being in the initial stages of SMON - those suffering from common abdominal pains or diarrhea - were treated with clioquinol, thus causing many who had not contracted SMON to actually develop the disease.
In September 1970, just one month after receiving the report of a researcher attributing SMON to clioquinol, the Japanese Ministry of Health banned the drug from the Japanese market. Ciba Geigy (now merged) released statements defending the drug, stating that clioquinol could not be the cause of SMON because it was essentially insoluble and could not be absorbed into the body. However, in preparing a lawsuit against the company, attorneys found disturbing evidence that the drug could indeed be absorbed into the body and that it was hardly as safe as Ciba had been claiming - evidence that had been available to the company for many years.
In 1944, clioquinol's inventors advised, in light of animal studies, that the administration of the drug be strictly controlled and that treatment not exceed 10 to 14 days. In 1965, a Swiss veterinarian published findings that dogs treated with clioquinol developed acute epileptic convulsions and died. Ciba simply inserted a warning in the drug's packaging in England that it should not be used for animals. In 1966, Swedish pediatricians Olle Hannson and Lenart Berggen studied a three-year-old boy who had been treated with clioquinol and suffered severely impaired vision. Hannson and Berggen reported in medical literature and directly to Ciba that clioquinol was absorbed into the intestines of the boy and that the drug could damage the optic nerve and lead to optic atrophy and severe deterioration of vision. Other studies challenged the drug's efficacy as an anti-diarrhetic.
Ciba, and other producers of clioquinol, failed to respond to any of these warnings with serious investigations into the effects of the drug, instead continuing to market it in Japan as well as throughout Europe and in Indonesia, Australia, India and the United States. The Japanese were particularly devastated by SMON because it had been administered to great numbers of people in large doses over long periods of time. In Japan, SMON victims filed over 5,000 lawsuits against the company. By 1981, Ciba Geigy had paid out over $490 million to Japanese SMON victims.
The company eventually released an apology to the victims of its drug: "We who manufactured and sold clioquinol drugs deeply sympathize with the plaintiffs and their families in their continuing unbelievable agony; there are no words to adequately express our sorrow. In view of the fact that medical products manufactured and sold by us have been responsible for the tragedy, we extend our apologies, frankly and without reservation, to the plaintiffs and their families." In March 1985, Ciba Geigy finally took the drug off the market worldwide.
The SMON case was not the only instance in which Ciba Geigy has earned criticism for its marketing decisions. The company, for example, produces Butazolidin and once manufactured Tenderil, non-steroidal anti-inflammatory drugs once widely used for the treatment of arthritis and rheumatism. Their side effects include agranulocytosis, a potentially fatal blood disorder. In 1983, Ciba Geigy issued an internal memo saying that the drugs had caused the death of 1,030 people and seriously injured 4,481 others. The company did not withdraw the drugs, but instead only advised public health officials that the use of the products be limited to treatment of acute illnesses and administered for a maximum of one week.
It was not until Hansson, who was instrumental in the fight against clioquinol, obtained and publicized the memo that the company was forced to take substantive action on the drugs. In 1985, in response to pressure from the Amsterdam-based consumer and health advocacy group Health Action International (HAI), Ciba Geigy withdrew Tanderil from the market worldwide, and severely restricted the use of Butazolidin. Dr. Andrew Herxheimer said in a statement released at the time by HAI, "Safer alternatives for both drugs have existed for years. ... Ciba's decision was overdue."
Even now, the company displays an appalling lack of responsibility in its marketing of Butazolidin, particularly in Third World countries. A report on Ciba Geigy's social performance by the Info-Center, a Swiss-based research organization, says "In Switzerland, Ciba Geigy recommends a short one-week therapy with ... Butazolidin. This indication of time is non-existent in Mexico."
More recently, the company came under pressure in Bangladesh for its 1991 "depression awareness and detection" campaign. Ciba Geigy's Richard Williams describes the program: "Television, radio and print media were used in addition to stickers (used in doctors' offices and chemists' shops) and posters (used in doctors' offices only). No products name were included in any of the public material. The whole campaign was submitted to, and approved by the Ministry of Information, the Ministry of Health and the Director of Drug Administration."
Bangladeshi activist Farhad Mazhar, however, claims that the company had already advised doctors and pharmacists to prescribe its anti-depressant Ludiomil to patients seeking advice after having seen the advertisements. In response to questions about Mazhar's claim, Williams says simply that "Despite favorable public and medical feedback, the Director of Drug Administration expressed concerns with the campaign and requested that it be withdrawn. The campaign was immediately discontinued in June 1991."
The company does not restrict its questionable advertising methods to the Third World. In 1988, Ciba Geigy came under fire from the U.S. Food and Drug Administration (FDA) for its publicity campaign for a new arthritis medicine called Voltaren. The FDA forced the company to discontinue public relations events (including a press conference featuring athlete Mickey Mantle praising the drug which he also hawked on NBC's "Today" show). The FDA claimed these events allowed the company to in effect market a prescription drug directly to consumers, in violation agency policy at the time.
Pioneering poisonous pesticides
Ciba Geigy holds the dubious honor of having discovered the pest control uses of DDT, and of marketing the poisonous pesticide worldwide. While the company no longer produces the toxic substance, in 1991 it was forced to repurchase over 100,000 gallons of insecticide containing DDT which had been sold to Tanzania in violation of the company's internal policy relating to the marketing of banned products to the Third World.
Ciba Geigy also has an extensive record of manufacturing and marketing other dangerous pesticides throughout the world:
Remarkably, the Galecron incident was not the first to involve tests of this nature. According to Greenpeace, in 1975 the company's Indian affiliate Hindustan Ciba Geigy sprayed the pesticide monocrotophos on more than 40 Indian children and adult volunteers over the course of four days. The World Health Organization classifies monocrotophos as highly hazardous, and the EPA considers it a highly toxic organophosphate that is neurotoxic to insects and animals.
Mask of concern
As their activities come under increased scrutiny by international health, consumer and environmental watchdogs, chemical manufacturers are changing tack slightly, emphasizing concern for health and environmental standards in the countries in which they operate. Klaus Leisinger, director of Third World relations at Ciba Geigy, says, "Ciba Geigy is the only multinational corporation in the world that has an explicit Third World Policy. ... Part of that policy forbids double standards with regard to the safety of and information on products which are sold in Third World and developed countries."
There is some indication that consumer demand and pressure are having some effect on the products the company is choosing to market, particularly in the Third World. The Australia -based health advocacy organization Medical Lobby for Appropriate Marketing (MaLAM) ranked the company first in marketing standards among the 10 largest pharmaceutical manufacturers. And a 1992 MaLAM newsletter says that the "company's guidelines include many excellent features not found in any of the other companies' standards."
Furthermore, in 1977, Ciba Geigy founded a subsidiary, Servipharm Ltd., which supplies appropriate pharmaceuticals (those which are of some use in rational drug therapy) at a lower cost to Third World countries. A 1989 HAI study on German and Swiss drug supplies to the Third World found that Servipharm was exceptional in supplying essential and appropriate drugs. "The Swiss firms' overall product range, with 17 percent essential drugs, ... display no specific targeting of the most urgent needs of the Third World. One exception is the Ciba Geigy subsidiary, Servipharm, with 58 percent essential drugs in [its] range." The report notes however, that Servipharm is unique not only among other Swiss pharmaceutical manufacturers, but also differs greatly from its parent company. "If the figures for all Ciba Geigy companies are combined ... the percentage of essential drugs drops to 19 percent," the report points out.
Anna Sax of the Berne Declaration, a Swiss advocacy organization that works on Third World development issues and launched the HAI study, says that the group is currently corresponding with Ciba Geigy as a follow-up to the investigation. Sax says that in response to HAI's findings, the company suspended sales of "two or three products, and [it] changed some details in product information in Mexico and Brazil ."
Leisinger told Multinational Monitor, "Ciba Geigy is not only open to dialogue with consumer groups regarding the safety and efficacy of its products, but has initiated a ędevelopment dialogue' between all Swiss NGOs, the Swiss Development Cooperation, churches and Ciba Geigy." He says that "the last dialogue was on the issue of pesticides in the Third World; the critical aspects were presented by a member of PAN [Pesticide Action Network] Germany."
Catherine Hodgkin, Europe coordinator for HAI, however, questions the usefulness of communication with Ciba: "Ciba Geigy is anxious to promote an image of being very open to dialogue with consumer groups and setting high standards for the industry. In our experience, organizing a serious and productive dialogue with them rather than a Public Relations ęchat' is not easy."
Useless and dangerous products
Ciba Geigy's vices are not restricted to its Third World marketing practices. The company has come under fire around the world for its environmental practices. In 1985, for example, the state of New Jersey fined the company's U.S. subsidiary $1.4 million for illegally dumping hazardous wastes at three landfills near its Toms River dyeworks. A year later, an accident at a company facility in Basel, Switzerland led to the release of a large amount of the herbicide atrazine into the Rhine River. The accident occurred only a few days after a fire at a facility of competitor company Sandoz led to the dumping of toxic mercury compounds into the same river.
But it is the Ciba Geigy's promotion of itself as an ethical and benevolent corporate presence in the Third World that most angers its critics. Health and consumer advocates concede that the company has set up some charities to benefit people in developing nations; they note, however, that these programs do little to provide systematic change for the improvement of life in these nations, and that they also serve as good public relations for Ciba Geigy. Charitable contributions, critics insist, should not be allowed to obscure the mendactity of the company's core operations. As Sax concludes of the company's pharmaceutical operations, "We still think that selling useless or even dangerous drugs to people who are sick because that have not enough to eat, no clean water or appropriate housing, is a scandal."