Have a Heart
The Mark Thomas Comedy Product, Channel 4, Thursday 20 January
Demand for heart and kidney transplants continues to outweigh supply. The pharmaceutical industry thinks it has the solution: it has seen the future, and the future is pigs.
Xenotransplantation may have left the realms of science fiction, but there are still many obstacles to its use. The chief one is transplant rejection. We could in theory use monkey organs in the hope of reducing the rejection response, except that monkeys are endangered and the risk of transmitting diseases from primates to man is unacceptably high. And this is where the pig comes in. The animal is in plentiful supply, and its organs are just the right size.
But why should the human body accept a pig's parts? It won't of course, unless it's a very special kind of swine. Pharmaceutical companies are competing to produce a genetically engineered donor pig whose cells have been modified to trick the human immune system into acceptance. Huge financial rewards are at stake. The race is on to find a Babe with a human heart.
Enter Mark Thomas, Channel 4's stand up comic with a conscience. His "comedy product" is a weekly series in which he attempts to expose the forces of capitalism. His pet hates are corruption and secrecy. He targets individuals in positions of financial or political power and disarms them with humour and a hidden camera. The films are presented to a live studio audience, interspersed with his shrewd gags.
Mark Thomas, the comic with a conscience
At the start of his show on xenotransplantation, he quotes from a financial report commissioned by the drug company Sandoz, which later became Novartis after a merger. By the year 2010, the pig heart transplant market will be worth $5bn a year. The company will charge $12 000 per heart, making a 1100% profit. Hence Thomas's advice to city brokers: "Get out of baboons' arses and buy pig hearts now." With the NHS in perpetual crisis, Thomas posits a world where only the rich could afford such treatments. The wealthy patient will get the colour coordinated designer organs, while the poor one will get a budgerigar's heart.
The irreverence continues when he attends an open meeting of the UK Xenotransplantation Interim Regulatory Authority ("UKXIRA, warrior queen"). The authority oversees applications for clinical trials of xenotransplant products, so we could reasonably expect it to be independent of the drugs industry. Thomas gets up and fires questions at John Dark, a cardiothoracic surgeon and authority member, inquiring whether he has any financial links to Novartis. Mr Dark admits that Novartis has paid for his attendance at meetings, and points out that "many people in the transplant world" have such links. While this may not be news to doctors, Thomas is indignant.
Amid the ribald satire, a serious health warning emerges that worries Thomas even more than these financial ties. Scientists are concerned that retroviruses in pig transplant tissue could become activated in humans and cause disease. Thomas tells the audience that patients in clinical trials must promise not to have children or to practise unsafe sex, and their family and friends must agree to be monitored by doctors in case of retroviral spread. To make his concerns known to UKXIRA, he confronts the authority's chairman, Lord Habgood, in the street. He brings with him a group of comedians who are dressed up in huge rubber "virus protective kits." Lord Habgood is not amused.
So what is the answer to the unmet need for organs? Thomas thinks he has it: it's called a donor card. He suggests that we should follow Belgium and introduce an "opt out" system, in which it is assumed that you will donate your organs unless you specify otherwise. He says gleefully, "I rather like the thought that one of the greatest challenges to the pharmaceutical industry, and to capitalism, beats within every single one of us."
When comedians blend humour with investigative journalism they run the risk of being dismissed as unscrupulous opportunists seeking the last laugh. Mark Thomas warrants more serious attention. He quotes the sources of his information throughout, and he eloquently voices genuine concerns shared by many doctors, scientists, and public interest groups. His guerrilla tactics may not please all viewers, but his powerful targets should be able to justify their positions. The show was successful because he usefully informed his audience of the vested interests at play in the world of pharmaceuticals and biotechnology.
Gavin Yamey, BMJ.
studentBMJ 2000;08:45-88 March ISSN 0966-6494
