The bulk of Project AON-P7-304 took place in a large, windowless room located in an equally featureless building in Park Extension, a working-class neighbourhood in the northern part of Montreal. At 9 p.m., the 48 test participants were in their assigned seats facing a glass wall, behind which several medical technicians, who work for Montreal-based contract research organization (CRO) Algorithme, milled about in white lab coats. The test participants—always referred to as volunteers, though they certainly weren’t sitting there for free—behaved as strangers do when forced to socialize: they chatted politely, obsessed over their cellphones, read magazines, cast an eye to the TV in the corner.
When the technician yelled out “numéro 34”—the number written on the plastic bracelet around his arm and pasted on his chair—number 34 got up, walked into the laboratory, sat down in a chair and rolled up his sleeve. A technician then applied a tourniquet and extracted three millilitres of blood from a spot just below number 34’s right bicep. Number 34—actually a Maclean’s reporter participating in the study—will have 26 such extractions over the next three days, during which 89 ml of his blood will be harvested.
Most of the time, he can’t shower, drink water or go to the bathroom. His belongings will have been searched for contraband—cigarettes, drugs, bottled water. He will have a dose of atovaquone, an anti-pneumonia drug and the subject of Project AON-P7-304, sprayed into his mouth several times at regular intervals. He sleeps in a 60-by-six-foot room filled with bunk beds for the 30 other men in the experiment, and is given earplugs to cope with the snoring. He can’t eat until the technicians allow him; when they do, he must present his empty cafeteria plates as evidence that he ate everything, under threat of expulsion. He can smoke two cigarettes an hour, up to 10 a day, in the smoking room. He has the right to view one DVD a night.
For his trouble—that is, for playing a small but essential part in the costly process of getting atovaquone onto the generic drug market—he is given a “compensatory indemnity” of $1,400, tax-free. In 28 days, the mandatory waiting period between studies, he can repeat the process; if he is anything like the small army of roving “volunteers” who have made a career out of donating their time and bodily fluids for profit, he would.
These volunteers are in the right spot for this odd line of work: Montreal is the clinical testing capital of North America. It is so thanks to a confluence of favourable factors—comparably low salaries, generous tax breaks from various levels of government, industry-friendly federal laws governing clinical trials, not to mention one of the largest per-capita student populations on the continent. The city, according to a recent KPMG study, is the cheapest place to research, test and market a drug, and pharmaceutical companies have taken note: nearly 33 per cent of “healthy patient research” conducted in North America happens in Montreal. Over half of these tests are performed for drugs for sale in Europe, where in many cases stricter laws and higher costs make such testing prohibitive.
In Canada, a menu of name brand drugs that ring up annual sales of $28 billion are set to move to the generic market over the next three years, and each one must be tested on human guinea pigs beforehand. There is a booming industry ahead for Quebec’s contract research organizations, hired by drug companies to recruit volunteers and test their drugs, including Algorithme and competitors Anapharm and MDS Pharma Service, the three biggest in the country.
Yet critics of the industry say the Canadian and Quebec governments, in their quest to secure the lucrative clinical testing industry, have become more industry cheerleader than watchdog. Oversight of the industry, they say, is largely arbitrary and shrouded in secrecy, compromising the quality of research and endangering the safety of the “volunteers” on which the industry depends. Internal Health Canada documents, newly obtained by Maclean’s, show how the government agency was seemingly unaware of the extent of a tuberculosis outbreak in 2005 during a test until three months after the fact—when an American journalist called looking for answers. For many “volunteers,” the field is lucrative enough to weather the dozens of blood extractions and the often crushing boredom of the drug trials. Some are even willing to lie about how healthy they are for the privilege.
Quebec has a long history of courting the pharmaceutical industry. In 1965, the federal government founded BioResearch, considered Canada’s first contract research organization. It employed about 30 people, and was one of the first North American labs to conduct trials on the psychedelic effects of marijuana. It also conducted studies on carcinogenic properties of bacon (in the mid-’60s) and cigarette smoke (in the early ’90s) before being sold off to pharmaceutical research giant Charles River. Today, the former BioResearch labs employ 1,600 people and are involved mostly in pre-clinical trials of drugs not yet on the market. “Here in Quebec, it’s the kind of work that is known and understood,” says Algorithme CEO Louis Caillé. “It’s nothing new. It’s been demystified. People are comfortable with it.”
Caillé, who started Algorithme in the 1970s, now oversees a multi-million-dollar company that has grown 400 per cent in the last four years. Nor is the availability of able and willing bodies for testing much of a secret. Investissements Québec, the province’s business development arm, touts “easy access to patient populations” and “a willingness among patients to take part in studies,” as well as “intense promotional activities that allow for quick subject recruitment” in its sales pitch to pharmaceutical companies. The federal and provincial governments sweeten the pot with generous tax holidays and credits—“the most generous in the world,” according to Investissements Québec. The results, according to the KPMG study: “Montreal ranks first in the world for its research and development fiscal incentives.”
