The pharmaceutical industry endorses crooked clinical drug trials, carries out hits on British diplomats and is no better than the illegal arms trade. Such is the inescapable conclusion of The Constant Gardener, a movie--adapted from a John le Carré thriller--now playing at a theater near you.

The plot revolves around a multinational pharmaceutical company conducting drug trials in Kenya. Why Kenya? Well, the company knows that its drug is harmful and therefore needs pliable data to ensure that it can sell the drug widely. In Africa, the movie's logic goes, lives are cheap, and the company's bribery and intimidation will be accepted by local politicians eager for the influx of dollars.

The movie's accusations have sparked little public debate, which is surprising given that when the book was published four years ago it caused an uproar. Back then, some readers were shocked and dismayed at what they took to be the true dark underbelly of big drug companies, while others decried the ludicrousness of the charges.

Now, though, these ideas seem ingrained in the public consciousness; few people have bothered to stand up for the drug companies since the movie hit theaters and even fewer are questioning the validity of the backstory. A typical review from Kansas City's Infozine Web site says that the movie is a "chilling reminder of the plight of Africa and a timely indictment of Big Pharma."

So how did it come to this? How did the industry most associated with saving life become so easily and obviously despised?

For one, Hollywood has been searching for new bad guys to expose since the fall of the Berlin Wall. Latin American drug dealers, environmentally unfriendly oil companies and evil tobacco executives have all been given a run. The pharmaceutical industry entered Hollywood's crosshairs with films like "The Fugitive" and "Mission Impossible II." But if anything the movie business has followed public opinion rather than led it.

In the latest Gallup industry poll, only the oil and gas industry showed a worse image rating than pharmaceuticals. In a 1997 Harris poll, 79% of respondents said that drug companies did a "good job" of serving their customers, but last year a majority of Americans said they did a "bad job." The percentage of adults who say that they can trust what drug companies say in their advertising has decreased by almost half in seven years.

The beginning of the decline in public image coincided with the launch of Direct to Consumer advertising. Begun in 1997 after a loosening in Food and Drug Administration regulations, its success in providing specific information to patients--allergy sufferers were early targets, with Allegra--has come at the cost of much mockery. (Ever seen the Cialis ad with two people watching the sunset in separate bathtubs waiting for "the right moment"?) Moreover, despite the change in regulations, drug companies are still required to include in these commercials long lists of repulsive side effects, no matter how small the chance of their occurrence.

To combat these negative impressions, companies began to try image advertising--commercials that make viewers aware of the research-and-development efforts under way to cure, for example, cancer and Alzheimer's. While the image ads were heartwarming, they often backfired, leading viewers to believe that the industry has money to waste on commercials. Pfizer recently tried another tactic with its "Helpful Answers" campaign--a TV spot, Web site and print ad--designed to encourage patients without health insurance to apply for discounted or free medicines.

Despite advertising worth at least $10 billion a year, perceptions about the drug industry are often wildly inaccurate. Ten percent of the U.S. health-care budget is spent on pharmaceuticals, yet opinion leaders and the general public put the number at 50%, according to various surveys. They believe health care is controlled by big pharma and so assume that, by lowering drug costs, we can substantially reduce health-care bills.

The industry faces other problems too: Drug development requires massive up-front costs, and companies charge high prices to recoup R&D expenditure. This obviously angers the senior citizen with a tight budget who has to pay a lot for his arthritis medicine; he only gets more irritated when he finds out that Canadians are paying less.

But Americans are not just outraged on their own behalf. When desperately poor people world-wide are dying for want of medicines, it is too easy to believe that drug companies are "profiting from disease," as some media outlets have put it. GSK, which has more drug patents in Africa than any other company, was vilified at the 2002 Barcelona AIDS conference, where signs read: "GSK: Greed Still Kills."

Most perniciously, it is widely believed that companies take risks with our lives by suppressing information about the dangerous side effects of painkillers such as Vioxx. (The recent $253 million decision against the drug's maker is not helping the situation.) This complaint is even stronger regarding products tested in poor countries (much like the fictional claims made in Mr. le Carré's novel). But clinical trials are often undertaken in Africa because that is where the disease proliferates, and testing there can lead to greater understanding about a drug's efficacy.

Ultimately, drug companies are caught in an impossible situation. Good health is seen as a basic human right, and the idea that a corporation would charge you for your rights, let alone deny them to you because you can't afford its product, is seen as morally reprehensible. Mr. le Carré says that he needed to warn people about the "corrupting power of pharmaceutical companies when they operate in emerging countries," but Merck and Pfizer are not in the business of testing drugs they know do not work or of avoiding regulations because they want to harm the poor.

Industry leaders have made mistakes to be sure--Direct to Consumer advertising, although useful for patients, is costly (insiders say several billions of dollars a year in America alone) and undermines pharma's image. But most of the industry's problems are not of its making, and there is probably little it can do to rectify them.

Given limited resources, drug companies have funneled money away from image advertising toward more political purposes, such as defending themselves against charges of price-gouging made by leftist candidates like Sen. Charles Schumer.

As the attacks on the industry from politicians, entertainers and lawyers have intensified, it has sensibly retreated into the notion that actions speak louder than words: Drug companies have recently donated large supplies of their products to developing countries and instituted greater transparency in clinical trial data publication. Now all they can do is hope that Americans don't believe everything they see at the movies.

Roger Bate is a resident fellow at AEI.