Friday, March 03, 2006

Who's Afraid of Big Bad Pharma?

Not Indians, apparently: An article in Wired by Jennifer Kahn called A Nation of Guinea Pigs, describe how drug companies are conducting clinical trials in South Asia, using tens of thousands of poor Indians as "guinea pigs."

Fellow blogger Chris MacDonald does a nice job of outlining the ethical issues:

- Drug companies pay hospitals and doctors to enroll patients in drug trials. The potential for conflict of interest is clear: hospitals and doctors, far from wealthy themselves, may succumb to financial temptations to enroll patients inappropriately. Of course (and with a few important differences) the same worry applies here in North America.

- Most of the people being enrolled in trials are poor, illiterate, and culturally deferential to doctors. Their ability to give free and informed consent is questionable.

- Most of the drugs being tested are drugs that are irrelevant to the health needs of a nation like India; they're mostly medicines (like blood-pressure drugs) aimed at the North American & European markets.

Kahn points out that the path of medical progress is strewn with cases of questionable ethics, desperate practices, and misguided experimentalism, if not outright exploitation. And since patients with the fewest options are invariably the ones most likely to try (or be forcibly volunteered for) risky new treatments, be it an artificial heart, an unproven pill, or a radical lobotomy, they're also the ones who bear the brunt of medicine's experimental nature. In this light, outsourcing trials to a country where decent medical care is scarce, and medication scarcer, is just the globalization of an old equation. Can this really be justified?

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