the brief moments of their participation, and that is not insignificant.
More troubling are the potential implications for health care in poor countries. As clinical trials become an ever-larger cash cow for strapped hospitals and clinics, a larger portion of scarce resources gets diverted away from providing care. In many countries governments have stoked the trend by tightening up patent laws, easing ethics reviews of experiments, and converting medical record keeping into industry-friendly English. Nurses, doctors, and other clinicians already overwhelmed with needy patients find themselves with even less time for healing when institutional priorities shift from treating the ill to experimenting upon them for drug companies. And whether it is a quickie experiment or a well-intentioned study, if ethical oversight is shoddy or patient subjects uncomprehending of its purposes, the mistrust engendered runs deep, contaminating all of Western medicineâs offerings, including life-saving vaccines and medicines.
The business of experimentation in developing countries intensifies the pressure to crack open these markets for the sales of new brand-name drugs too, by adding the quid pro quo demands oflocal clinicians and government officials proffering their patients as experimental fodder. Pfizer, Eli Lilly, GlaxoSmithKline, and other drug giants jostle at the borders of India, Brazil, Russia, and China, foreseeing huge markets for their cholesterol-lowering, antidepressant, and erectile-dsyfunction-alleviating blockbusters. The industryâs philosophy of equating medical innovation with ânew productsâ is especially pernicious in places where simpler solutions have yet to be attempted. While innovative approaches to the health dilemmas posed by the lack of clean water and safe food, for example, are needed, the answer does not lie in new brand-name drugs. And even when new products are indeed what are most needed, from new malaria drugs to cures for sleeping sickness, those that aid the poorest are generally of little interest to drug companies, which commit themselves to the financial needs of their investors. The more likely result will be a drug-marinated class of rich alongside a meds-famished poor. In that case, brand-name drug sales in poor countries will worsen inequality, not correct it. And as has been well documented, inequality itself worsens the health of the have-nots even more.
Finally, we need to open up the debate over the very idea of using human bodies as experimental matter. For some, performing the work of an experimental test subject is the same as, say, taking a job in a factory. But for many others, industry trials in poor countries offer an impossible choiceâbe experimented on or die for lack of medicineâthat undermines human rights. In the streets of Lagos and the halls of international AIDS conferences, people from developing countries are condemning Western scientistsâ use of them as guinea pigs. The body hunters disregard the growing outcry at their peril.
Â
Conclusion
Listen long enough to biomedical researchers, as I recently did at a multidisciplinary scientific conference, and you will doubtless hear admiring commentary about human experiments of days past, when daring trials free of onerous regulation produced spectacular results. Such experimentation, the research scientist will say, is unfortunately no longer possible âdue to ethical concerns.â
Due to ethical concerns . I heard the phrase at least a few times over the course of a single week-long conference. It is an interesting construction, which seems to be almost exclusively reserved for biomedical transgressions. Itâs hard to imagine anyone talking about indentured labor, or oil spills, or corporate embezzlement as not being possible âdue to ethical concerns.â Those things are simply considered morally wrong and socially illegitimate, and are punishable by law. But when clinical
More troubling are the potential implications for health care in poor countries. As clinical trials become an ever-larger cash cow for strapped hospitals and clinics, a larger portion of scarce resources gets diverted away from providing care. In many countries governments have stoked the trend by tightening up patent laws, easing ethics reviews of experiments, and converting medical record keeping into industry-friendly English. Nurses, doctors, and other clinicians already overwhelmed with needy patients find themselves with even less time for healing when institutional priorities shift from treating the ill to experimenting upon them for drug companies. And whether it is a quickie experiment or a well-intentioned study, if ethical oversight is shoddy or patient subjects uncomprehending of its purposes, the mistrust engendered runs deep, contaminating all of Western medicineâs offerings, including life-saving vaccines and medicines.
The business of experimentation in developing countries intensifies the pressure to crack open these markets for the sales of new brand-name drugs too, by adding the quid pro quo demands oflocal clinicians and government officials proffering their patients as experimental fodder. Pfizer, Eli Lilly, GlaxoSmithKline, and other drug giants jostle at the borders of India, Brazil, Russia, and China, foreseeing huge markets for their cholesterol-lowering, antidepressant, and erectile-dsyfunction-alleviating blockbusters. The industryâs philosophy of equating medical innovation with ânew productsâ is especially pernicious in places where simpler solutions have yet to be attempted. While innovative approaches to the health dilemmas posed by the lack of clean water and safe food, for example, are needed, the answer does not lie in new brand-name drugs. And even when new products are indeed what are most needed, from new malaria drugs to cures for sleeping sickness, those that aid the poorest are generally of little interest to drug companies, which commit themselves to the financial needs of their investors. The more likely result will be a drug-marinated class of rich alongside a meds-famished poor. In that case, brand-name drug sales in poor countries will worsen inequality, not correct it. And as has been well documented, inequality itself worsens the health of the have-nots even more.
Finally, we need to open up the debate over the very idea of using human bodies as experimental matter. For some, performing the work of an experimental test subject is the same as, say, taking a job in a factory. But for many others, industry trials in poor countries offer an impossible choiceâbe experimented on or die for lack of medicineâthat undermines human rights. In the streets of Lagos and the halls of international AIDS conferences, people from developing countries are condemning Western scientistsâ use of them as guinea pigs. The body hunters disregard the growing outcry at their peril.
Â
Conclusion
Listen long enough to biomedical researchers, as I recently did at a multidisciplinary scientific conference, and you will doubtless hear admiring commentary about human experiments of days past, when daring trials free of onerous regulation produced spectacular results. Such experimentation, the research scientist will say, is unfortunately no longer possible âdue to ethical concerns.â
Due to ethical concerns . I heard the phrase at least a few times over the course of a single week-long conference. It is an interesting construction, which seems to be almost exclusively reserved for biomedical transgressions. Itâs hard to imagine anyone talking about indentured labor, or oil spills, or corporate embezzlement as not being possible âdue to ethical concerns.â Those things are simply considered morally wrong and socially illegitimate, and are punishable by law. But when clinical
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