Ethical drug use

America has a serious drug problem. I’m not referring to methamphetamine or marijuana—I’m talking about the pharmaceutical industry. This mammoth global business is expected to reach $880 billion in 2011, and the United States is one of the biggest players. The prevalence of pharmaceuticals in our daily lives is obvious: It seems that every other ad on television urges you to “ask your doctor” about the latest cholesterol-lowering or eyelash-growing prescription drug. Considering that health care reform was a hot-button issue in this election cycle, it seems that the pharmaceutical industry is all but omnipresent. We assume that an industry with such a strong presence in American life is well regulated and held to high ethical standards. However, with ever-increasing demand for new pharmaceuticals and a push by the U.S. Food and Drug Administration for larger clinical trials, companies have taken trials overseas. With this boom in the industry of foreign drug trials, the integrity of the pharmaceutical industry must be called into question.

From 1999 to 2009, a time when the U.S. population experienced a growth of just 9 percent, the number of prescriptions increased an astounding 39 percent. With so many customers eager to shell out for name-brand and generic drugs alike, pharmaceutical giants have more than enough incentive to produce the next big drug, and to do it as quickly as possible. Furthermore, drug companies are pushed to conduct more trials with more participants as rare side effects are discovered in the population. For example, women taking Thalidomide for morning sickness in the late 1950s delivered infants with a high incidence of birth defects.

Since prescription drugs are such a significant and necessary part of our lives, we often fail to consider the ethical implications of pharmaceutical research. In 2010, the Department of Health and Human Services reported that a whopping 80 percent of drugs approved for sale in 2008 had trials in foreign countries. Additionally, 10 medicines approved in 2008 were tested without a single test subject in the United States. It seems companies are flocking to countries in the developing world, where much of the population is desperate for any access to health care. In India, for example, recruitment for research subjects has become a boom industry. With almost 1.2 billion people, India boasts the second largest population in the world, and, as of 2007, 77 percent of this population was estimated to live on less than 50 cents a day. Drug companies are required to obtain informed consent from subjects in foreign countries, just as they would in the United States. But does the vulnerability of potential research subjects in many developing countries change the nature of consent?

All of these issues muddle the ethical clarity of conducting drug trials in countries with populations vulnerable to manipulation. In 2000, The Washington Post first reported the story of a 1996 drug trial sponsored in Nigeria by the pharmaceutical giant Pfizer. The trial was executed during a deadly meningitis epidemic to test the effectiveness of an experimental antibiotic known as Trovan. Families of the child subjects have since filed suits against Pfizer, claiming that Pfizer conducted medical experiments without informed consent. But for every reported abuse like this one, there are undoubtedly hundreds that go unnoticed.

Weighing the benefits and costs of this type of research is not easy. On one hand, some foreign drug trials, like the aforementioned, clearly violate points of the Nuremberg Code’s standards for ethical medical research. The definition of consent in the Code is clear: Participants should have sufficient knowledge and comprehension of the elements of the subject matter and all hazards that can reasonably be expected.

On the other hand, drug companies often have little choice but to send trials abroad. The demand for drugs is high, but the domestic supply of research volunteers is dwindling, and it seems unlikely to improve anytime soon. Pharmaceutical companies are simply conforming to the familiar formula of exporting production. Without large and efficient clinical trials, medical progress in pharmaceuticals would come to a halt, yet the pharmaceutical industry is blighted by cases of questionable ethics, coercion and occasional exploitation.

Is true informed consent a lofty ideal of the days before 21st century globalization? Unfortunately, it seems that American consumers have a habit of shelving high ethical ideals in the name of a comfortable lifestyle. Although instances of ethical abuse by pharmaceutical companies have been made public, the consumption of prescription drugs by Americans continues to increase. We seem to preach the ethics of medical research when it is personally convenient, but when it comes time for us to refill our blood pressure medication, we have made our priorities clear: meds over morals.

Maggie LaFalce is a Trinity Sophomore. Her column runs every other Monday.