E-drug: Drug Testing in Developing Countries (cont)
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In reply to
Bonnie Fundafunda Ph.D, MBA, B.Pharm.
Marketing Manager
ECHO International Health Services Limited
Bonnie,
I would like to *echo* your comment related to drug trials in the developing
world that, " we cannot accept . . . one rule that applies to patients in
developed countries, and another, less rigorous, that applies to
patients in developing countries."
Corporations owe a legal and moral duty to maximize profits for their
shareholders. There is nothing wrong in this. It is the engine of
capitalism that generates material abundance in countries that don't suffer
the privation of the developing world. But profit incentives must be
regulated to prevent abuse of human rights since there is never a clear
bright line between right and wrong when judged under the influence of the
profit motive. Regulations to protect the public and make clear to
corporations what conduct *is* permitted and what *is not* permitted are
essential to the smooth operation of markets while also protecting human
rights. Perhaps there is nothing more common to the history of man than
that he has all too often erred in favor of profits at the expense of the
lives, liberty and property of the poor and powerless.
These regulations, including regulation of drug trails, are the 'rules of
the game' and must be written and enforced only by people who owe a
duty to the public interest and whose judgment and actions are not
influenced by
private interests--the very essence of corruption lies in official actions
that serve private interests over public ones. All systems in all countries
suffer from some level of corruption. Some are worse than others. But the
better become the worse when they join together to use the jurisdiction of
the worse to do what is not permitted in the better. And the world will
never be lacking governments willing to put their people at risk for money.
The present attempt to relieve American corporations conducting trials in
demonstrably corrupt countries from U.S. based independent ethical
review is an attempt to legalize and institutionalize corruption.
Committing such an official act of corruption depends first on gaining
general acceptance of the proposition that it is 'ethical' to treat poor
people in other countries differently than America treats its own people.
If one accepts that all men and women are created equal, a principle
enshrined in Western political philosophy and America's sacred Declaration
of Independence, then, any distinction between Americans and test subjects
in other countries must be based on relative circumstances and not on human
qualities such as race, ethnicity, religion, nationality, etc. The
distinctions between circumstances common to test subjects in developing
countries and those in America are, among others, that those in other
countries are poor, powerless, and unprotected compared to Americans.
Indeed, were it not so, American companies would not prefer to conduct
trials there rather than in America.
At the root, is the idea that people who are poor, powerless, and
unprotected are not made that way by those wishing to use them as
subjects; that they will suffer and die all the same whether or not
they participate in research and trials. The logic is that no
additional harm is done to them because they participate. For
example, when 750 uninfected prostitutes were recruited to the So.
African HIV virucide trial we have all heard so much about, it was
thought ethical because these women are prostitutes destined to
become infected eventually whether or not they participate in the
trial. But, if this argument were ethical, on what grounds is the
whole world so committed to advancing the cause of safe sex? It is
not true.
In the 20th Century, civilized nations accepted the proposition that abuse
of human rights is criminal and that nations have a duty to prosecute those
who commit atrocities. But what is the qualitative difference between
lining people up in front of a firing squad and lining them up in front of a
virus when both are equally lethal? We would never accept the notion that
the victims of the firing squad would have died anyway. And we should not
accept that argument when they are lined up in front of a virus.
Perhaps this issue calls for a study of various treaties and conventions on
genocide. It is worth noting that most, perhaps all, of the trials in
question are conducted in countries where the subjects are non-white.
Scott D. Hillstrom, J.D.
scott.hillstrom@analyticorp.co.nz
+(651) 452-6003; Mobile +(612) 730-5884; Fax (312) 803-0175
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