Week 6 Reflection: Global Pharmaceuticals

May 23

With lower risk of litigation, less rigorous ethical review, increased funding, and populations willing to participate in any program which hints at a cure, clinical trials in developing countries are attractive for those seeking large populations impacted by the targets of their treatment (2:57 - 5:01 in Titanji, 2012). But without informed consent, ethical review or comparable standards of care, it becomes challenging to hold those responsible to a higher moral conscience which doesn’t compromise human welfare. Without the Belmont Report’s principles of autonomy, beneficence, nonmaleficence and justice (Petryna in Joiner, 2024a), such clinical trials motivate a colonial violence of abstraction where those with the highest burden and least agency provide the human scale for those who seek institutional approval in countries far removed from the trials themselves (Petryna, 2011). Without localized consultation and participation, it exploits suffering in one place to solve it in another.

The most ethically contentious of these applies a different standard of care, especially post-program care, towards participants in developing countries (Titanji, 2012). A value becomes attached to those currently within the trial which changes after the trial has concluded, removing hope and placing a definitive conclusion on the benefits of the trial for the individual. It applies an economic and temporary worth to a life rather than placing a value upon life itself (Fassin in Joiner, 2024b), where those who bear the burden of disease only become valuable while they serve the timeboxed needs of the trial. Such morally exploitative complexity bends medical ethics away from justice, and begs a remoralization of method and clinical conscience (Kleinman, 2009) which provides dignity to sufferers and comparably applicable standards of care across cultures.

References:
Joiner, M. (2024a). Week 6 Required Lecture (51:10). [Digital File]. Retrieved from: https://canvas.upenn.edu/courses/1781220/pages/week-6-required-lecture-51-10?module_item_id=29900585.
Joiner, M. (2024b). Week 4 Required Lecture. [Digital File]. Retrieved from: https://canvas.upenn.edu/courses/1781220/pages/week-4-required-lecture-47-00?module_item_id=29900561.
Kleinman, A. (2009). Global mental health: a failure of humanity. The Lancet. Vol. 374. August 22 2009. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61510-5/fulltext.
Petryna. A. (2011). Pharmaceuticals and the Right to Health: Reclaiming Patients and the Evidence Base of New Drugs. Anthropological Quarterly, Vol. 84, No. 2 (Spring 2011), pp. 305-329. [Digital File]. Retrieved from: : https://www.jstor.org/stable/41237497.
Titanji, B. K. (2012). Exploitation and ethics in clinical trials | Boghuma Kabisen Titanji | TEDxGoodenoughCollege. YouTube.com. [Digital File]. Retrieved from: https://www.youtube.com/watch?v=HOBlWaH-Owo.