Clinical Trials Offshored

This week, we read more from Adriana Petryna in her article Clinical Trials Offshored: On Private Sector Science and Public Health.  In this article, she discusses the concept of clinical trials for pharmaceuticals being conducted in middle and low income countries   due to large populations of willing participants and limited ethical standards to maintain itself.  Similar to the concept of shipping jobs overseas, the pharmaceutical industry is shipping their testing overseas (this article highlighted Latin America and Eastern Europe as two testing hotspots).  One of the most compelling reasons that companies will pick certain locations to do medical research is to fill in a gap in the medical infrastructure of the country.  She highlights Ukraine post-Chernobyl, where the lack of medical infrastructure and support for individuals affected by the disaster forced them to look elsewhere for medical treatment.  Due to their financial status, they were also unable to seek out private medical care and pay for their own treatments.  Similar to Petryna’s book, themes of desperation come into play and people will do whatever they have to (ie. Purposely expose themselves to radiation and undergo risky treatment), to get help.  It is unfortunate that measures as extreme as these must be taken to get medical coverage- though I certainly do not blame the people.  I do, however, wonder how doctors can ethically participate in any of this clinical outsourcing as it seems to challenge a large number ethical standards they swear to follow when they become doctors (ex. Manipulating trials in ways that will be financially beneficial yet not safe in the long term, taking advantage of poorer populations who have few alternative medical options etc.)  I like to think that physicians and business are relatively distinct things, and those who go into medicine do so to help people, yet the emergence of the rather profitable pharmaceutical industry challenges my image of a physician.  Finally, I think that these industries need to consider the impacts that their clinical testing is having in the long run.  For one thing, they are creating huge groups of people who are dependent on them for medical care.  But what happens when a drug is created?  These people are left to suffer.  Or what happens if the drug is found to have negative effects on a population?  Aside from the obvious issue of who is responsible for assisting in incurred damages, there are widespread emotional effects.  For instance, this could be hugely damaging on the trust between pharmaceutical companies (and their countries or origin) and the local people subjected to therapy.  Petryna mentions the AZT trials in Africa and I wanted to add that for another class I read many articles about the devastating conspiracy theories that to this day plague parts of the continent that say that Americans are trying to kill off the African population with these drugs. And finally, will these people ever see the final results of the work they subjected themselves to?  Most likely no, because they are in poorer nations and pharmaceutical companies would not make a profit there.