Treatment naivete and unethical (un)treatment

                Adriana Petryna’s article, “Clinical Trials Offshored: On Private Sector Science and Public Health” stirred up a lot of interesting points and commentaries that I haven’t considered before in the realm of ethics and clinical trials.  Outsourcing itself is a vastly common phenomenon in many industries and reasoning behind it is usually always quite similar: either higher profits or laxer standards.  Learning that many clinical trials were first conducted in developing countries before considered in the United States did not surprise me.  However, two things did shock me: the search for treatment-naïve patients and pharmaceutical companies’ ability to withdraw treatment during clinical trials.

                The question of treatment-naivete is an interesting one.  First, it is understandable that a desirable trait in patients is one that has not been previously treated.  Obviously it may reduce the number of possible interactions with other drugs.  However, the article also mentions that these individuals may be treated with multiple drugs simultaneously.  Doesn’t this immediately void the intended result?  Wouldn’t it be better for an individual to have taken drugs for a condition, stopped, and started a new drug, than to have them on many at once?  Also, unless the drugs that people have taken induce a permanent effect, after they stop taking them, wouldn’t they lose their drug interaction? 

                Perhaps the most shocking thing about the article is how much power pharmaceutical companies in administering drugs for their clinical trials.  When operating in low-income populations or populations with a very specific disease, patients often have nowhere else to go than to participate in clinical trials.  This in itself is a problem, but one too large to be readily addressed.  However, once in a clinical trial, I think it is extremely unethical for pharmaceutical companies to stop treatment before the duration of the study.  In other contexts, this would be completely unacceptable.  Can you imagine giving someone chemotherapy to treat cancer, only to stop midway, allowing the cancer to come back and forcing the patient to suffer through the side effects?  Unless a drug has noticeable problems, it should be administered for its fully intended duration; to do otherwise is unethical.