Friday, November 03, 2006

(Perhaps) The Most Heroic Job...... Ever

A long time ago (almost a year now) I blogged about the moviefilm "The Constant Gardener". Not an attractive movie title, I admit, but an absolutely amazing film which highlights some extremely pertinent social issues while preserving the highest aesthetic quality possible.

I wrote, at the time,
"Pharmaceutical companies test drugs for side effects on Africans who are going to die anyway, either of HIV, or of the many other dieseases that are easily treatable if only there were the resources. Hopefully, no one will tell me that these companies are doing a good thing by making sure those drugs will work for us. But would you use such a drug if you'd die without it? What if you didn't know about the exploits? How can we stop the illicit acts of these profit-driven corporations? They are motivated merely by the "golden" economic laws of supply and demand..."
David Friedman (Milton's son) suggests in "Drugs for Africa: A Modest Proposal" to
1) Let charitable donors in rich countries buy out the patent on the second best AIDS drug or combination of drugs and public domain it—let anyone who wants make it.

2) Make FDA [design] rules on testing so as to encourage drug companies to make not yet approved drugs available abroad in order to use the information so generated to meet the requirements for approval in the U.S.
The first suggestion is a sound idea, both pragmatic and socially beneficial. However, the second proposal really bothers me, despite the lack of a feasible alternative. According to Friedman, people like me will
[Make] good demagogic use of the idea that it is wicked to use human beings as guinea pigs for potentially dangerous drugs—despite the fact that using humans as guinea pigs is the only way we have of finding out whether or not drugs are safe.
The fallacy is why should people with less money be the only ones targeted as guinea pigs? If we believe in universal human rights, then the status of a human being in Zambia should be no less than one in Arkansas, Faroe Islands or Timbuktu. Why are some lives put at risk so that others can benefit?

Should the guinea pig option not be a voluntary activity, open for participation to people from all places by providing compensation (aka cash incentive) for the risk? Risk is inevitable in a fireman's job, yet there are plenty of people who willingly take up the job. Same goes for policemen. Drug testing is as heroic a job as theirs. Volunteers accept a certain amount of risk by helping to save people in the future. Surely that job should merit an amount of respect such that the applicant pool for firemen and policemen would consider it.

That said, I know that Africans will end up as the guinea pigs because the cash incentive (*cough* wage) would be the lowest. I wonder: if one day we are able to outsource dangerous jobs like firefighting to poorer countries (e.g. via teleporting), will we have any more firefighters in rich countries?

We are, in the end, just outsourcing "guinea pig" jobs to Africa.

3 comments:

John Fast said...

I'm embarassed to say that I'm confused about the argument here. As far as I know, drug companies (unlike governments) get people (whether poor Africans or anyone else) to test drugs for side effects only because they by provide compensation -- possibly cash incentives, possibly something even better such as free medical treatment -- in return for the risk.

Am I mistaken about this? Are you saying that drug companies are getting people to test drugs for side effects without providing any compensation or incentives? Or are you saying that they do provide cash and/or free medical care for "guinea pigs" and you disapprove of this? Or are you saying that cash and free medical care for experimental volunteers are good, but there should be some other way to get test subjects?

I've volunteered for medical tests; have you?

Bronson Fung said...

John,

I'm saying that in spite of cash incentives pharmaceutical companies may provide, all the "guinea pigs" end up being people in poor African countries.

My problem with this is not their poverty (low income citizens of the US would readily volunteer for an appropriate cash incentive), but the risk that may be incurred to them due to a lack of regulation.

The same program in the US would be guarded under the eyes of journalists and lawyers, thus the side effects of drug-testing will be limited.

By contrast, drug testers in Africa (babies even) may lose their lives or incur life threatening conditions.

Just as "Sweat Shops" are wrong not due to their low wage, but because of the inhumane working conditions, outsourcing Guinea Pigs to Africa is a problem unless we institute agencies that would guard against the life-threatening tests of corporate pharmaceutical companies.

Anonymous said...

Kano state in Nigeria is suing Pfizer for drug trials for a meningitis pill that caused deaths and deformities in several young children, the number varies depending on who you ask (Pfizer or Kano ). There are several flaws in the case, anyways, I'm definitely interested in the outcome of the case as it would set a precedent for drug companies and their 'outsourcing', which isn't only in Africa

Ada