Drug trials and tribulations

13 November 2012

Recent investigations have revealed that for the drugs that save our lives, a disturbingly high price is paid on the Indian subcontinent.

Sitting in a hospital ward with an IV drip in my arm, I wasn’t quick to question where my life-saving drugs had come from. Had I done so, I’m sure I would have expected the answer to be closer to a Cambridge lab than the backwaters of Delhi, but increasingly the shadowy origins of new drugs are being brought to light. Pharmaceutical companies, under enormous pressure to develop urgently needed drugs, are cutting the most worrying of corners: those of ethics.

India, home to a flourishing generic drug industry and a population wracked by poverty, presents an ideal site for drug trials. Targeting the poorest, often illiterate hospital patients, local doctors are paid to sign up unwitting subjects for experimental trials. Although not directly implicated, Big Pharma has driven the demand for much of the testing, with giants like Glaxo Smith Kline and Astra Zeneca sub-contracting tests out to Indian subsidiaries.

Statements from a number of such companies have absolved themselves of any blame, citing their commitments to the highest level of international ethical requirements. In reality, though, this amounts to little. Faced with confusing contracts often presented in English, the grubby fingerprints that mark such documents can hardly be taken as the ‘informed consent’ demanded of trials by international conventions.

The most recent investigations in India have exposed deliberately misleading ploys portraying trial drugs as attractive treatments that would usually be beyond the pockets of most Indians. Ironically, it is generic drug industries like India’s that make these medicines widely available to the most needy, while heightening the financial pressure on pharmaceuticals that invest in their development. A cruel twist of fate, then, that these people are now the unwitting guinea pigs of Big Pharma.

Awareness of these trials seems widespread within Indian medical circles, often hidden and justified as necessary costs in the pursuit of life-saving drugs. After all, as it is argued, it is these same people that are most in need of such treatments, even if it seems far-fetched that they will be the ones to most benefit from their development.

The international community has to decide the cost that it is willing to bear for new drugs. Human drug trials are of the utmost importance to the medical profession, but the exploitation of the world’s most vulnerable is almost Dickensian in its callousness.

Far greater supervision is needed to police drug trials in the developing world, both to guarantee the moral footing of transnational interests and to protect the world’s vulnerable from being ‘bought’: a cheap alternative to those deemed to be of more value in the West.

Global society must either renew transnational cooperation on clinical trials, or provide proper compensation for those who shoulder the risks. Perhaps then I could feel more at ease in my own hospital bed.

Joseph Ataman is a second-year Geographer at St John’s