The web magazine Medium features a searing examination of the US clinical trials industry. The headline of the first part, written by bioethicist Carl Elliott, says it all: “The Best-Selling, Billion-Dollar Pills Tested on Homeless People: How the destitute and the mentally ill are being used as human lab rats”.
Elliott begins his investigation in Philadelphia, which has a large homeless population and a number of medical schools and pharmaceutical companies. He says that companies run clinical trials for drugs, even dangerous drugs, cheaper and faster than universities. This leads to questionable ethical practices.
“Pharmaceutical companies now typically outsource clinical studies to contract research organizations like South Coast, which run trials faster and at lower cost than universities do. Their job is simply to follow the instructions of their sponsors. This formula is working: The contract research industry has grown steadily since the early 1990s and may now generate over $100 billion in annual income, according to the Tufts Center for the Study of Drug Development. At the top of the heap are corporations like Quintiles, which has 28,000 employees and operates in about 100 countries. At the other end are private physicians and small companies like South Coast, which are often based in strip malls or suburban office parks.”
These companies pay participants. for the destitute and mentally ill, it is money for jam. “The main ethical issues here, of course, are the competence and judgment of the prospective subjects,” writes Elliott. While compensation is not coercive, the poor can barely resist the temptation.
Elliott has been a harsh critic of fellow bioethicists for years, regarding many of them as shills for Big Pharma. He writes:
“None of the bioethicists or review board managers I spoke to were willing to publicly defend paying mentally ill homeless subjects to take part in clinical trials, although most did not seem especially surprised to hear that the practice was occurring. But some prominent bioethicists do not see homelessness as a barrier to research.”
The article is confronting and provocative. It’s well worth reading.
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