Sunny Hundal website

  • Family

    • Liberal Conspiracy
    • Sunny Hundal
  • Comrades

    • Andy Worthington
    • Angela Saini
    • Bartholomew’s notes
    • Bleeding Heart Show
    • Bloggerheads
    • Blood & Treasure
    • Campaign against Honour Killings
    • Cath Elliott
    • Chicken Yoghurt
    • Daily Mail Watch
    • Dave Hill
    • Dr. Mitu Khurana
    • Europhobia
    • Faith in Society
    • Feminism for non-lefties
    • Feministing
    • Gender Bytes
    • Harry’s Place
    • IKWRO
    • MediaWatchWatch
    • Ministry of Truth
    • Natalie Bennett
    • New Statesman blogs
    • Operation Black Vote
    • Our Kingdom
    • Robert Sharp
    • Rupa Huq
    • Shiraz Socialist
    • Shuggy’s Blog
    • Stumbling and Mumbling
    • Ta-Nehisi Coates
    • The F Word
    • Though Cowards Flinch
    • Tory Troll
    • UK Polling Report
  • In-laws

    • Aaron Heath
    • Douglas Clark's saloon
    • Earwicga
    • Get There Steppin’
    • Incurable Hippie
    • Neha Viswanathan
    • Power of Choice
    • Rita Banerji
    • Sarah
    • Sepia Mutiny
    • Sonia Faleiro
    • Southall Black Sisters
    • The Langar Hall
    • Turban Head

  • “They almost never question the doctor”

    by Rohin
    20th March, 2006 at 12:05 am    

    Hello all. I shall endeavour to write at least a post or two about my time in the States, I did plenty of Hunter S. Thompson-esque article research for you lucky people. But first something I encountered via this month’s Wired magazine.

    A Nation of Guinea Pigs is a hard-hitting piece written by Jennifer Kahn about how Big Pharma is outsourcing clinical trials to India, raising many concerns about the patients participating.

    It’s a familiar tale. Huge and powerful Western company grows tired of spending what it sees as excessive amounts of money in the West and looks toward the developing world. Yet just as there are two sides to every business outsourcing story, it is likewise unfair to brand all clinical trials in India as unsettling. Some truly hold patient care paramount. Many will help people otherwise too poor to afford any treatment. But most won’t. Why elements of the medical world are somewhat concerned about this eastward trend in clinical trials is the sheer scale. Sean Philpott, managing editor of the American Journal of Bioethics, likened the shift to the nineteenth century gold rush:

    “Not only are research costs low, but there is a skilled work force to conduct the trials,” he said. In the rush to reap profits, Philpott cautions that drug companies may not be sensitive to how poverty can undermine the spirit of informed consent. “Individuals who participate in Indian clinical trials usually won’t be educated. Offering $100 may be undue enticement; they may not even realize that they are being coerced,” he said.

    The interest in the subcontinent has not only been sparked by the willingness of often desperate patients in India, but also the reticence of patients in the West. In the US, a mere 3% of cancer patients enrol in trials for new drugs. In light of the recent high profile examples of how trials can go wrong, who is safe-guarding the rights of those involved?

    The pharmaceutical industry has been the victim of its own success. With the widescale distribution of drugs like Celebrex (Vioxx), rare side effects like heart attacks and strokes became apparent. Hence the final stage of drug testing is now forced to be even more extensive than ever before, requiring tens of thousands of patients and a good part of a decade. Herceptin, a drug I’m sure you’ve all heard of, spent many years in trial stages as volunteers were so hard to come by.

    A large proportion of drug-testing already occurs in Brazil, India and China - three countries with their own successful pharmaceutical industries. However India has been most aggressive in trying to catch the eye of Big Pharma, by playing to its strengths - English-speaking competent doctors and over a billion patients just waiting to get ill. Indian patients are also “treatment naive”, meaning that they have more often than not never taken any medication for their condition, reducing the complications of interactions with other drugs.

    The Indian government last year lifted a law that only allowed trials on Indian patients to take place if the drug in question had been proven safe in the country from whence it came. “India..was positioning itself in a newly lucrative role: guinea pig to the world” writes Kahn.

    She interviews a doctor involved in a trial for a stroke drug from German company Boeringer Ingelheim:

    Patients here are very passive,” he reflects. “They will almost never question the doctor.”

    “Nine out of ten times, the patient will just ask me to make the decision about [entering] the trial for him. So what role do I play? Am I physician, concentrating on what’s best for the patient? Or am I a researcher interested in recruiting patients?”

    The financial rewards to the hospitals participating is a major factor. Each patient enrolled can bring in hundreds of thousands of rupees and a low-paid government doctor in a dank and poorly-equipped public hospital is no more above corruption than anyone else. The doctor interviewed alleged much of the money goes into the doctors’ personal accounts.

    Another concern is whether the trials are really of that much benefit to the predominantly poor Indians who try them. Whilst affluent Indians are starting to enjoy death from the same diseases we Westerners are fond of (arterial disease, stroke, lung cancer), poor Indians have a far shorter life expectancy and are more likely to die from infectious disease like malaria or filariasis and poisoning (e.g. snakebites, pesticides). Is spending a few years on a wonder-drug that halves their cholesterol really going to help them all that much?

    On the flipside, will the results be useful to white Americans who may not be affected by a disease in the same way an Indian is?

    As with most aspects of Indian life, individuals have stepped in where the government has failed to deliver. Programmes to train doctors to adhere to the WHO guidelines have bee started; review boards consisting of a doctor, a pharmacist, a lawyer, a social worker and a housewife should, in theory, approve trials before they begin.

    There are many in India who wish to capitalise on what they see as a huge money-spinner. McKinsey agrees, projecting the worth of clinical trials in India at $1.5 billion by 2010. Collateral damage is part of the process. The eggs broken whilst making an omelette will help to build new facilities. But on the front line, it is the nameless doctors slaving away at nameless hospitals across India who are left with the difficult job of deciding which trial, which patient and how much money a life is worth.

                  Post to

    Filed in: Current affairs,India,Science,The World

    9 Comments below   |  

    Reactions: Twitter, blogs

    1. Don — on 20th March, 2006 at 12:39 am  

      Welcome back.

    2. Sunny — on 20th March, 2006 at 12:50 am  

      Oh mate, there’s so much to say!

      I linked this article about two weeks ago when it came out as part of a series of articles advocating human testing over animal testing.

      Since then a big incident has occured here, with six human volunteers becoming severly ill after a drugs trial gone wrong. I’m writing another piece about that but this is quite interesting… will write thoughts about it later.

    3. Rohin — on 20th March, 2006 at 1:11 am  

      Sorry I missed your link Sunny, I didn’t mean to cover old ground. But I know about the recent fuck up - I linked it above (…high profile example…).

      Cheers Don. Only here for a few days though!

    4. Nush — on 20th March, 2006 at 2:28 pm  

      This really winds me up when massive Pharma companies take trials like these overseas in light of what happened here last week i wonder what the repercussions have been that we dont even know about.

    5. Amit — on 20th March, 2006 at 3:43 pm  

      ’tis a pickle indeed!

      It’s almost a double edged sword but if the motivation is money on both sides then there is unlikely to ever be a solution to this kind of problem unless the gov’t steps in and does the right thing.

    6. xyz — on 20th March, 2006 at 5:08 pm  

      Very true. Just look at the e-waste problem. It’s a huge profit-making business. The U.S. refuses to sign the international treaty banning its export to developing countries and even European countries that have signed it can’t prevent illegal shipments of toxic waste to India, China and other countries. As long as there are poor people willing to do dangerous things for money and governments that look the other way, this will continue.

    7. Don — on 20th March, 2006 at 6:09 pm  

      I take it most of us would agree with Hazlitt that;

      ‘Corporate bodies have no soul.

      Corporate bodies are more corrupt and profligate than individuals, because they have more power to do mischief, and are less amenable to disgrace or punishment. They feel neither shame, remorse, gratitude, nor goodwill. The principle of private or natural conscience is extinguished in each individual (we have no moral sense in the breasts of others), and nothing is considered but how the united efforts of the whole (released from idle scruples) may be best directed to the obtaining of political advantages and privileges to be shared as common spoil.’

      This being the case we can assume that Big Pharma will seek out those places where costs are lowest and restrictions least onerous. That they will maintain ethical standars no higher than they are held to by the law of the country in which they are operating and that even these standards will be disregarded if they feel they can get away with it.

      The high skill levels available in India and the extent to which research is integrated with the rest of the world make it a plausible operation. I don’t want to offend anybody (at the moment) but I seriously doubt that, overall and in the long run, concern for informed consent and standards of safety will be as high as they are in the UK. and we all know what happened here. However India is a relatively open society with an established system of advocacy groups and investigative journalists. But the whole point of outsourcing is that when it is possible to save a buck by relocating, corporations do it in a heartbeat. The next step will, I believe, be a move to countries with neither of those constraints.

      May I refer those interested in what that means to #24 on;

    8. Sunny — on 21st March, 2006 at 12:34 am  

      I’ve written about this in my new Guardian column, as I’ve linked on a recent blog piece, so my views are well known. Outsourcing to India was going to happen sooner or later, and I’m only concerned that companies will have lax standards of compliance because they know they’ll be able to take these people for a ride.

      But I’d still rather humans got tested on than animals - that’s the only way we’re going to re-think this obsession with chemicals and drugs testing IMO.

    9. Don — on 21st March, 2006 at 1:30 am  

      ‘But I’d still rather humans got tested on than animals’

      Sunny, esentially all of these animals were bred for the purpose, and spend most of their (admittedly often short) lives in conditions far more regulated than that of the average family hamster. Short life or no life?

      They leave behind them no grief, no fading memories, no lost potential. It’s not the same. I know that is just sentimental, but your position is no less so. As we are both coming from roughly the same secular ethic it couldn’t be otherwise.

      To extend human testing is bad enough, to say that it is preferable to animal testing is something I can’t let go by.

    Sorry, the comment form is closed at this time.

    Pickled Politics © Copyright 2005 - 2010. All rights reserved. Terms and conditions.
    With the help of PHP and Wordpress.