W8- Research on Poor Pogge

Question 1

Background testing our drugs- market failure

Answer 1

• Ethical issues associated with medical research/drug studies in developing countries
• Pharmaceutical/medical companies from relatively affluent countries going to relatively poor countries to recruit participants for their research studies

Question 2

Local Standard of Care

Answer 2

domestic, highest standard of care in the countries where trials take place- adopts principle of non maleficence (not doing harm, no one is made worse off)

Question 3

Global standard of care

Answer 3

global, highest standard of care available anywhere (in the known universe) -adopts principle of beneficence = makes people better off compared to what they would be otherwise

Question 4

Exception to Moral Freedom

Answer 4

A drug company should not test a new treatment for a life-threatening medical condition in its home/rich country when it knows that there is a poor country where the test can be performed at reasonable cost and would save many human lives

Question 5

International collaborative research

Answer 5

cheap, fast but different standards for conducts research on humans

Question 6

ethical governance

Answer 6

mechanisms to protect human subjects - poses an issue as there arent matching ethical commities in poor countries

Question 7

Informed consent challenge

Answer 7

Language barriers- difficult to trasnlate complex things
Uneducated participants- may not understand info
Is it sufficient?

Question 8

Culpability and social injustice

Answer 8

• The infants are not culpable for their being in nee
• ‘Taking advantage of an emergency (when one could have helped instead) and also of a wrong, e.g. unjust background conditions
• Without these unfair background conditions, no such infants would be available for the research

Question 9

Complicity

Answer 9

• D-Lab is complicit in unjust practices that led to the infants being in need
• Shared responsibility for the background injustices, which make them responsible (to some extent) for the plight of the infants in the first place
• Pogge suggests that people in affluent countries are deeply implicated in the severe and persistent poverty of half of humankind (125)

Question 10

The moral problem

Answer 10

However, this then means that drug companies will stop scouring the earth for poor sick people, and just conduct their research at home instead

Question 11

Standards of care

Answer 11

what should be administered to trial before, during and after treatment?

Question 12

Why test in poor countries?

Answer 12

Quicker
Cheaper
Easier recruitment
Different ethics/ standard of care

Question 13

Gold Standard

Answer 13

Placebo, double blind, randomised clinical trial

Question 14

Declaration of Helsinki (WMA)

Answer 14

need to test against best proven or best current treatment for the condition
should they test against the best locally available or best in the world? has watered down if there is a strong scientific rationale for others

Question 15

Vertical transmission of HIV

Answer 15

Reduced transmission by 1/3 from mother to child

wanted to compare the short corse to the long- possible to give poor countries shorter doses

Question 16

Unintended harm to children

Answer 16

-The harm to (death of) placebo infants is not intended, although foreseen
-Placebo infants have a legitimate claim against D-Lab; D-lav could have designed the research differently, and the harm would have been prevented
The main one is to gain FDA approval

Question 17

No harm argument

Answer 17

Not depriving participants of anything, they benefit if they receive treatment that works
Should help them if there is no rationale to use placebo?