Ethics, equity, action
(Note: This reading reflection paper was written in the second half of 2020 as part of an Introduction to Global Health course)
The readings this week shows how the contention between capitalist interests and the common good manifests in the field of global health. The readings raise questions about whose lives matter, how do we decide on the lives that matter, and how do we show that those lives matter. In addressing these issues, the readings highlighted the importance of building alliances, transnational collaboration, and developing an effective strategy.
As a business oriented person, I am conflicted about judging harshly pharmaceutical companies who hoard or charge exorbitant prices for drugs in the face of public suffering and misery. If they have invested so much in the research for these drugs, they should recoup their investments with some profit. If this is not the case, what motivations would the pharmaceutical companies have and how would they plan for financial sustainability. Only if the public has funded this research, does it have a moral authority to request that generic versions of these drugs be made available. I think this is one area where an effective communication and negotiation strategy with the pharmaceutical companies would be very useful.
However, I am of the opinion that unethical research using human subjects is not acceptable on any grounds. I continue to grapple with the reasons why despite knowing what the ethical thing is to do, it never gets done until vulnerable and marginalized persons adversely affected begin to make demands or finally form a coalition strong enough to fight before there are changes. Is there ever going to be a time when without a constant oversight, in all places and for all people the ethically right thing to do is the norm? Would the same criteria be applied for pharmaceutical research and clinical trials in low, middle, and high income countries and among vulnerable and other populations?
Finally, having legal framework and having the right to health and health care written into country constitutions is great. It shouldn’t be broad based statements such as “a right to health care” it should state more clearly what the stipulations are and what the consequences of breaching the guidelines are. This would provide clarity and support for monitoring and compliance efforts by global health and human right professionals. In addition to including this in countrys’ constitutions, there should also be more international and binding protocols such as the Helsinki Declaration requiring that provisions be made for “post-trial access for all participants who may need an intervention identified as beneficial in the trial” (Basilico et al). Pharmaceutical and medical research should also sign documents that show their commitment to ethical research and accept consequences of violation.
Question
· Thinking about my suggestion that, “Pharmaceutical and medical research should also sign documents that show their commitment to ethical research and accept consequences of violation.” Is this feasible or too idealistic? Apart from the financial and legal power some pharmaceutical companies hold, what other reasons might make this difficult to enforce? What would this consequence be? A charge of crimes against humanity for the key researchers and top management? Fines are often too paltry compared to profits and revoking the pharmaceutical company’s license would mean the loss of employment for many others? What else would be an appropriate and effective consequence of ethical violations?
· Skolnick mentions that some of the challenges for implementing ethical guidelines is the presence of a knowledge gap, “first, many students of public health and global health get insufficient exposure in their training to ethical and human rights issues.” While more knowledge helps, aren’t some of these ethical and human rights violations common sense issues for someone who sees human beings as having intrinsic value and not as tools?