Stuffed and Starved; The Body Hunters

[sanguinity]

...So. Far. Behind. Also, these numbers are annoyingly all out of order. What I'm calling "book 18" I finished yesterday; what I'm calling "book 19" I finished in October. Ergh.

18. Raj Patel, Stuffed and Starved: The Hidden Battle for the World's Food System.Wide-ranging, engaging analysis (from a systems perspective!) of the global markets in

Comments

[eccentricweft]

The absolute standard makes it very difficult to conduct some kinds of experimentation. For example, new treatments for an already-treatable disease can ethically only be tested to see if they are more effective than existing treatments; they cannot ethically be tested to see if they are more effective than a placebo.

It seems like this is another element tempting drug companies to seek test subjects among populations that have no access to health care. If they want to test a placebo, but they can't do it with subjects who are already getting the existing treatment, use subjects who aren't getting any treatment at all.

There are at least two ethical standards concerning experimental subjects: one is local and relativistic (the experimental subjects should be no worse off from participating in the experiment than they would have been had they declined to participate)

I'm familiar with the relativistic standard from university research situations. The way it was explained in the training I had to take was that you can compensate people modestly for their time but it's not supposed to be enough money to influence them to participate in the research if they didn't want to otherwise. You can pay subjects in a 60-minute test enough to buy a latte, but not next month's rent.

And so I *cannot* wrap my head around how anyone could use that to justify infecting disabled minors who also can't give consent. Okay, I guess the argument is "this won't make you any sicker than you're probably going to get sick anyway." Which is - let me see - SICK. No, you know what? I think having someone push you down on purpose is a greater harm than just tripping by accident. Even if you don't know that that's why you fell.

[eccentricweft]

Okay and I also did not mean that a society so screwed up that it allows children to be housed in conditions such that they're likely to get hepatitis is as morally neutral as randomly tripping on your shoelaces. It's horrific. It just seems to me that deliberately infecting them is even worse. Horrific-plus.

[sanguinity]

:: If they want to test a placebo, but they can't do it with subjects who are already getting the existing treatment, use subjects who aren't getting any treatment at all. ::

Absolutely. It's difficult to find subjects for HIV trials stateside, because the existing treatments already work pretty well. Who would give up an existing, effective treatment to roll the dice on an untried one? And what drug company wants to put their proposed drug up against a proven treatment, when they only need to show that they are better than a placebo?

Whether or not it's acceptable to do placebo-controlled out-of-country studies is another matter, though. International ethical standards have relaxed on that point during the past decade; prior to that, the Declaration of Helsinki (if I'm getting my various standards documents correct) appeared to prevent the use of placebos in out-of-country studies when a treatment existed in the originating country. Revisions in 2000 appeared to codify the permissibility of placebos out-of-country even when treatment existed in the originating country. Shah goes into the standards-shift in a fair amount of detail, and I don't want to make a mess of it here, but this is a matter of active debate, and a few whistleblowers' careers have been broken over it.

:: The way it was explained in the training I had to take was that you can compensate people modestly for their time but it's not supposed to be enough money to influence them to participate in the research if they didn't want to otherwise. ::

You might find interesting the section about financial bonuses to general practice M.D.s for encouraging their patients to enroll in medical studies. While large payments to subjects are proscribed, large payments to the medical providers of new subjects are apparently not.

:: And so I *cannot* wrap my head around... ::

I know! And yet you still find glowing articles about the lead researcher, Saul Krugman, and PubMed shows active debate in the medical literature about the ethics of the Willowbrook studies continuing at least into the mid 1980s. (If there is consensus on Willowbrook now, I don't know what it is.) So, apparently a number of people did think that study was ethically acceptable.

[sanguinity]

There's just been a settlement in one of the major cases Shah discussed. A glimpse into how not to conduct a drug trial.