27 May 2008

Thank a Third-worlder for those pills.

The Mormon-Utah-depression-prescription drug use meme seems to be everywhere these days. In some cases, it appears as a legitimate and serious concern, and occasionally as a farce (see second paragraph, third line).

My own issue in this post is not Mormons and prescription drugs, by prescription drugs in general, and more specifically how we come to obtain them. I recently wrote a student note for a forthcoming issue of the Duke Journal of Comparative and International Law on the international ethical codes which apply to pharmaceutical companies and CROs (contract research organizations) as they conduct human clinical trial all over the world. Most of these codes and the principles contained therein are inspired by the Nuremberg Code that emerged from the Nazi War Crimes trials following WWII. I will not go into further detail about the codes, but will point you to my forthcoming article if you want to know more. However, the most important of these codes has historically been the World Medical Association's (kind of like an international AMA) Declaration of Helsinki.

Earlier this month, the FDA announced that it would no longer follow the Declaration of Helsinki. The likely effect of this change will be to push more pharmaceutical clinical trials abroad, to areas with large populations of the poor and sick, such as Eastern Europe, Africa, and India. Anyone who has seen the movie The Constant Gardener is probably familiar with this phenomenon. Americans are notoriously unwilling to undertake the risk of clinical trials, even though the drugs produced are primarily for their consumption. The pharmaceutical companies and researchers are being given more leeway to self-regulate the conduct of these trials with very little oversight either at home or abroad. The FDA does not conduct its own ethical review of such studies, and medical personnel in foreign countries are generally not equipped or educated to conduct such a review; further, the financial incentives given to them by the drug companies and CROs puts the objectivity of any such review seriously in doubt.

More specifically, any tests of improved treatment protocols may now be tested against a placebo rather than against the best existing treatment, which is what the Helsinki Declaration would have called for. That means people in the Third World who believe that they are receiving treatment for serious illnesses may in fact be receiving...sugar pills. The use of a placebo is designed to make the comparative results of clinical trials clearer and more impressive. But at what moral cost? All this so that Americans can enjoy the fruits of such research. (Pharmaceutical companies are under no obligation, and generally do not, provide the tested drugs to the former test subjects once the clinical trial is concluded.) The moral distributive economics of this situation are unacceptable to me- one party bears all the risk (primarily chosen because of their poor health status, poverty, and accessibility) while another enjoys all of the benefit.

As Latter-day Saints, we acknowledge that all of us are God' children. The life of my American neighbor ought not to be preferred over that of an African, Indian, Pole, Czech, or Vietnamese. The use of these people to provide members of rich and privileged societies with life-saving drugs, while the risks and long-term consequences to their health are ignored, is a moral outrage and a sad continuing legacy of imperialism. It needs to stop. So, at the very least, Mormons (and everyone else) should say a prayer for the Third-worlders when you pop those pills tonight.

If anyone is interested in learning further about this topic, see Sonia Shah's book, The Body Hunters, which was a major jumping-off point for my own research and writing. Ms. Shah posted on another blog about this development here.

22 May 2008

Content analysis of a Deseret Book catalog

Finally! It has been a long month+ indeed but I am back. Since my last post, I have been swamped with exams, graduation, vacations, and the beginning of bar review, with nary a moment for blogging. But I have a much lighter schedule now, and should find time for more regular posts.

After that aside, I would prefer to jump right into the meat of the post. Of course, it turns out that the intro to the post really is the meat so here goes...

I've been meaning to write this post for about six months now. I wanted to analyze your typical Deseret Book catalog, which I receive approximately every month or so, to see what was in it, how the items were placed relative to one another, and in what proportion. I kept putting it off because I would get the Christmas issue and say, "well the Christmas issue is going to have a little more kitsch than a normal catalog, so it would hardly be fair to judge them on that basis." Then you get a Conference edition, and then its Mother's Day, and it would really be unfair to judge a company on the basis of what is essentially the catalog version of the sappiest Hallmark card ever. Hence my delay.

Earlier this week, the summer issue of the catalog arrived in my mailbox. By this point, my patience is nearly exhausted and so I forge ahead. In the final analysis, what I was missing all along is that Deseret Book does not just put out bad holiday catalogs....they are ALL terrible! Like raze it to the ground and let's start from scratch terrible.

The title and first page of the summer catalog feature a new book by everyone's favorite motivate-a-Mormon, John Bytheway. His most recent book carries the unfortunate title Golf: Lessons I Learned While Looking for My Ball. My wife finds this funny, since it tends to bring to mind musings by Brother Bytheway on his testicular integrity. Pages 3 through 11 run the gamut from really bad Mormon historical fiction through really bad Mormon adult fiction all the way to really bad Mormon youth fiction. On pages 12 and 13, we stumble upon the first items that might endanger us with actually learning something- a book on pornography (in the shape of an iPhone no less- now you've reminded me that I can get porn on one of those, I really have learned something!) and an audiobook on Mormon perspectives on C.S. Lewis. If I am not mistaken, catalogs ought to lead with something that a well-adjusted intelligent person with disposable income might actually want to purchase, kind of like that "hook" that sucks you into the latest novel, but here Deseret Book makes us wait until we are nearly halfway through the catalog. Not good business, people, not good business. It might be time to call Sheri Dew back into the Relief Society presidency as a third counselor.

Next we find a solid six pages of videos and music, more or less LDS-related. I don't listen to Mormon music (other than a little Mo'Tab on Sundays) or watch Mormon movies, so I can hardly have an informed opinion. However, I do hang out with Mormons in and out of Utah all the time, and I have never even seen one of these CDs, much less heard them (except of course Mo'Tab) so I don't think that Jenny Phillps qualifies as either a "highly requested recording artist" or worthy of a greatest hits album. And if you think you need six CDs to contain all of Michael McLean's best songs, let's talk another time.

On the next two pages, we find that from last month's Mother's Day issue, almost entirely female-oriented, Deseret Book is going to remind women of their place this summer. You get two pages full of motivational material, but don't worry, nothing that might require you to open your scriptures. It's nearly June, so its the men's turn, right? Father's Day, as in your average ward sacrament meeting, is a small footnote in this catalog, relegated to page 26. The contrast with the previous women's material could hardly be greater. The men's pages are dominated by historical and biographical literature (but not of the fictional kind), featuring LDS heroes such as Brigham Young, Hugh Nibley, and Henry Eyring, and other notable figures such as US Presidents, the Founding Fathers, soldiers and pilots. None of that sissy namby-pamby emotionalism for the Priest....oh wait, never mind. See page 28. The Holy Secret by James L. Ferrell. Is that like Oprah's The Secret? And more importantly for Mormons, will it make me rich like Oprah's The Secret? Finally, no good catalog for Father's Day would be complete without a half page of the one gift that every dad already knows that he doesn't want -- TIES, especially the ones that are good to wear to the office or the courtroom, like ties with Captain Moroni and the Stripling Warriors.

I wish I could say that this was a particularly poor example of Deseret Book's offering, but in the end it may be the least pathetic catalog in recent memory. Even so, if you are looking for something edifying or thoughtful, with the exception of a small speed bump on pages 12 and 13, do not pass GO and do not collect the latest Mo'Tab CD, go straight to the Father's Day pages, four of the LAST SIX PAGES in the catalog. Everything you need from Deseret Book in four pages in a 30+ page catalog. Unfortunately, while I scan the horizon for someone to blame, I realize that it's US and no one else. The old law of supply and demand, biting us in our rears at the gas pump and at Deseret Book. And so in the immortal words of the late Jerry Falwell, I say: "I point the thing in [the Mormons'] face and say you helped this happen."