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.