Pathologies of Power: Health, Human Rights, and the New War on the Poor (California Series in Public Anthropology) by Paul Farmer

Author:Paul Farmer [Paul Farmer]
Language: eng
Format: epub
Published: 2009-12-21T14:04:00+00:00

In the real world there is no such thing as a fixed local standard of care. Rather, the local standard of care in, for example, India, is a standard of care determined by the prices set by Western pharmaceutical multinationals. The only reason why the [AZT placebo] trials took place at all is the pricing schedule set by the manufacturer of the drug. Glaxo-Wellcome therefore, more than anything else, determines what is described by bioethicists and clinical researchers as the "local standard of care."12

What does medical ethics have to say about such transnational research? The short answer: very little, so far. This in spite of the demands contained in the International Code of Medical Ethics, first drafted in Geneva in 11949, that physicians not only place the well-being of research subjects above the supposed benefits to science and society but also that they declare, "I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient."" But is it not precisely "social standing" and "nationality" that place Ugandans at risk for becoming AIDS research subjects and for receiving substandard medical care? By substandard, I mean lower than the care that the researchers would expect for themselves in the unlikely event that they were to contract HIV.

It is not my intention here to focus overmuch on one particular study. Indeed, Quinn and colleagues are likely not guilty of violating the ethical codes established by their university and by their Ugandan counterparts, as they were quick to protest. They pointed out that four institutional review boards in the United States and Uganda had approved the study and that a data safety and monitoring board from the National Institutes of Health, composed of U.S. and Ugandan representatives, monitored their work. At no time was it recommended that the researchers provide antiretrovirals to the participants.14 What I am suggesting is that ethical codes and review boards are not always helpful, to put it politely. They often share an unacknowledged agreement that in fact all humans are not created equal and that this inequality accounts for both differential distribution of disease and differential standards of care.

It is no exaggeration to say that the majority of such international biomedical research has inequality as its foundation. As Marcia Angell has argued:

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