Illustration by Mahgul Farooqui
All of the world’s pharmacies include an extensive selection of prescription drugs intended either to maintain or improve the wellbeing of a person. When these widely distributed drugs are purchased, a specific dosage is given to the person depending on his or her physiological condition. The consumer is also informed of any unintended side effects that may occur. The reason why we know all of these — the therapeutic dosage, the side effects, and so on is because the drug has already been researched extensively so as to reveal most, if not all, of its effects. It has gone through drug trials.
Before a medicine is made available to the public, it must first undergo a long process of research and development, which includes experimental tests on humans.
Where do these human test subjects come from? Within the United States, the world’s largest market for pharmaceuticals, approximately 10 million test subjects are required per year. While there exists a small population of people who volunteer for these clinical trials, with a few even participating as professional subjects, the amount is not enough.
Depending on the risk and duration of the experiment, volunteers are paid up to $10,000, and the number of experimental test subjects required continues to increase. Trials are a definite and increasing financial burden on drug manufacturers. In response to these costs, the increasingly common answer for U.S. American companies is outsourcing drug tests to foreign countries.
According to the Department of Health and Human Services, U.S. pharmaceutical companies began to visit cities around the world to find people willing to participate in clinical trial processes for new drugs as early as 1990. By 2008, a report was published revealing many unethical drug trials had occurred in these countries outside the U.S. For instance in Kano, Nigeria, during a bacterial meningitis outbreak, schoolchildren were given an experimental antibiotic called trovafloxacin without their parents’ consent. Of the 200 children that were tested, 50 died while several others suffered brain damage and paralysis.
The Kano incident and others incidents detailed in a report from the Centre for Research on Multinational Corporations occurred nearly two decades ago, but unethical testing in foreign countries is still a problem to this day. There is a rising number of incidents in which sick people are tricked into receiving medication which they believe is a cure to their ailment, but is in fact an irrelevant drug that is undergoing testing. In Indore, India, a poor woman went to a hospital to treat her chest pains. She was told she would be given a foreign drug that cost 125,000 rupees (7,000 AED) — much more than the woman could afford — as charity. But what she did not know was that she was enrolled in a drug trial for Tonapofylline, a potential treatment for heart failure. She suffered heart abnormalities after being given the trial drug, and, only a month later, she suffered from cardiac arrest and died.
Not only sickly people are unwittingly coaxed into dangerous trials; there exists a notable healthy but poor population that agree to dangerous clinical trials for financial compensation. These people are aware that there are risks involved in the process, but because the clinical trial often provides more money than their annual wage, they decide to gamble with their health and participate in these trials. Even then, because these volunteers are often illiterate and from the lower socioeconomic class, they are easily taken advantage of and are paid much less than was initially promised.
Many people are unaware of the outsourcing of clinical trials and the unethical experiments that follow, but this is because companies do not always accurately record what has occurred. Many committees like the U.S. Food and Drug Administration have less influence in foreign countries, so companies have much greater control over what is and is not recorded. Even within the U.S., medical literature is falsified, leading to unsafe drugs being distributed in the global market. According to the Institute for Safe Medication Practices, a reported 19,551 people died in the U.S. from prescription drugs in 2009. In these cases, the drugs have already passed the clinical stage and still many deaths are caused, especially in the case of opioids. Who knows what the death toll of unethical experiments is, and how much greater that number is compared to existing statistics?
Nevertheless, the situation is improving. It is true that the pernicious influences of pharmaceutical companies are growing stronger, but so are the influences of ethical review committees. With the growing evidence of unethical trials performed in foreign countries, these committees are more closely monitoring experiments abroad, ensuring that the subjects are well informed and treated fairly. Drug development is still a relatively new scientific field, but as awareness for these issues become more well known, the measures to combat these problems will also become more well known.
Nathan Quimpo is a Features Deputy. Email him at [email protected]