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Apr-Jun2002-10(2)
FROM OTHER JOURNALS
Pharmas, physicians and
ethics
The relationship between doctors and the drug
industry is complex; both exist to serve people and to improve health. Yet,
their interests can often conflict. The authors elaborate on some of the
problems and make recommendations for reducing the conflict. From their well
referenced article, we learn that the cost of development of a new drug is
between US$300 and $600 million, most of which is provided by industry. In the
United States, about US$6 billion was spent on clinical research in 2000, of
which 70% came directly from industry. Promotion and marketing consumes a
quarter to a third of a company's entire budget, and over $8,000 per
physician.
They stress that transparency between doctors and drug companies is essential and recommend that dualities of interest should be publicly declared, acceptance of gifts should be kept to a minimum while non-service-oriented gifts should not be accepted. Further, support for travel should be restricted to those making formal contributions to meetings while research should be guided by scientific and ethical rather than commercial values.
They stress that transparency between doctors and drug companies is essential and recommend that dualities of interest should be publicly declared, acceptance of gifts should be kept to a minimum while non-service-oriented gifts should not be accepted. Further, support for travel should be restricted to those making formal contributions to meetings while research should be guided by scientific and ethical rather than commercial values.
Komesaroff P A and Kerridge I H. Ethical issues
concerning the relationships between medical practitioners and the
pharmaceutical industry. The Medical Journal of Australia 2002; 176 :
118-121
Why is the Hippocratic oath
taken?
The renowned ethicist at Georgetown University
Medical Center, Ed Pellegrino, points out that although the Hippocratic oath has
come under fire in recent times from a variety of groups including ethicists,
historians, feminists, and patients' rights activists and has been called
outdated, it continues to be in use at commencement exercises in virtually all
American and Canadian medical schools, though modified to satisfy today's
mores.
Pellegrino argues that oath taking persists because it unites the medical profession as a de facto moral community and sets it apart as one committed to beyond self interest. It reminds one of the antiquity of the profession and has the seed of hope in it. Forgetting the oath would risk converting medicine into a commercial or industrial enterprise.
Pellegrino argues that oath taking persists because it unites the medical profession as a de facto moral community and sets it apart as one committed to beyond self interest. It reminds one of the antiquity of the profession and has the seed of hope in it. Forgetting the oath would risk converting medicine into a commercial or industrial enterprise.
Pellegrino E D. Medical commencement oaths:
shards of a fractured myth, or seeds of hope against a dispiriting future? The
Medical Journal of Australia, 2002, 176: 99.
Illusions about informed
consent
The authors describe a study of informed consent in
Bangladesh, among 105 pregnant women participating in a community-based study of
iron supplementation.
"Although most women were informed about the objectives of the study, many...did not understand that they were free to decline to participate. Even fewer women understood that they might choose to leave the study. About half believed that participation was part of ordinary, routine health care. Eighty-seven percent indicated that they participated because they believed that doing so might carry such great advantages, primarily in terms of medical treatment for themselves or improved health for their babies, that it was difficult to say no."
"Although most women were informed about the objectives of the study, many...did not understand that they were free to decline to participate. Even fewer women understood that they might choose to leave the study. About half believed that participation was part of ordinary, routine health care. Eighty-seven percent indicated that they participated because they believed that doing so might carry such great advantages, primarily in terms of medical treatment for themselves or improved health for their babies, that it was difficult to say no."
Lynoe N, Chowdhury M, Ekstrom L. Obtaining
Informed Consent in Bangladesh. N Engl J Med 2001; 344 (6):
460-461
When using a cheaper vaccine is unethical
Should one use the unsafe but cheaper Semple
vaccine for rabies when a safer non human cell culture vaccine exists? The
writers argue that smaller intra-dermal doses of the latter vaccine are as
effective and medically accepted, require fewer visits to the doctor, and bring
costs down to the same as for the Semple vaccine. This makes it unethical to
continue Semple vaccine which results in 600 Indians developing Allergic
Encephala Myelitis annually.
Kale A, Phadke A. Intra-dermal cell-culture
vaccination: cost-effective alternative to Semple vacination. BODHI 2000; 7:
151-153.
Pre-implantational genetic
diagnosis
Despite our flourishing industry in assisted
reproductive technologies, there has been little debate, in India, on ethical
questions raised by the technique of preimplantation genetic diagnosis (PGD).
This has been the subject of heated debate in Japan, where people with genetic
disorders face stigma and discrimination. This article describes the development
of guidelines before reporting the results of two surveys, of geneticists and of
lay people participating in support groups for parents of children with genetic
abnormalities. Questions were asked on attitudes towards PGD, amniocentesis, and
women's right to abortion. The results show interesting differences
in the opinions of lay people and experts, and between men and women. The
discussion and conclusion refer to attitudinal changes evident in more recent
studies, and call for more open public debate on the subject. The guidelines are
given as an appendix.
Shirai Y. Ethical debate over Preimplantation Genetic Diagnosis in Japan. Eubios Journal of Asian and International Bioethics 2001; 11: 132-136.www.biol.tsukuba.ac.jp/~macer/index.html
Shirai Y. Ethical debate over Preimplantation Genetic Diagnosis in Japan. Eubios Journal of Asian and International Bioethics 2001; 11: 132-136.www.biol.tsukuba.ac.jp/~macer/index.html
Exporting medical ethics education
It is most amusing to read a letter from a
fourth-year medical student suggesting that the St Johns Medical College
experiment of teaching medical ethics to their students (Natl Med J India
1997;10: 288-9) be used as a model for teaching medical ethics in British
medical schools. At a time when Indian medical schools themselves have yet
to introduce ethics in the course, it appears that, once again, the grass is
greener on the other side.
Iyer Ashok. Student BMJ. Medical ethics: can the East guide the West?www.studentbmj.com/back_issues/1101/letters/436c.html
Iyer Ashok. Student BMJ. Medical ethics: can the East guide the West?www.studentbmj.com/back_issues/1101/letters/436c.html