The really unpleasant work under socialism
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i doubt it will be very much different from how they are conducted at present. http://www.technologyreview.com/printer_friendly_article.aspx?id=16815This article has observations about drug trials in India. In “A Nation of Guinea Pigs,” Kahn describes the uncomfortable fact: that economic disparity between investigators and subjects in human research creates possibilities for abuse and coercion — possibilities that we do not really know how to manage. Kahn worries that payments to hospitals and doctors, which are meant to cover the costs of running and overseeing a trial, sometimes serve as bribes, encouraging improper human experimentation. She questions whether trials in remote areas receive proper oversight, from either the Indian government or foreign institutions. (Indeed, pharmaceutical trials that do not receive government funding are overseen by commercial institutional review boards, which are paid by the companies they are supposed to be monitoring — an obvious conflict of interest.) Kahn does not demonstrate specific wrongdoing or scandal. But she clearly explains the perverse incentives that might encourage unethical behavior.There are, however, very strong medical, scientific, and economic arguments for conducting clinical trials in the poor world. The drugs tested might be intended for the population testing them; the trials might benefit from genetic diversity; or the trials, usually the most expensive part of the drug development process, might be cheaper. Given that clinical trials will be conducted in the poor world, what would be a better system?The ethical requirements for human research were established by international agreements such as the 1964 Helsinki declaration. [ The Nuremberg Trials of medical experimentation crimes and then later in America the Belmont Report laid down guidelines.] They include various commonsense rules: for instance, physicians ought to consider the health and well-being of subjects above other considerations; any adverse effects that occur during the course of a study should be scrupulously monitored, reported, and treated; researchers must fully communicate potential risks and benefits; and subjects must not be coerced into participating. Most importantly, the subjects of a trial should bene-fit personally from the results of the research (that is, they should not be induced to participate in a trial for solely economic reasons).But obvious difficulties arise in interpreting these principles and applying them in impoverished settings. A common dilemma is, Just what constitutes excessive inducement? If researchers pay for their subjects’ transportation and lunch, or reimburse them for missing a day of work, is that a bribe? What if they offer direct payments?Informed consent is particularly elusive in places where patients are not well educated and where doctors’ authority looms large. Informed-consent agreements are lengthy, bureaucratic documents. One recent improvement is to supplement documents with -visual aids and require patients to answer a brief quiz to ensure they have really comprehended the nature and terms of the transaction. It is important that patients understand they may leave the trial whenever they wish and will -neither be punished nor lose their primary health care.Among the most vexing questions is, Who should oversee the people who oversee clinical trials? A variety of promising initiatives, sponsored by international bodies like the World Health Organization (WHO), may help these groups to grow stronger. WHO is funding projects that teach ethics and provide infrastructure. This sounds sane: American and European private and public institutions cannot provide the oversight required for ethical clinical trials in the poor world, particularly when American and European pharmaceutical companies are involved. Helsinki Agreementhttp://www.wma.net/en/30publications/10policies/b3/index.html Belmont Reporthttp://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html
Why would an emancipated worker with no pre-existing conditions take massive risk and consent to test a drug? They wouldn’t all be Johnny Knoxvilles would they?
A lot of drug testing are double blind randomised trials of people with existing medical conditions to try out potential treatments against placebos. But then why should someone donate blood or become an organ donor? I think we can say though that much of the medical testing for many cosmetics will disappear. i remember there was a cold cure institute and the attraction for volunteers was that it was a free holiday away from it all the stresses of modern society. I am sure similar recreational/research facilities could be created.
Donating blood and organs has known quantifiable consequences. I’m a bit sceptical about the free holiday since there would be free access to these recreational facilities anyway.I hope you’re right that there would be an incentive, I just can’t see it.
Why would people need to have trials conducted? Perhaps under a socialist world with common sense prevailing many medical disorders would disappear anyway, especially those issue associated with stress, poor lifestyles, poverty, starvation, poor quality foods etc.Secondly, computers and the massive unrestricted advances I suggest would come from having thos genuinely interested and full of ideas about how to improve technology and science would push boundaries of what we know and can do at a massively increased pace. Perhaps the advance of such techology would remove the need for physical trials in the manner they are carried out now?Even if things remain much as they are now and volunteers are needed, I suspect that many people for many reasons, some selfish, some altruistic, some out of duty or care or some just because they want to, would happily donate themselves to this kind of research anyway?Perhaps something as noble as furthering science and medical understanding isn’t considered by some as ‘unpleasant work’ for the reasons outlined above?No-one really knows though but I will say that healthcare and medical research cannot be worse than it is now, left to chance and the will and whims of speculators who care only for the possible profits to be made from the suffering of others.
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