The Business Ethics Blog

Glenn McGee is a thoughtful guy, and I almost always find his arguments convincing.
In his recent column in The Scientist, he argues that the use (and abuse) of human research subjects in India by western pharmaceutical companies amounts to a kind of “imperialism.” (Salt in the Wound: Will India rise up against the oppression of foreign clinical trials?)

But I think it’s important here to separate our legitimate moral outrage about indefensible abuses (such as failures of informed consent, or the conducting of unacceptably risky trials), from our sense that there is, in some hard-to-describe way, something unjust about people in developing nations serving as research subjects in clinical trials that Westerners are unwilling to participate in.

In particular, the charge of “imperialism” seems out of place, here, for it stretches a metaphor beyond recognition. We shouldn’t use the word “imperialism” to refer to just any situation in which particular Westerners (or Westerners in general) profit from the labour (even undesirable labour) of folks in the 3rd world. Imperialism, after all, typically involves a central authority (usually, but not necessarily, a government) trying to exert control over foreign entities (either other countries or colonies). Further, imperialism typically involves oppression. So, for a charge of imperialism to be apt in this case, we would have to see evidence that the pharmaceutical industry is acting oppressively, making a concerted effort to profit specifically through frustrating the interests of Indians.

I see no evidence of such oppression, So what does McGee say the real problem is?

…the problem [is] the outsourced clinical trials that have enrolled tens of thousands of Indians in a $1 billion business aimed not at the improvement of Indians’ health or technology, but at providing deep discounts to pharmaceutical companies in other nations.

But why is the question, according to McGee, one of whether the clinical trials are aimed at improving Indians’ health or technology? Shouldn’t the question more simply be whether Indians enjoy a) improved welfare and/or b) increased autonomy as a result of having Western pharmaceutical companies running (or contracting research firms to run) clinical trials in India? Now, generally the fact that such trials are happening reflects the fact that the Indian government, Indian physicians, and (ultimately) Indian citizens see them as being, on the whole, beneficial. In particular cases, of course, the view that enrollment in a clinical trial is a good idea might be mistaken (say, due to failures of informed consent). But it’s hard to see that that is generally the case.

Is it, in some sense, regrettable that there are people in India (or anywhere) who feel compelled to either a) earn an income, or b) acquire basic healthcare, through enrollment in clinical trials? Sure it is. But we need to be careful with words like “compelled.” It is their regrettable situation that is compelling them to enter clinical trials, not pharmaceutical companies. Do pharmaceutical companies (and their Western customers) benefit from the enrollment of Indians in clinical trials? Of course they do. But that, in itself, isn’t morally wrong.

Pharmaceutical companies do lots of lousy things, and deserve harsh criticism for many of their behaviours. But running clinical trials in India is not, in general, one of them.

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Two places to point you for further reading:
First, see the substantial literature on sweatshop labour. Oversimplifying greatly, I’d say that the general tone of that literature is that the garment industry provides an overall benefit to people in developing nations by operating factories there, though care needs to be taken to make sure that abusive practices are avoided. One good example is this book: Rising Above Sweatshops: Innovative Approaches to Global Labor Challenges.

See also James Stacey Taylor’s book, Stakes and Kidneys: Why Markets in Human Body Parts are Morally Imperative, for a convincing argument about why offering the world’s poor jobs that most Westerners wouldn’t want doesn’t have to be counted as exploitative or coercive.