EXPLOITATIONS AND THEIR COMPLICATIONS: THE NECESSITY OF IDENTIFYING THE MULTIPLE FORMS OF EXPLOITATION IN PHARMACEUTICAL TRIALS.

CLINICAL trials & ethics; INFORMED consent & ethics; PLACEBOS; PHARMACEUTICAL industry & ethics; HUMAN research subjects; DRUG therapy; RESEARCH; PATIENT selection; CONTROL (Psychology); CONFLICT of interests; ETHICS; HEALTH care rationing; HEALTH outcome assessment; RESEARCH ethics; PHARMACY; AT-risk people; TREATMENT effectiveness; PARTICIPANT-researcher relationships; DEVELOPING countries; ECONOMICS; SAFETY

ABSTRACT Human subject trials of pharmaceuticals in low and middle income countries (LMICs) have been associated with the moral wrong of exploitation on two grounds. First, these trials may include a placebo control arm even when proven treatments for a condition are in use in other (usually wealthier) parts of the world. Second, the trial researchers or sponsors may fail to make a successful treatment developed through the trial available to either the trial participants or the host community following the trial. Many commentators have argued that a single form of exploitation takes place during human subject research in LMICs. These commentators do not, however, agree as to what kind of moral wrong exploitation is or when exploitation is morally impermissible. In this paper, I have two primary goals. First, I will argue for a taxonomy of exploitation that identifies three distinct forms of exploitation. While each of these forms of exploitation has its critics, I will argue that they can each be developed into plausible accounts of exploitation tied to different vulnerabilities and different forms of wrongdoing. Second, I will argue that each of these forms of exploitation can coexist in single situations, including human subject trials of pharmaceuticals. This lesson is important, since different forms of exploitation in a single relationship can influence, among other things, whether the relationship is morally permissible. [ABSTRACT FROM AUTHOR]

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