DRUG TRIALS: Only Means of Care for Some Uninsured

      The New York Times reports on a growing trend that has medical ethicists divided: uninsured who rely on experimental drug trials for care and medication, which reach many who would otherwise go untreated, but also pose troubling problems. As the need for clinical research subjects has exploded in recent years as more new drugs are developed, this has been matched by the growing number of uninsured, who are often chronically ill with diseases they cannot afford to treat. For some patients, the trials can be a godsend -- they are "better off getting experimental therapy than no therapy at all," said Pacific Lutheran University's Paul Menzel. But Boston College ethics professor John Paris countered, "It becomes a further exploitation of the poor."

Crap-Shoot
      The situation is far from optimum. Patients run a high chance of receiving a placebo, or a drug that "does not work or that even worsens their condition." And even if treatment is effective, study participants are left out in the cold when the study is over. The Times reports that the "subjects of drug trials are not, technically speaking, being treated for a disease. Rather, they are participating in an experiment." Tufts University ethics expert Norman Daniels said, "One will often hear from physicians and economists that there is always a way for them to get medical care, so this must be one of the ways. In my view, it does not count as medical care." Some doctors make a concerted effort to find indigent care services for study participants when the research is concluded, or even provide them with drug samples to tide them over to the next study. Maria Lopez, who coordinates studies for gastroenterologist Dr. Herbert Rubin, said that the practice of providing samples is "frowned upon" by drug companies. "Drug company representatives will be like, 'Remember, you have to give these to patients who will actually buy,'" she said (Kolata/Eichenwald, 6/22).