14
The rise of paid drug testing
Our subject today might seem unrelated to diversity in science and engineering. But have some patience and let us make the case.
We learned about the new career path of professional drug testers, called “guinea pigs”, in a fascinating New Yorker article last month by Carl Elliott (the January 7, 2008 issue; the article isn’t available online). This economic trend is driven by major shifts in the way clinical trials of new drugs are conducted. According to Elliott, it used to be that most drugs were tested in academic settings: in 1991 80% of trials were in academic hospitals, despite being sponsored by pharmaceutical companies. Today, more than 70% of trials take place in private/commercial facilities instead, often run by “contract research organizations”.
To make drug trials happen faster, private companies are willing to pay their research subjects increasingly large sums. According to Elliott,
The result has been to broaden the range of subjects who are used and to increase the rates of pay they receive.
Hence the rise of the professional guinea pig: a healthy person who submits to tests of new drugs or procedures for money. Typically guinea pigs work in Phase I clinical trials. If you’re not familiar with drug testing, the key fact is that in a Phase I trial a new drug is tested on healthy subjects to see if it has dangerous side effects.
Officially, an Institutional Review Board is supposed to oversee the trials and make sure they are conducted ethically—in most academic facilities, this is taken seriously and works fairly well. In contrast, for-profit contract research organizations have little oversight. Elliott describes a facility in Florida run by SFBC international, which for 10 years did medical testing on undocumented illegal immigrants in a run-down former motel. According to Elliott,
there were seven or eight subjects in a room . . . . the waiting area was filled with potential subjects, mainly African-American and Hispanic; administrative staff members worked behind a window, like gas-station attendants, passing documents through a hole in the glass.
By shifting control of drug testing to for-profit organizations with little oversight, we are creating a system with great potential for abuses. This reminds us, with increasing horror, of America’s poor record of medical experimentation on African Americans. Receiving thousands of dollars for participating in a clinical trial appeals to those who need money quickly. For the recruits, guinea-pigging sounds like easy work, but the “volunteers” sometimes die as a result of the drug testing. The coercive economics of guinea pigging are summarized by Alan Milstein, an attorney who has sued drug companies on behalf of injured participants:
“This is not something you or I do. This is something the poor do so that the rich can get better drugs.”
According to Elliott, many guinea pigs don’t even get free medical care if they are injured in a trial: only 16% of US academic trial centers provide free care http://www.doctormedusa.com/wp-admin/post.php?action=edit&post=34 Dr. Medusa › Edit — WordPressto the injured. And since many guinea pigs don’t have health insurance, they are uniquely vulnerable to the health impacts of drug testing.
On the positive side, guinea pigs are starting to organize to prevent abuses. Bob Helms started a journal called Guinea Pig Zero for professional guinea pigs (with a website here). Through Helms’ site, we also learned about the Alliance for Human Research Protection, an organization that works to protect the rights of people in clinical trials. Perhaps in the future oversight and protections will increase.
But for now, Elliott summarizes the dangers to guinea pigs:
no one institution is keeping track of how many deaths and injuries befall healthy subjects in clinical trials. Nobody appears to be tracking how many clinical investigators are incompetent, or have lost their licenses, or have questionable disciplinary records. Nobody is monitoring the effect that so many trials have on the health of professional guinea pigs. In fact, nobody is even entirely certain whether the trials generate reliable data.
It’s a system that is ripe for abuse—and the abuses are happening.