This edited edition of chapters brings together a balanced view on the ethical issues facing the pharmaceutical industry. Santoro and Gorrie and their contributors achieve a text that presents the key issues of business conduct for multi‐national pharmaceutical corporations. The book highlights effectively the opposing forces underlying the tension between the requirement for financial incentives for drug discovery and the global need for affordable medicines.
Despite the pharmaceutical industry's notable contributions to human progress, including the development of drugs for treating cancer, AIDS, and heart disease, there is a growing tension between the industry and a public ethic. Government officials and social critics have questioned whether the multi‐billion dollar industry is fulfilling its social responsibilities, and relocating research and development in developing countries does little to assuage this fear.
This book has four sections and addresses many of the issues that are important to the general public and has a number of focused chapters that might appeal directly to the readership of this journal. It starts with a discussion of profits and patients” rights, moves to marketing, then patents, pricing and equal access, finishing with a future‐orientated concluding section. Each section has many chapters of interest and I have selected one from each section for a short review.
Nelsons’ chapter in the first section which considers the potential exploitation of children in research was the first to draw the eye. His conclusion is that children should only be exposed to the risks of research if: it is absolutely necessary, the risks reflect the ethical limits of the wellbeing of children, and even given these first two issues, the results of the research should be publicly available in order to avoid the risk of exploitation. These points are well made in the context of the developed world – and especially in the USA which is the context of the chapter – but how much more important are they as a basic right for all? His final comment, I think, is the essence of the chapter; in the absence of “transparency and public disclosure, the participation of children is simply exploitation” (2007, p. 79).
In the second section Daniels et al's discussion of access to particular drugs provides an illuminating debate. Daniels, Sabin and Teagarden bring their combined expertise in ethics, psychiatry and clinical practice to bear on this question. The result is a discussion on limitations and fairness. Not wishing to avoid the issue, they take it straight on and present a four‐part template for decision‐making on pharmacy coverage. In appealing to the notion of reasonableness they make a compelling argument devoid of the emotional images that are associated with the denial of last chance treatments. For sure their philosophical grounding could have been more explicit but nevertheless the paper may have transferability where these issues are applicable: perhaps to food, energy, water?
I was drawn to Gathii's paper on third world access in section three and I was glad I was. The purpose of the chapter is to investigate whether the barrier to affordable antiretroviral drugs is poverty or a combination of the legal protection of patents, and economic programmes whose agendas have lowered public health funding. Dramatically, he frames the issue of projection of blame away from restrictive patents to indigenous poverty and the claims that this absolves the pharmaceutical industry from culpability. His analysis, he asserts, shows the opposite and the price exacted from Western nations whose donations help to fight the pandemic do so at an economic and political price that reduces funding for healthcare.
My final chapter selection brings to a conclusion this review and stands out for me from this interesting and often compelling edition. It is written by Kosi and is aptly titled Renegotiating the Grand Bargain. This chapter is perhaps all that the poorly informed reader needs. It summarises some of the book's issues and returns to the notion of the grand bargain with which Santoro frames the book in his opening chapter. The bargain of large profits for better health seems fair enough, provided all get good health and the profits are fair. Koski argues that a credibility gap has emerged in which the bargain seems fractured, if not broken. Having read the book I tend to agree. Koski's solution is a renegotiated social contract guided by ethical principles but this hoped‐for solution is problematic in the globalised and commoditised economic environment in which these companies operate. Koski needs more than the pharmaceutical companies to change – more the economic system – I fear and hope.
The chapters selected are, I believe, a reasonable sample of the 24 available to the reader but all warrant time for reading and reflection. Each is well‐written and researched by leading figures in industry, government, NGOs and the medical community, and academics discuss and propose solutions to the ethical dilemmas of drug industry behaviour. The result is an interesting, if rather America‐centric, snapshot of the issues and dilemmas facing the industry. There is a clear emphasis on respecting others’ rights and a pragmatism which is almost always required of business. The two key issues set out by Santoro in his introduction are profits vs medical need and the need for cooperation.
I left the book agreeing with the analysis, more informed about the issues but not really any surer of any answers. I am now more sensitive to these issues and for that I recommend the book not just for chapter picking, but, more for its coherent and flowing argument. Its language and style enable access to the specialist wishing to address specific issues and for the more generalist looking for a broad discussion of pharmaceutical ethics. In this sense the readership is eclectic and should appeal to academics, industrialists and lobby groups in differing measures.
