Pharmaceutical influence?
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Pharmacists are in a critical position when pharmaceutical agents are prescribed for the purpose of physician-assisted suicide and/or euthanasia and they may need to decide whether dispensing a lethal dose of a medication is ethically and morally acceptable for a patient. In many cases, pharmacists may not even be aware that prescriptions are intended for physician-assisted suicide and/or euthanasia. Pharmacists have a special responsibility to protect patients who are contemplating end-of-life decisions such as physician-assisted suicide and euthanasia. Pharmaceutical care ("Responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life ...") requires that the pharmacist not only understands the medications but also the individual patient and the complexities of their lives and suffering. Only in this way can pharmacists provide safe and effective use of medications for the patients they serve.
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Some or all of the promotional activities of pharmaceutical companies are typically governed through self-regulatory codes administered by industry associations. However, the conflicts between the commercial objectives and the ethical and scientific goals of promotion can potentially lead to serious weaknesses in the way in which these codes are enforced. This paper focuses on 5 critical aspects involved in the enforcement of codes governing pharmaceutical promotion: mechanisms for recognizing violations, composition of monitoring committees, sanctions for code violations, the quantity and quality of information in reports issued about complaints and code violations, and the circulation these reports receive. The Code of Marketing Practices of the Pharmaceutical Manufacturers Association of Canada (PMAC) has serious weaknesses in all of these areas. Although the Pharmaceutical Advertising Advisory Board's Code of Advertising Acceptance avoids many of the deficiencies of the PMAC code, it, too, has weaknesses. Proposals for strengthening the enforcement of both codes are offered.
This paper discusses how adoption of the social dimensions of the marketing concept may unintentionally restrict innovation and corporate entrepreneurship, ultimately reducing social welfare. The impact of social marketing on innovation and entrepreneurship is discussed using the case of multinational pharmaceutical firms that are under pressure when marketing HIV treatments in poor countries. The argument this paper supports is that social welfare may eventually be diminished if forced social responsibility is imposed. The case of providing subsidized AIDS medication to less developed nations is used to illustrate how social blackmail may result in less innovation, entrepreneurship, and product development efforts by the pharmaceutical industry, ultimately reducing social welfare.
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Ethics of clinical trials in children have been a longstanding topic for debate. Children are vulnerable, unable to consent to participation in trials from a legal perspective and deserve to be protected. Ethical principles and the European legal framework define the safeguards that need to be put in place in any paediatric trial, be it performed in developed or in developing countries. It was considered that children should not be included in trials for ethical reasons. However, there is an ethical need to study medicines as data obtained in adults cannot be extrapolated to children. It is our collective responsibility to obtain sufficient information to be able to prescribe medicines safely whilst protecting children who are exposed in the trials. Future European paediatric regulations should encourage the development of medicines in high-quality ethical research and ensure availability of information to the public.
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