*10-FEB-2012*

With the Supreme Court issuing notice to the Central government on the
matter of illegal drug trials, the sordid state of human clinical trials is
all set to be exposed. For multinational companies eager to cut corners,
India offers an attractive package of weak laws, lax and almost
non-existent oversight of trials, a huge illiterate, vulnerable population
that can be easily exploited, very little volunteer protection and a
sizeable number of unscrupulous doctors willing to compromise on ethics for
gain. Recent reports of 42 mentally ill patients in Madhya Pradesh being
enrolled in a trial held between 2008 and 2010 for testing the efficacy of
dapoxetine in curing premature ejaculation highlights the scant regard for
ethics. Mentally ill patients can be enrolled only in trials involving
drugs that would directly benefit them or reduce the harm they cause to
society. In fact, around 230 such patients were enrolled in several trials
that do not benefit them. Cases of patients becoming a part of a study
without knowing it, and of children being enrolled without obtaining
informed consent from parents, have also been reported from the State. It
will not be wrong to assume that in other trials the poor, unlettered
parents who had signed the informed consent form — the most sacrosanct
document of a trial — were ignorant or misled and misinformed of the
contents. Individuals subjected to multiple trials, and principal
investigators being involved in many studies have also been reported from
Madhya Pradesh. The situation may be the same in other States as well. The
2010 expose of human papilloma virus (HPV) vaccine trials conducted without
proper consent on nearly 23,500 girls in the 10-14 age group in Vadodara,
Gujarat and Khammam district of Andhra Pradesh is a case in hand.

It is essential that the Central and State governments put a quick end to
this sordid state of affairs. Ensuring the safety of patients is paramount
as more than 1,700 persons have died in clinical trials across the country
between 2007 and 2010. Doctors go scot-free despite failing to follow up
serious adverse events, including deaths. Having amended the patent laws in
2005 to make India an even more attractive destination for trials, the
government is duty-bound to put in place a proper regulatory and monitoring
mechanism that would prevent unethical trials from being initiated and
flagrant violations from taking place. Doctors and companies earning
handsome profits by throwing ethics and procedures to the winds and turning
vulnerable people into guinea pigs will then, hopefully, become a thing of
the past.

http://www.thehindu.com/opinion/editorial/article2876316.ece

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