When I was in college, a friend told me something that sounded too good to be true: I could get paid forty dollars for a blood test. And if I didn’t have a history of a certain symptom, they would pay me forty dollars every month for the next two years in exchange for more blood tests. They were in the last year of signing up subjects for a clinical trial (something I’d read about in my biochemistry classes) on a common, as-of-yet uncured disease for which a bigger pharmaceutical company had developed a vaccine. There were no abnormal reactions worse than those of a flu shot, and I might get the placebo, making the whole thing even more of a walk in the park. The first nurse I talked to assured me that during the trial, anyone contracting the disease would receive immediate and free treatment for as long as it was required, even if they had been on the placebo.
If the above sounds like your dream job, you can be a guinea pig, joining the ranks of many familiar faces from Western popular culture. Medical test subject was the entry-level occupation in the first version of The Sims, and is featured a few times on the Simpsons. When Bart gets expelled, he imagines a future testing dangerous food additives; the “2-4-dexoxypropaniramine” in Nature’s Goodness, a new diet soft drink, mutates him into a hulking beast (whereupon the lead scientist remarks “pleasing taste, slight monsterism”). In a different episode, Homer signs up to be a guinea pig at the “Screaming Monkey Research Lab” where he goes blind from a diet pill.
Unfortunately, clinical trial participants overseas face a situation much closer to Homer Simpsons’ than to that of the North American undergrad. Far from the gaze of the undermanned and budget-strained F.D.A, pharmaceutical companies are running more and more drug trials in increasingly remote locations; trials accused of being unethical, unsound, and unsafe. Deadly Medicine, an article from the January 2011 issue of Vanity Fair, exposed the current state of the global pharmaceutical industry, where thousands of clinical trials take place “in countries with large concentrations of poor, often illiterate people, who in some cases sign consent forms with a thumbprint, or scratch an ‘X.’” Donald L. Barlett and James B. Steele, the article’s authors, lamented that “the only people who seem to care about the surge of clinical trials in foreign countries are the medical ethicists—not historically a powerhouse when it comes to battling the drug companies.” While drug companies have argued that their clinical trial participants receive a higher standard of care than they do at any other time in their lives, critics point to massive conflicts of interest (many doctors in these countries receive ten times their salary for each new patient enrolled), lack of regulations, and an uncertainty about whether such results are even relevant to the North American eventual consumers of such medication.
Cash-strapped North American undergrads – or anyone tempted by the “Are you a non-smoker between 18 and 35?” bus ads, aren’t likely to face a situation as dire as that of the overseas clinical trial participant. It’s unclear to me, however, that the former aren’t another vulnerable group being taken advantage of. Despite assurances of safety and tighter regulations, there’s still a dotted line to sign that absolves the company of liability should something go catastrophically wrong. And things sometimes do go wrong, as in the 2006 clinical trial of TGN1412 which left all non-placebo participants in the intensive care unit; comments by family members suggest to me that some participants did not understand the risks of signing up for the trial. So be careful with renting your body to drug companies, no matter how much of a damage deposit they can afford.