Petryna’s article discusses some further ethical issues which exist within the clinical trial phase of drugs’ development, focusing on CROs heavy recruitment of ‘offshore’ subjects for these trials. She shows that there exist many less visible motivations for companies to engage in this practice, besides the mere cost effectiveness commonly accepted as the reason. The vast difference between the world of those involved in these trials and first-world users of the drugs makes the use of these trials both unethical and potentially ineffective for both parties involved. First, the lack of protective legal and government institutions in the countries where offshore trials are performed also leaves subjects vulnerable to unacceptable risks. These offshore trials also may rely upon subjects’ being inappropriately informed or lacking proper healthcare to begin with and making anything offered by drug companies look good. Petryna suggests that the ethical issues for these subjects are ignored or justified based upon an attitude of ethical relativism that is prevalent within the drug industry.
Further, completing drug trials offshore allows drug companies much greater ability to manipulate the trials in order to achieve certain desired outcomes. Selecting subject groups from specific areas and a focus on those who are ‘treatment naïve’ allows CROs to engineer their studies for optimal results, but Petryna proposes that the information acquired from these subjects may not be appropriately applicable to the ‘treatment-saturated’ first-world subjects who will subsequently use the drug. Her article suggests that higher standards of protection in both of these regards are needed, as well as a broader change in mindset that will revert the system back to patient-, not profit-, centered healthcare.