Getting informed consent from desperate people and their families for experimental treatments is quite easy.
When the latest Ebola outbreak hit, there was criticism that experimental treatments were only given to Westerners, but they were the only ones able to give informed consent. It wouldn't just be a financial penalty if pharmaceutical companies enrolled people from other cultures, the CEO would go to jail. In back to back weeks there will be mainstream news articles complaining that developing world people are too easy to exploit for treatments while complaining that children and minorities are not used enough in clinical trials so the efficacy of treatments for them is unclear.
Yet with the most recent Ebola scare, there were calls to circumvent the mechanisms that protect people from experimental treatments and the desire to try anything that might help.
Writing in The Lancet, bioethicists Professor Ezekiel Emanuel of the University of Pennsylvania, and Dr. Annette Rid, of King's College London outline ethical principles which need to be adhered to if experimental drugs are to be deployed in the Ebola outbreak, stating that the patients selected to receive such drugs must not be limited to well-off or well-connected patients, including health care professionals, yet in developing nations only wealthy people are going to have the education to understand informed consent.
They also point out that, given the limited supply of experimental drugs and their low probability of success, containment of the epidemic and strengthening health systems in affected regions should be a priority. That would require giving blanket amnesty to every drug company and medical professional involved in the experiments.
With all of those other wide-open suggestions, they still insist that experimental drugs are provided to patients as part of randomized-controlled trials, in collaboration with local communities and other stakeholders and any communities who participate in research trials must receive fair benefits, such as access to any successful treatments. That means no treatments will be given in the next few years.
According to Rid, "Less than less than 10% of candidate drugs make it from pre-clinical selection to commercial launch. Although promising in non-human primates, there is no reason to believe that the experimental Ebola interventions will be more successful. In other words, it is more likely than not that the interventions will not improve symptoms for patients, and might even weaken them as they battle a life-threatening disease. Experimental Ebola treatments or vaccines should only be deployed in clinical trials, and if trials are done, they must meet ethical principles for research."
Emanuel adds that, "Now that the global response to the Ebola outbreak is picking up, the international community needs more focus on strengthening of health systems and infrastructure and less on experimental treatments. Adoption of infection containment measures with a view to strengthening health systems and infrastructure is the most effective way to curb this epidemic and prevent future ones, and the international community now needs to show that it can meet the challenge of this public health emergency, while learning the lessons for future Ebola and other epidemics."