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Medical Research for Hire: The Political Economy of Pharmaceutical Clinical Trials

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Overview


Today, more than 75 percent of pharmaceutical drug trials in the United States are being conducted in the private sector. Once the sole province of academic researchers, these important studies are now being outsourced to non-academic physicians.

According to Jill A. Fisher, this major change in the way medical research is performed is the outcome of two problems in U.S. health care: decreasing revenue for physicians and decreasing access to treatment for patients. As physicians report diminishing income due to restrictive relationships with insurers, increasing malpractice insurance premiums, and inflated overhead costs to operate private practices, they are attracted to pharmaceutical contract research for its lucrative return. Clinical trials also provide limited medical access to individuals who have no or inadequate health insurance because they offer "free" doctors' visits, diagnostic tests, and medications to participants. Focusing on the professional roles of those involved, as well as key research practices, Fisher assesses the risks and advantages for physicians and patients alike when pharmaceutical drug studies are used as an alternative to standard medical care.

A volume in the Critical Issues in Health and Medicine series, edited by Rima D. Apple and Janet Golden

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Editorial Reviews

Choice

"For the last two decades, pharmaceutical drug trials increasingly have been outsourced to nonacademic physicians, many of whom now devote a majority of their practice to conducting clinical trials. Fisher examines this trend and outlines many of the problems and risks entailed for both bioethics and economic policy. A valuable contribution to any course in the economics of health care or to more advanced courses in bioethics. Recommended."
Nursing History Review

"Novel, worthwhile reading, and a solid scholarly contribution."
Health Affairs

"Jill Fisher's book on ethical integrity in the clinical trials enterprise is a welcome and timely contribution."
Science

"Fisher examines the social milieu and the ethical implications of for-profit research in private-practice settings at the height of the boom. The interviews bring out the effects of participating in the clinical trials industry on the doctor-patient raltionship. Her skillful presentation brings out the complexity and contricitions in her subjects' experience."
author of Inclusion: The Politics of Difference in Medical Research - Steven Epstein

"Medical Research for Hire presents a vivid and often disturbing picture of everyday life at the new frontiers of pharmaceutical drug development. In this timely book, Fisher sounds the alarm about the new economics of research, where volunteering to be a human subject may become the way for the poor to earn cash or for the uninsured to access medical care."
author of The Wounded Storyteller and The Renewal of Generosity - Arthur W. Frank

"Jill Fisher shows us the daily workings of neoliberal medicine that produce the 'gold standard' of clinical trials. Anyone concerned with the future of medicine—and with the testing of the pharmaceuticals we ingest—should read this well-crafted, provocative, and disturbing book."
co-editor of The View From Here: Bioethics and the Social Sciences - Raymond De Vries

"In Medical Research for Hire, Jill Fisher goes behind the curtain of the drug trial industry to tell an interesting and complicated story of what has gone wrong in pharmaceutical research. This well-crafted study offers those who seek justice in health care the rich detail and brilliant analysis they need to change a broken system."
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Product Details

Meet the Author

Jill A. Fisher is an assistant professor in the Center for Biomedical Ethics and Society at Vanderbilt University.
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Table of Contents

Acknowledgments ix

Chapter 1 Clinical Trials: Coming Soon to a Physician Near You 1

Chapter 2 Governing Human Subjects Research 19

Chapter 3 Pursuing Contract Research 33

Chapter 4 Coordinating Clinical Trials 66

Chapter 5 Monitoring the Clinical Trials Industry 97

Chapter 6 Recruiting Human Subjects 126

Chapter 7 Mobilizing Informed Consent 158

Chapter 8 Cultivating Pharmaceutical "Compliance" 180

Chapter 9 Changing Markets in Pharmaceutical Research 208

Appendix On Methods 217

Notes 221

Index 245

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