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Diabetes and Ethical Issue 45

venting discrimination and stigma against people people’s needs. Traditional medicines can contribute
who have diabetes, a predisposition to diabetes, or significantly towards the development of cost effec-
family members with diabetes; and analyzing the ef- tive treatment modalities, guided by evidence based
fects of direct marketing to patients on diagnosis, research. Currently, compartmentalization within
prevention, and treatment. medical education and in the medical profession
prevents scientific research in traditional medicines.
Ethical issues with Primary prevention Such issues of market influences generate ethical
interventions deliberations relating market influences of diabetes
care.
The burden of diabetes in the next 25 years is likely
to sharpen the ethical dilemma of access to prima- Research for new modalities for the prevention or
ry care as opposed to technologically-intensive care treatment of complications must consider the fact
for complications. There is an urgent need to consid- that certain research such as for diabetic peripheral
er public health interventions to reduce the burden neuropathy and diabetic ulcer, cannot be done on
of diabetes and to contain its economic and social animals. Therefore, research in various treatment
costs. Without primary prevention strategies at the modalities for these problems must have stricter eth-
public health level, the number of undiagnosed and ical controls and independent reviews. Market-driven
uncared-for diabetics will increase, as will the number research can deprive patients of effective treatment
of complications be requiring a higher technological modalities. In the worldwide economic liberalization,
services. This in turn will limit access to health care the interests of the private sector are likely to take
for large numbers of patients impacting on the ethi- precedence over the needs of the healthcare system.
cal issues around access and distributive justice. Sci- This must be countered by vigilant patient interest/
entific evidence of treatment efficacy must also be consumer groups and the medical profession. An-
considered before the allocation of limited healthcare other area is in regard to traditional medicines, which
resources available. Primary prevention with popula- can contribute significantly towards the develop-
tion health initiates that limit or delay the onset of di- ment of effective treatment modalities, guided by
abetes are the direction that will be effective and cost evidence-based research. Currently, compartmental-
effective. The question of dividing funds between pri- ization within medical education and in the medical
mary prevention and pure research will cause intense profession prevents scientific research in traditional
political, social and ethical debates. The appetite medicines. This is also seen as an ethical issue that
for technologically-intensive, hospital based care in needs to be contended in the management of dia-
some regions will ensure that these interventions will betes. An open debate about various ethical, social,
take precedence over more cost-effective measures. economic aspects of diabetes, with the involvement
At present, bureaucratic regulation, corruption and a of all sectors of society.
lack of motivation are reported factors, responsible
for the poor quality of primary health care in India. Ethical Issues related to Diabetic Clinical
Thus, compromising the primary prevention strate- Trails
gies for diabetes, which leads to several ethical is- The Helsinki Declaration 2013 updated version, eth-
sues that this will bring up.
ical principles to be used in clinical investigations,
states that “In any medical study, every patient, in-
Ethical Issues in Market-driven research in cluding those of a control group, if any, should be
Diabetes assured of the best proven diagnostic and thera-
As the number of diabetic patients’ increases, the peutic method”. But many of the placebo-controlled
private health sector will find new and lucrative mar- trials currently being performed to assess new oral
ket opportunities. Market-driven research can deprive diabetic therapies do not meet this ethical standard.
patients of cost effective treatment modalities. For Comparing an experimental drug with a placebo is
example, companies have stopped production of perfectly ethical when no proven effective therapy
cheaper forms of insulin (Bovine and Pork) arguing exists and when the risk-to-benefit ratio needs to
that human insulin is more physiological. Now there be assessed. However, when effective therapy ex-
is promotion of analogs as compared to human in- ists, the use of placebo control subjects does not
sulin. However, the cost difference is phenomenal. meet the ethical standard because efficacy and safe-
There is ample evidence that health related strate- ty of the experimental medication should be tested
gies, including those in the development of newer by blindly randomizing to an existing drug that has
drugs, tend to be driven by the market rather than by been shown as effective and safe and not to placebo.

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