Clinical drug trials are unquestionably necessary in the process of testing and releasing pharmaceutical drugs circulated in the wider public sphere. However, the ethics of pharmaceutical experimentation with human subjects is very intricate and involves a variety of moral concerns. Drug trials conducted in prisons are particularly problematic, due to the questionable validity of the consent given by the prisoners, the pressure exerted on them by the pharmaceutical companies, and the coercive character of the prison environment influence the prisoners’ decisions and render the trials exploitative and coercive. It would therefore be justified to impose stricter regulations on drug trials in prisons, or even to entirely discard them.

The ethics of pharmaceutical experimentation with human subjects is fraught with moral concerns.

Exploitation refers to the act of taking unfair advantage of a person by engaging them in a transaction in which their gain is less than gain they ought to have had, as defined by a normative baseline.1 Coercion refers to the act of restricting the choice set of a person, by removing or making options inaccessible, or by threatening to make them worse off compared to a normative baseline if they do not make the desired choice. To determine whether a person has been exploited we need to look at the net gain of the transaction. To determine whether a person has been coerced we need to look at how their options were manipulated to influence their decision.2

Before we explain how drug trials conducted in prisons are exploitative and coercive, we should establish why the consent given by prisoners should on face be discarded as invalid. The consent given by prisoners cannot be regarded as informed; prisoners disproportionately suffer from lack of education, mental instability, unfamiliarity with language and norms, and infectious and psychiatric disorders,3 which inhibit their ability to understand the material relevant to their decision to participate in a drug trial, especially if the information is presented to them in a manner inappropriate to their status and abilities. Their consent cannot be regarded as voluntary; prisoners have to make decisions under duress, they are continuously reinforced to comply with directions, and their well-being is contingent on their obedience. They can be easily manipulated to comply with the directions of those who have authority over them, and often subject them to forms of direct or subtle coercion, including risks, threats, or acts of physical and even sexual assault. This institutional pressure damages the ability of the participants to freely choose to participate in the study, draw boundaries of privacy, and withdraw consent from the study, as they are likely to give consent out of habit, disempowerment, or an attempt to appear favorably in the eyes of their keepers.4

We will now focus on the exploitative character of drug trials stemming from the incentives of the pharmaceutical companies to take unfair advantage of the prisoners. While most trials offer a monetary reward to outweigh the small health risk undertaken by the participants, the health risks involved in drug trials in prisons outweigh this small benefit, a claim supported by historical and analytical data. For example, inmates of the Holmesburg prison between 1951 and 1974 were paid up to $1,500 a month to test dandruff treatments and dioxin, and were exposed to radioactive, hallucinogenic, and carcinogenic chemicals, without being informed of the immense risks.5 Furthermore, from the ‘40s through the early ‘70s, doctors regularly injected inmates with malaria, typhoid fever, herpes, cancer cells, tuberculosis, syphilis, and cholera in attempts to test cures for those diseases, and did things as horrible as pulling out prisoners’ fingernails and inflicting flash burns to approximate the results of atomic bomb attacks, and using isolation techniques and high doses of LSD to perform mind-control experiments. By 1972, pharmaceutical companies were conducting more than 90% of their experimental testing on prisoners, demonstrating the attractiveness of drug trials in prisons to pharmaceutical companies.6 They permit experimentation that would never have occurred outside of prisons, because no citizen free of pressure would agree to participate regardless of the monetary reward.

By 1971, pharmaceutical companies were conducting more than 90% of their experimental testing on prisoners.

We will finally examine the coercive character of clinical drug trials in prisons by referring to the particularities of the prison environment. In addition to the abusive nature of the prison environment that makes the consent of prisoners of questionable validity, as outlined previously, researchers, or prison guards, oftentimes threaten prisoners, by taking away rights like forms of communication, and refusing personal requests, like cigarettes and visits, unless the prisoners participate in the studies. Furthermore, because prisoners often do not have access to competent health care, they agree to participate in drug trials to have a doctor examine and diagnose them,7 which amounts to an underlying threat for prisoners to be kept away from competent health care unless they participate in the trial.

The practice of drug trials in prisons ultimately amounts to the state forfeiting its responsibilities against the prison population, and it can demoralize and negatively affect society. Even though prisoners generally deserve their incarceration, it is still the responsibility of the state to ensure that the rights they do maintain are being respected. Rather than doing that, if drug trials in prisons are allowed, the state would be handing pharmaceutical companies one of the most vulnerable, under-resourced, under-educated, and suggestible because of their environment populations. Regardless of possible societal benefits, we do not have the right to exploit prisoners.

Furthermore, allowing for such practices can potentially have a greatly negative symbolic effect on society. Allowing for pharmaceutical companies to thus coerce and exploit prisoners, can send the message that prisoners are lower-class citizens and lower-class humans, and further deepen the stigma of the former-inmate.

In conclusion, drug trials in prisons are exploitative, since the consent given by prisoners cannot be regarded as valid, and the testing conducted is higher-risk and lower-reward than at clinical drug trials outside prisons, and coercive, since the participation of prisoners is guaranteed by threats, and an environment reinforcing compliance.

  1. Alan Wertheimer, “Exploitation in Clinical Research”, in Jennifer S. Hawkins and Ezekiel J. Emanuel, Exploitation and Developing Countries: The Ethics of Clinical Research, 2008, pp. 63-104.
  2. Nozick, Robert (1969). “Coercion,” in Philosophy, Science, and Method: Essays in Honor of Ernest Nagel, Sidney Morgenbesser, Patrick Suppes, and Morton White (eds.), New York: St. Martin’s Press, 440–472.
  3. Stone, Howard T. “Prisoners as Human Subjects: Clinical Researcher Reference Guide.” National Institute on Drug Abuse of the National Institutes of Health. © 2004. Web. 9 May 2015. <http://www.uthct.edu/files/pdf/bioethics_rg.pdf>.
  4. Stone, Howard T. “Prisoners as Human Subjects: Clinical Researcher Reference Guide.” National Institute on Drug Abuse of the National Institutes of Health. © 2004. Web. 9 May 2015. <http://www.uthct.edu/files/pdf/bioethics_rg.pdf>.
  5. Goodman, Howard. “Studying prison experiments Research: For 20 years, a dermatologist used the inmates of a Philadelphia prison as the willing subjects of tests on shampoo, foot powder, deodorant, and later, mind-altering drugs and dioxin.” The Baltimore Sun. The Baltimore Sun, 21 Jul. 1998. Web. 9 May 2015. <http://articles.baltimoresun.com/1998-07-21/news/1998202099_1_holmesburg-prison-kligman-philadelphia>.
  6. Talvi, Siljia J.A. T. “The Prison as Laboratory: Experimental medical research on inmates is on the rise.” In These Times. The Institute for Public Affairs, 23 Jan. 2002. Web. 9 May 2015. <http://inthesetimes.com/issue/26/03/feature4.shtml>.
  7. Golembeski, Cynthia, Fullilove, Robert. “ACA and Improving Health Access and Outcomes for Justice-Involved Populations.” The Fortune Society. The Fortune Society, 14 Jun. 2014. Web. 9 May 2015. <http://fortunesociety.org/2014/06/14/aca-and-improving-health-access-and-outcomes-for-justice-involved-populations/>.