Does the American Medical Association Journal of Ethics Comprehend the Ethics of Informed Consent?

The American Medical Association Journal of Ethics, Virtual Mentor, has devoted its January 2012 issue to the question of vaccine ethics. Unsurprisingly, none of the articles deal with the very real problems that taint vaccine trials and present a false view of vaccine safety. Apparently, using reactive placebos that hide the true rate of serious adverse events or claiming long-lasting effectiveness while having no long-term placebo-controlled data regarding the vaccine’s efficacy is normal, and not cause for ethical concern as far as the AMA is concerned.

What is cause for concern, according to Virtual Mentor, is that parents who have educated themselves on vaccine safety are choosing not to vaccinate. Instead of discussing the very real reasons behind these decisions, they simply chalk it up to stupidity. Not that they use that word of course; no, according to one author, “We question the value of vaccines because they have become a victim of their own success.”

Whether this analysis is actually based on genuine research of parental concerns is up for debate, especially since the author does – very briefly – mention a much bigger cause of people’s fears of vaccination: adverse events: “Who bears the burden of responsibility when vaccines inevitably cause an adverse event? Should we embrace future “vaccinations” that target the brain, specifically normal stress responses? Why should we risk the side effects of a vaccine when regular checkups can screen for disease instead of trying to prevent it?”

These are all questions that the author more or less ignores. According to him, those of us who question vaccine safety do so only because we have – thanks to vaccines – not been exposed to the horrors of the diseases the vaccines prevent (because the vaccines have been so successful).

This type of thinking is rampant in all the articles present in the Journal. There are many I could discuss here, but I’ll focus on the most egregious: An article by Susanne Sheehy and Joel Meyer titled “Should Participation in Vaccine Trials be Mandated?

The main purpose of this article seems to be to argue for a government mandate that requires individuals to state whether or not they would be willing to participate in a vaccine trial. This seems innocent enough on the surface – as the article points out, most vaccine trials today rely on volunteers who “appreciate the potential risks but still choose to participate for altruistic reasons,” with participant payment being minimal and the risk borne mainly by students and the unemployed, who need the financial compensation, however meager it may be. However, when one thinks about it a little further, more problems emerge. How do the authors plan to ensure that all those making their decision are making an informed choice? In other words, in a world where even the US Food and Drug Administration has admitted it is unable to effectively police drug safety, who are we to rely on for an unbiased and objective analysis of the costs and benefits of participating in a vaccine trial – the pharmaceutical companies who stand to make a profit from that same vaccine?! As it is, the pharmaceutical companies have begun marketing their vaccines through professional medical associations, feeding doctors the same vaccine safety data that they themselves have generated. Where are the checks and balances?

In addition, not all vaccines stand to have an equal amount of risk or benefit attached to them. Some vaccine trials may be more dangerous than others. By having people make decisions on whether or not they will participate in vaccine trials (in general), the authors remove all possibility of informed consent with regard to the specific vaccine being tested. If informed consent is no longer necessary, what is to stop pharmaceutical companies from performing all sorts of unethical experiments on victims who have no legal recourse? Remember, even today it is impossible to sue a company if you are vaccine injured – they are already protected from any legal costs coming from faulty or dangerous drugs!

This plan would also neatly remove any need for pharmaceutical companies to even pay trial participants. After all, why pay people who are required by law to participate in the trial? I’m sure the companies would love this idea!

Interestingly, neither Sheehy nor Meyer suggests anything drug companies could do to actually make vaccines safer, and thereby reduce the risk associated with testing vaccines. I, for one, am not too surprised by this. Making vaccines safer might cost more money, and that would cut into Pharma profits. And it’s all too clear that they’re the ones calling the shots in this farce of a medical article.

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