Journal of Medical Ethics 47 (12):16-16 (2021)

Douglas MacKay
University of North Carolina, Chapel Hill
Hospital systems commonly face the challenge of determining just ways to allocate scarce drugs during national shortages. There is no standardised approach of how this should be instituted, but principles of distributive justice are commonly used so that patients who are most likely to benefit from the drug receive it. As a result, clinical indications, in which the evidence for the drug is assumed to be established, are often prioritised over research use. In this manuscript, we present a case of a phase II investigational trial of intravenous thiamine for delirium prevention in patients undergoing haematopoietic stem cell transplantation to emphasise several shortcomings in the overarching prioritisation of clinical over research uses of scarce drugs. Specifically, we present the following considerations: clinical use may not have stronger evidence than research use; a strong scientific rationale for research use may outweigh the claim for clinical indications in which there is weak evidence; treatment within the context of a clinical trial may be the standard of care; and research use may not only benefit patients receiving the treatment but also offers the prospect of improving future clinical care. In summary, we argue against allocation schemes that prohibit all research uses of scarce drugs and instead recommend that allocation schemes include a balanced approach that weighs risks and benefits of access to scarce drugs irrespective of the research versus clinical use designation. All data relevant to the study are included in the article.
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DOI 10.1136/medethics-2020-106739
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References found in this work BETA

Payment for Research Participation: A Coercive Offer?A. Wertheimer & F. G. Miller - 2008 - Journal of Medical Ethics 34 (5):389-392.
The Tensions and Challenges of Unpredictable Drug Shortages.Annekathryn Goodman - 2012 - American Journal of Bioethics 12 (1):20 - 22.

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