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Public health; Angell’s Arguments

People who participate in placebo-controlled trials are taking chance on them: they might get the treatment,
and they might better, or they might get placebo, in which case they stay the same. Angell argues it is morally
wrong to run randomized, placebo-controlled clinical trials in developing countries. (Some examples: HIV
regimen without AZT zidovudine, prophylaxis against tuberculosis)
For this writing assignment, please do the following:
First, reconstruct Angell’s main argument in premise-conclusion form. (Hint: her main argument appears in the
first paragraph.) The first premise should be a general moral principle, taking the form “If…then…” or “…only
if…” (Sometimes one phrasing is more natural than the other, even though they are logically equivalent.)
Although you’re welcome to be more creative (without sacrificing clarity), here’s a template you can use–your
job is to correctly fill in the blank(s):
Premise 1: It is morally permissible to run a randomized, placebo-controlled trial comparing two treatments for
a condition only if __________ .
Premise 2: It is not the case that __________.
Conclusion: Therefore, it is morally impermissible to run a randomized, placebo-controlled trial.
Second, motivate the premises–i.e. provide at least one reason to think Premise 1 is true and at least one
reason to think Premise 2 is true.
Third, challenge the premises–i.e. provide at least one reason to think Premise 1 is false (i.e. at least one
reason to think that randomized, placebo-controlled trials can be permissible even if the statement you put in
the blank is false) and at least one reason to think Premise 2 is false (i.e. at least one reason to think the
statement you put in the blank is true).
Fourth, answer the following questions concerning some of Angell’s key claims:
C1. “Subjects in the control group must receive the best known treatment”
Q1: Is this always true? Why or why not?
C2. “Goals of the research are always secondary to the well-being of the participants”
Q2: Is this true? Can you think of any exceptions? If so, what are some?
C3. “Informed consent, important though it is, is not protection enough”
Q3: Why not? Do you think Angell right about this? Why or why not?
C4. “With the most altruistic of motives, then, researchers may find themselves slipping across a line that
prohibits treating human subjects as means to an end.”
Q4: Are we ever justified in treating others as means to an end? If so, what might be an example? If not, why
not?
C5. Angell regularly appeals to the standards of research set forth in the Declaration of Helsinki and other
international organizations/treatises.
Q5: Might the Declaration of Helsinki (etc.) be wrong in some cases? If so, how? If not, why not?

Sample Solution

“At the outbreak of the epidemic there was no city Board of Health in existence. The last board had been totally ineffective since it lacked sufficient authority to enforce its rules and regulations, and had been denied support by the city authorities” (Carrigan, 1853). No one was trained enough nor had been exposed to yellow fever enough to understand the specific cause and protection methods. People were left in the dark with the true severity of the infection and well as close by cases. “When informed of the first cases of yellow fever that appear in summer, the newspaper press almost invariably denies the truth of the reports, and, not unfrequently, showers upon the heads of those whose duty it is to pronounce upon the character of the prevailing disease, volumes of abuse and ridicule. If the cases multiply and the sign of the times plainly indiare the approach of an epidemic, the able editors of our valuable daily journals, under what i must pronounce a most erroneous impression of their duty to the public, studiously endeavour to conceal or suppress the true state of affairs” (Fenner, 2008). Newspapers were hesitant to release stories regarding yellow fever because businesses feared that word of an epidemic would cause a quarantine to be placed on the city and trade would suffer. In their defense, there was no trained physicians that could properly treat yellow fever so it became difficult to write a story solely based on guesses. “A cartoon posted in the Daily Item mocked the handling of fever cases in New Orleans by depicting sufferers from non-fever maladies, like a toothache and a broken arm, as yellow fever cases according to the Board of Health. By doing so, the newspaper vocalized its disapproval of the Louisiana Board of Health’s handling of fever cases and the medical knowledge of the board’s employed physicians” (Runge, 2013). People were aggravated with the lack of awareness and accuracy from journals, so they found comic relief in making fun of them. “Journals began to comment on the pestilence, blaming the city council and its do-nothing policy. Under tremendous pressure from public opinion and urged on by the Mayer, the Council on july 25 finally appointed a Board of Health” (Carrigan, 1853). Pathophysiology “The phenomenon of yellow fever was like a jigsaw puzzle with a number of missing pieces. Until those pieces were discovered the picture remained distorted until the discovery of the insect vector, the irregular spread of the pestilence presented a knotty problem in logic to speculative minds” (Carrigan, 1853). U.S Army surgeon Major Walter Reed made the first important contribution to the field of medicine with his study of yellow fever. During his time of service in the Spanish-American war, Reed found soldiers dying from both yellow fever and malaria. Unsure of the cause, Reed set out to appoint a commission to investi
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