A recent study by Olivieri et al, published in PLOS ONE, reports that between 2009 and 2015 a third of patients with thalassaemia in Canada’s largest hospital were switched from first-line licensed drugs to regimens of deferiprone, an unlicensed drug of unproven safety and efficacy. Based on retrospective data from patient records, the PLOS Study reports that patients treated with deferiprone, either as monotherapy or in combination with first-line drugs, suffered serious (and often irreversible) adverse effects. The data reported by Olivieri et al give rise to a number of ethical issues. These ethical issues are identified, placed in historical context and analysed. For purposes of this analysis, reliance is placed on two core principles of research ethics, harm minimisation and informed consent, and also on the hospital’s mission statement. Then a mystery is explored: How and why did it happen that Toronto’s University Health Network treated large numbers of patients with an unlicensed drug over a period of many years? ‘Institutional conflict of interest’ is considered as a possible explanatory hypothesis.
- research Ethics
- drugs and drug industry
- clinical trials
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Correction notice This paper has been corrected since it was first published online. The formatting of two quotes was updated to reflect the source manuscript.
Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests The author served as (unpaid) ethics consultant to Nancy Olivieri during her conflict with Apotex, the Hospital for Sick Children and the University of Toronto. He appeared at three press conferences with Nancy Olivieri in the autumn of 1998 and the winter of 1999, at which his role was to analyse and evaluate the ethical issues arising from the conflict.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information
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