Comment

Medical research ethics in China

This system has led to artificially high price schedules, overpayment for pharmaceuticals, overuse of expensive high technologic testing, increase in health costs, and an erosion of professional ethics and practice norms.15 Ethical codes for medicine in China have been based on principles of autonomy, beneficence, and justice; however, in recent years the potential for conflicts of interest has undermined ethical relations between medical professionals, researchers, drug companies, and even regulatory agencies.16 The Chinese government has piloted new ways of dealing with misdirected provider financial incentives, including the change from fee for service to aggregated and prospective payments for performance and treatment protocols that assure improved quality and emphasize prevention and primary care of chronic disease in place of curative services more appropriate to infectious illness.

This issue is important because of the recent tendency of pharmaceutical companies to shift their sponsorship of clinical trials from developed to developing countries such as China and the lack of ethical guidelines and monitoring agencies in such locations. Indeed, the number of clinical trials registered in China is increasing (Wang, 2010), but procedures and policies related to medical research ethics in China are underdeveloped (Wang & Henderson, 2008), and there is dispute in the health care system as to what are proper ethical procedures (Chinese doctors are under threat, 2010). As a result, some observers think ethical problems exist on a wide scale (Turner, 2004), and patients with mental illness are particularly vulnerable (Lopez-Munoz et al., 2007).