Pharmaceutics is the foundation of contemporary medicine. Indeed, there are few ailments that plague mankind today where we cannot prescribe some kind of drug. The philosophy of ethics is that which shapes and forms the bricks of that foundation of medicine – to bring medicine back to its original purpose of eliminating/reducing suffering and improving quality of life.

The practice of medicine has taken a bureaucratic/corporate nature over the last century — meaning government regulation and corporate finance mandates the direction drugs find their way to patients. When the importance of the process takes precedence over the lives and well-being of patients, then it is the role of philosophy to direct change where change is needed. This book does a good job of covering general contemporary pharmaceutical issues in dealing with the explosion of innovation and progress in this field over the last ten years.

We will cover the basic elements of the nature of this book, and give feedback and suggestions where needed.  It would be nice to give a detailed review of each individual article, but it is not necessary for the reader to know this in order to get an idea of what to expect in the book, so we will stick to the basic themes throughout.

We begin with an introduction by editor (and author of the final article) Dien Ho regarding the importance and scale of pharmaceutics — it being the least physically obvious and therefore most socially acceptable method of self-improvement. What we understand to be ‘pharmaceutical’ is something ingested or applied to improve our health.

The articles share a general theme of discussing the very old philosophical mind/body problem (topics of free-will, agency, effects of placebo, etc.). Since many improvements in quality of life are subjective, it is difficult to ascertain the objectively beneficial effects of said drug, or how a drug will actually work on an individual. The individual’s fear is that a drug will alter defining characteristics (be it personality change or physical) of an individual that would overall worsen ones quality of life. What might be unimportant for one person would be of vital importance for another (like eye color, or energy level, or even to maintain themselves as nature intended them to be).

Another common theme throughout this book is the ethical considerations of corporate interests – many are (rightly) highly critical of the for-profit motive of corporations and how it influences the pursuit of the science of medicine. It was refreshing to hear counter arguments that support corporate intervention (although I did not agree with their conclusions). It is certainly a difficult matter — and this book (rightly so, as one that discusses Ethics) — leaves one to ponder the question of how much intervention should government or corporate interests interfere with the doctor doing their job.

Yes, government ought to attempt to curb unethical behavior, but by delaying drugs reaching the market it potentially costs people their lives. Yes, corporate intervention may unduly influence doctors to prescribe the wrong drug (or the patient to demand that drug) which also may cost lives. What is preferable?  There is no easy answer here, but this book does well to encourage further thought on this matter.

The roles of government is considered throughout this book – most lament the overly lengthy process to get a drug to be approved for public use, that human-beings ought to have the autonomy to decide what is an acceptable or non-acceptable risk for trying unapproved.  Experimental drug possibilities are discusses as well, but are denied that by government policy. Freedom of the individual to decide their own care is being introduced to incorporate the feedback patient into the spectrum of care. The patient is no longer merely understood to be a naive child that ought to simply listen to the advice of their doctor, but one to participate and take some measure of responsibility for their care. Since the science of medicine has grown too complex for any one doctor to be aware of all drugs/treatment options available, and certainly what would be best for a particular patient, it behooves one to learn more about their own ailments and assist the care provider where necessary.

Ethical freedom for the pharmacist is discussed — that it is not just the patient’s needs are important, but the pharmacist’s need to feel they are acting as a moral and ethically sound individual — while still fulfilling their mandated role of helping others. Finally, there are some strange, yet welcome, articles that discuss the limits of pharmaceutics.  Indeed, they promote a holistic approach to the practice of medicine (more popular these days and rightly so).

Medicine takes a very important role in the curing of ailments and improvements in the quality of life, but it ought not to be the only solution to that which ails us – especially in incredibly complex ailments such as depression or diabetes. The wisdom of Renaissance practitioners of medicine is introduced to give us an idea of just how important the holistic approach to ailments of the mind are. Diet, exercise, a change of work or environment, in addition to pharmaceutics, is stressed.  This is not a call back to lost or magical ancient wisdom, but a call to rethink the approach to treatment of disease.   

Ho finishes with a reminder to us that ethical considerations in pharmaceutics are not merely niceties to be practiced only when convenient. Misuse of drugs is known to be a leading cause of death in the western world, and worse yet is the array of antibiotics are quickly losing their effectiveness. This threatens the survival of our species with destruction due to previously curable diseases.

All in all, I highly recommend this book not just for pharmacy students, but all those who practice medicine, especially those who do so in an academic or research setting. The average lay-person may find this book too complex, but there are still tidbits of wisdom to be gained from reading it, especially a reminder that you, the patient, are ultimately responsible for the safety and care of your body. Those suffering from complex health problems, like addiction, diabetes or depression, would find this book particularly helpful.  Indeed, the practitioner of medicine is there to help you, not to control you. The practitioner of medicine is a highly education person, one who has sworn an oath to help the patient become well – but they are still human, with all the faults that goes along with it.  Therefore, the pursuit of health is a responsibility not just with the medical professional but everyone. 

© 2018 Hans Krauch

Hans Krauch is a graduate student at Sofia University “St.Kliment Ohridsky”, Faculty of Philosophy.