A problematic benefaction

Medical and humanitarian organizations routinely collect recently expired medications from U.S. hospitals, doctors' offices, and ambulance services for distribution in impoverished nations. Proponents of this practice assert that the medication is still safe and largely effective, and it would have just gone to waste otherwise. This way people can have access to drugs that would have otherwise remained beyond their reach. Still, I can't shake the nagging doubt: Is this an ethical thing to do? A condescending one? Or is it noble and praiseworthy?

Reduced to its simplest form, the argument against sending expired medication to Third World countries goes something like this: These drugs aren't good enough for Americans to take themselves, but they're good enough for people in poorer nations? Who do we think we are?

I've never been involved in this practice myself, but I suspect that many supporters would reframe the question not as one of drugs being good enough for some and not for others but as one of regulatory reasonableness. Not all expiration dates refer to the medicine's point of last effectiveness/safety. Some, for example, refer to the guaranteed sterility of the packaging. And then there are some drugs which really don't "expire" per se. "D50,"  which is used to correct hypoglycemic emergencies, is a prime example: It's sugar and water. That's it.

One could make a further case against the regulatory standards that have been imposed on pharmaceutical companies, saying that many expiration dates have been artificially or arbitrarily contrived. I know little about pharmaceutical regulations, so I can't speak to this point. I am not persuaded by it, however, since I have a hard time believing that the oversight agencies knowingly impose false or incorrect standards.

I find the humanitarian argument most compelling and also most troublesome. I recognize that this may be one of the only ways that large numbers of people can obtain medicine they sorely need, and I in no way oppose that objective. But declaring medicine unfit for patient consumption in the United States and then turning around and sending it to patients abroad just doesn't seem right.

There has to be a better way to meet the needs of the medically underserved. Whether it be new international aid initiatives, pharmaceutical grant programs, or something else, this is a problem that has to have a solution. And I want to emphasize that I admire medical and humanitarian groups for the selflessness and dedication they practice day in and day out; it is only this one component of their work that I have doubts about.

I recognize the elements of truth in many of the arguments for and against doing this. Ultimately, though, if I have to remove a vial of medication from my ambulance because it is no longer appropriate to give to a patient, then I simply can't condone it being sent off for use on a patient.

Agree? Disagree? Leave a comment and let's discuss.