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Subtracting injury from insult: ethical issues in the use of pharmaceutical implants.


 Implantable drug delivery systems are devices that release a drug into the body in a controlled manner over a long time period. Examples are insulin diffusion systems and Norplant, the implantable contraceptive device developed by the Population Council. The advantages of these systems are many: they are noninvasive; they are reversible; they are efficient because, through "organ-targeting," the dosage and therefore the side effects can be reduced; and they are profitable because the ratio of development time to patent protection is lower than it is in new drug development. Superficially, it would appear that implantable drug delivery systems should not be subject to the same ethical constraints as psychosurgery, gene surgery, and surgical sterilization, which are invasive and irreversible. However, the question remains whether implantable devices which accomplish the same ends as the invasive, irreversible technics may not be equally reprehensible.
