The Crisis of Ethics in Medicine and Medical Research in the United States

Introduction

American medicine is often seen as the global frontier of biomedical innovation — home to the first organ transplants, genomic sequencing, and countless pharmaceutical breakthroughs. Yet behind this reputation lies a deep and ongoing crisis of ethics. The U.S. system is plagued by conflicts of interest, inequities in access, and the entanglement of scientific research with corporate profit. While extraordinary progress has been made in curing disease and prolonging life, the question remains: at what cost to fairness, transparency, and justice?

This paper examines the historical roots of medical ethical failures, the commercialization of medicine, inequities in care, new challenges posed by data and biotechnology, and the erosion of trust during crises such as the opioid epidemic and COVID-19. It argues that unless medicine in the United States realigns itself with its ethical foundations — respect for persons, beneficence, and justice — the very legitimacy of medical science is at risk.

Historical Legacies of Ethical Failure

The ethical failings of American medicine are not recent. They trace back through a history of exploitative research and systemic disregard for vulnerable populations. The most infamous case is the Tuskegee Syphilis Study (1932–1972), in which African American men were deceived and denied treatment for syphilis even after penicillin became widely available. The revelation of Tuskegee in the 1970s shocked the nation, fueling mistrust among Black communities toward medical institutions that endures today.¹

Other cases illustrate similar disregard. The Willowbrook hepatitis experiments deliberately infected children with intellectual disabilities under the justification of research.² In the 1950s, cells from Henrietta Lacks were taken without consent, giving rise to the immortal HeLa cell line that underpins much of modern research — but without acknowledgment or benefit to her family until decades later.³

These abuses, alongside the revelations at Nuremberg after World War II, led to the articulation of modern bioethics. The Belmont Report (1979) established three guiding principles: respect for persons, beneficence, and justice.⁴ Institutional Review Boards (IRBs) were created to oversee research. Yet these reforms, while vital, did not eliminate deeper structural pressures that continue to foster ethical compromise.

Commercialization and Conflicts of Interest

The greatest ethical challenge of modern American medicine lies in the commercialization of care and research. Pharmaceutical and medical device companies invest billions in clinical trials, but with the expectation of profit. Studies consistently show that industry-funded research is more likely to yield favorable outcomes for sponsors’ products than independent studies.⁵

The opioid crisis exemplifies this entanglement of profit and harm. Beginning in the late 1990s, Purdue Pharma and other manufacturers aggressively marketed opioids as safe and non-addictive, despite internal evidence to the contrary.⁶ Physicians were incentivized, prescribing soared, and millions became addicted. The resulting epidemic has killed more than 500,000 Americans and continues today. This catastrophe was not merely a medical failure; it was an ethical collapse driven by corporate deception, regulatory capture, and misplaced trust in pharmaceutical influence.

Even medical education is not immune. Many U.S. medical schools continue to rely on industry funding, and physician prescribing patterns are measurably influenced by financial ties to companies, even as minor as sponsored meals.⁷ Clinical practice guidelines — supposedly objective standards of care — are often written by committees with members receiving industry payments.⁸

Inequity in Access and Outcomes

Equity is a core ethical principle in medicine, but the U.S. system is marked by profound disparities. Despite spending more per capita on healthcare than any nation, the U.S. lags behind peer countries in life expectancy, maternal mortality, and chronic disease management.⁹

Maternal mortality reveals the crisis most starkly. Black women in the U.S. face a risk of dying in childbirth more than three times higher than white women, due in part to systemic racism, implicit bias in medical settings, and unequal access to prenatal care.¹⁰ Native American and rural communities face similarly high burdens of preventable disease and lack of access to specialty care.¹¹

Medical research priorities often reflect profit rather than population need. Pharmaceutical companies invest heavily in drugs for chronic lifestyle diseases, lucrative cancer therapies, and cosmetic treatments, while so-called “neglected diseases” receive far less funding. Global health disparities thus persist not only between nations but within the U.S. itself, where uninsured and underinsured populations remain excluded from the benefits of innovation.¹²

Data, Privacy, and the New Frontiers of Research

The age of genomics and artificial intelligence has opened vast new possibilities — but also new ethical dilemmas. Patients’ medical data, often de-identified, are shared between hospitals and technology companies, raising concerns about consent and ownership. In 2019, Google’s partnership with Ascension Health (“Project Nightingale”) drew scrutiny when it was revealed that millions of patient records were being shared without explicit consent.¹³

Genomic research introduces similar risks. DNA data collected for research may be re-used for secondary purposes, raising fears of genetic discrimination. While the Genetic Information Nondiscrimination Act (GINA) offers some protection, gaps remain for areas such as long-term care insurance. Algorithms used in health risk prediction have also been found to reproduce racial bias present in training data, systematically underestimating the health needs of Black patients compared to white patients with the same conditions.¹⁴

These examples show that the crisis of ethics is not confined to clinical care or drug marketing — it extends into the digital infrastructures that are rapidly redefining medicine.

Case Study: COVID-19 and Ethical Fault Lines

The COVID-19 pandemic magnified existing ethical fractures. Early vaccine trials highlighted the underrepresentation of Black, Latino, and Native communities — the very populations hardest hit by the virus.¹⁵ Distribution of vaccines and therapeutics mirrored systemic inequities: wealthier hospitals and private networks often secured doses before public clinics serving marginalized communities.¹⁶

At the same time, the rapid development of mRNA vaccines raised legitimate questions about emergency use, informed consent, legal accountability, proper testing and transparency. The rush to deployment deepened public mistrust, particularly among communities already scarred by historical abuses such as Tuskegee. The ethical lesson of COVID-19 is not simply about pandemic response; it underscores how fragile public trust is when communication, equity, and accountability are not prioritized.

Emerging Controversies: Stem Cells and Gene Editing

Beyond immediate crises, frontier technologies such as stem-cell therapies and gene editing present ethical dilemmas of their own. The U.S. has seen a proliferation of unregulated “stem-cell clinics” offering expensive and unproven treatments directly to consumers, often bypassing FDA oversight.¹⁷ These exploit the desperation of patients with chronic or terminal illnesses, blurring the line between research and commercial promise.

Similarly, the advent of CRISPR gene editing raises profound questions about what should and should not be altered in human genomes. While the U.S. has guidelines discouraging germline editing, the lack of clear, binding regulation leaves open the possibility of ethically questionable experimentation — particularly in the private sector.¹⁸ The challenge is not only scientific but moral: how to ensure that technologies with world-changing potential are not driven primarily by market incentives.

Restoring Trust: Toward an Ethical Medicine

The ethical crisis in American medicine is not merely a matter of individual bad actors; it is systemic. The commercialization of care, inequities in access, and privatization of research have created structures that reward profit over principle. To restore trust, several reforms are needed:

  • Strengthen regulatory independence: The FDA and CDC must be insulated from industry and political pressure.

  • Limit financial conflicts of interest: Physicians, researchers, and guideline committees should face stricter prohibitions on industry payments.

  • Expand public funding for research: Federal grants should prioritize neglected diseases, social determinants of health, and equitable care.

  • Community engagement: Research must involve the populations it serves, with transparency in design and results.

  • Data governance: Patients should retain ownership and consent rights over their medical data.

Above all, medicine must re-anchor itself in its ethical foundations. As the Belmont Report articulated: respect for persons, beneficence, and justice are not abstract ideals but living commitments.¹⁹ Only by re-centering these values can medicine fulfill its true calling — not as a marketplace, but as a public trust.

Endnotes

  1. Susan M. Reverby, Examining Tuskegee: The Infamous Syphilis Study and Its Legacy (Chapel Hill: University of North Carolina Press, 2009).

  2. David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (New York: Basic Books, 1991), 73–95.

  3. Rebecca Skloot, The Immortal Life of Henrietta Lacks (New York: Crown Publishing, 2010).

  4. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research (Washington, DC: U.S. Government Printing Office, 1979).

  5. Joel Lexchin et al., “Pharmaceutical Industry Sponsorship and Research Outcome and Quality: Systematic Review,” BMJ 326, no. 7400 (2003): 1167–1170.

  6. Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty (New York: Doubleday, 2021).

  7. Adriane Fugh-Berman, “Physicians and the Pharmaceutical Industry: Therapeutic Integrity and the Public Trust,” American Journal of Bioethics 10, no. 1 (2010): 18–24.

  8. Lisa Cosgrove et al., “Conflicts of Interest and Disclosure in the American Psychiatric Association’s Clinical Practice Guidelines,” Psychotherapy and Psychosomatics 78, no. 4 (2009): 228–232.

  9. Gerard F. Anderson et al., “Health Spending in the United States and Other High-Income Countries,” JAMA 319, no. 10 (2018): 1024–1039.

  10. Centers for Disease Control and Prevention (CDC), “Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016,” MMWR 68, no. 35 (2019): 762–765.

  11. Thomas D. Sequist, “Health Disparities: Lessons from the Pandemic,” New England Journal of Medicine 386 (2022): 1053–1056.

  12. Mariana Mazzucato, The Value of Everything: Making and Taking in the Global Economy (New York: PublicAffairs, 2018), 221–240.

  13. Natasha Singer, “Google’s ‘Project Nightingale’ Gathers Personal Health Data on Millions,” New York Times, November 11, 2019.

  14. Ziad Obermeyer et al., “Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations,” Science 366, no. 6464 (2019): 447–453.

  15. M. Anyane-Yeboa et al., “Racial and Ethnic Disparities in COVID-19 Outcomes: Social Determinants of Health and Vaccine Equity,” Journal of General Internal Medicine 36 (2021): 3169–3171.

  16. Kaiser Family Foundation, “COVID-19 Vaccine Distribution: Implications for Racial Equity,” KFF Issue Brief, January 2021.

  17. Leigh Turner, “The U.S. Direct-to-Consumer Marketplace for Stem Cell Interventions,” Perspectives in Biology and Medicine 61, no. 1 (2018): 7–24.

  18. Eric Lander et al., “Adopt a Moratorium on Heritable Genome Editing,” Nature 567 (2019): 165–168.

  19. National Commission, Belmont Report.