Several years ago there was extensive coverage in the U.S.A over the pricing of the Epipen® auto-injector for injecting adrenaline (epinephrine) which had increased from USD 165 for a set of 2 in 2011 to USD 609 in 2016, making the life-saving medication (which has only a 12-month shelf-life) unaffordable for many. 

It should be noted that the adrenaline is reported to cost ~1c per dose.  The high cost is related to the auto-injector for which there were (controversially) no FDA-approved generic equivalents until august of 2018. Hence the company were effectively allowed a monopoly on the product.

a.       Why would a situation such as this not arise for consumers in Australia?  (1 mark)

b.       The current dispensed price for a single dose pen for adrenaline in Australia is $84.21 and there are two brands listed on the PBS?  How much is the consumer likely to pay? (3 marks)

In the mid 2000s in the US, due to issues of drug enforcement,pseudoephedrine containing medications were brought behind thepharmacy counter and in most cases require ID, and phenylephrinewas substituted in most over-the-counter products.

Pseudoephedrine increases the amount of endogenousnorepinephrine, whereas phenylephrine works on ?1-adrenergicreceptors directly.

There are numerous cases where experts have spoken out about theeffectiveness of phenylephrine, so it likely is a less effectivesubstitute for pseudoephedrine in its main role as adecongestant.

What I'm curious about is whether there are clinical indicationsfor which the phenylephrine is actually preferred (so situationswhere the ?1-agonist nature without the increase of endogenous NEis sought after)?

1) Castrated male rats can have their mating behaviors restored by:
A) injections of estrogen into the hypothalamus.
B) injections of testosterone into the hypothalamus.
C) injections of testosterone into the hippocampus.
D) both A and B.
E) none of the above.

2) Research examining the biological differences between homosexual and heterosexual men and women have shown that:
A) homosexual and heterosexual males have no differences in brain structure.
B) homosexuals have a higher probability of having a homosexual sibling than do heterosexuals.
C) the medial preoptic area of the hypothalamus is larger in homosexual men than in heterosexual men.
D) homosexuality in families follows paternal lines.
E) homosexuality is only related to societal and cultural influences.

3) Which of the following are most likely to show preferences for masculine toys?
A) women with congenital adrenal hyperplasia
B) female vervet monkeys.
C) men with Turner’s syndrome.
D) men with congenital adrenal hyperplasia.
E) women with Turner's syndrome.

4) The capacity of some human couples to pair bond may reflect the activity of
A) oxytocin and dopamine.
B) glutamate and glycine.
C) dopamine and vasopressin.
D) vasopressin and oxytocin.
E) acetylcholine and norepinephrine.

5) Which of the following would be expected in a rat after stimulating central nucleus of the amygdala?
A) behavioral signs of fear
B) reduced secretion of gastric acids into the stomach
C) the rat would be more tame when handled by humans
D) lower levels of stress hormones in the blood
E) euphoria and sedation

6) Cannon disagreed with William James’s theory of emotion because:
A) emotion can be felt before the sympathetic stress response is initiated.
B) emotion is not dependent upon the cortex as suggested by sham rage.
C) many emotions elicit the same bodily responses.
D) all of the above.
E) none of the above.

Dewey Cheatham is the new Vice President of Marketing for a large online search engine company, Pottstown Innovative Enterprises (AKA, PIE). Dewey has been doing some research into how he can increase the Company’s revenues and thereby really impress the Company brass. During his research he came across an article about Brazilian pharmacies looking for an advertising vehicle to tap into the U.S. consumer market. Further research reveals that this could be a billion dollar venture and if PIE plays its cards right, it could make a substantial amount of money given its extensive advertising network. Dewey is super ecstatic about the possibilities and is salivating over what this could mean for his career with PIE.

Before Dewey pulls the trigger on this, he decides to consult with his legal department. The legal department tells Dewey the following:

1. The shipment of prescription drugs from pharmacies outside the United States to customers in the United States may violate the Federal Food, Drug and Cosmetic Act and in the case of controlled prescription drugs, the Controlled Substances Act.

2. The FDA cannot ensure the safety and effectiveness of foreign prescription drugs that are not FDA-approved.

3. Imported drugs typically do not meet FDA’s labeling requirements and may not have been manufactured, stored and distributed under proper conditions; and may not have been dispensed in accordance with a valid prescription.

4. The government has historically been very lax in enforcing the laws in this area and legally there are a few gray areas; therefore the risk of any prosecution may not be significant.

After the consultation with Legal, Dewey is confused as to what his decision should be. If you were advising Dewey on the ethical implications presented by this case, what would you say to him? Specifically, what ethical problems and issues do you see?