Patent protection creates an encouraging environment for innovation, but it can be a hindrance to the availability of new medications. There are many countries that still harbor this competition while ensuring that all citizens have access to these medications. There are downsides to certain patent systems, but with a few modifications they can be remedied to achieve the highest level of access, quality of care, and best cost for the insured. In most of the countries reviewed, the patent system is thoroughly regulated with the consumers in mind. There are opportunities for manufacturers to create generic and cost effective medications within the typical patent protection timeline to ensure access to new medications. The systems that are in place encourage innovation with medical devices and medication by providing incentives for the researchers.

The majority of trust research has focused on the benefits trust can have for individual actors, institutions, and organizations. This “optimistic bias” is particularly evident in work focused on institutional trust, where concepts such as procedural justice, shared values, and moral responsibility have gained prominence. But trust in institutions may not be exclusively good. We reveal implications for the “dark side” of institutional trust by reviewing relevant theories and empirical research that can contribute to a more holistic understanding. We frame our discussion by suggesting there may be a “Goldilocks principle” of institutional trust, where trust that is too low (typically the focus) or too high (not usually considered by trust researchers) may be problematic. The chapter focuses on the issue of too-high trust and processes through which such too-high trust might emerge. Specifically, excessive trust might result from external, internal, and intersecting external-internal processes. External processes refer to the actions institutions take that affect public trust, while internal processes refer to intrapersonal factors affecting a trustor’s level of trust. We describe how the beneficial psychological and behavioral outcomes of trust can be mitigated or circumvented through these processes and highlight the implications of a “darkest” side of trust when they intersect. We draw upon research on organizations and legal, governmental, and political systems to demonstrate the dark side of trust in different contexts. The conclusion outlines directions for future research and encourages researchers to consider the ethical nuances of studying how to increase institutional trust.

The United States Food and Drug Administration, or FDA, published 'General Considerations for the Clinical Evaluation of Drugs,' in September 1977. The document defined acceptable practices for investigators who studied new drugs. Specifically, the document outlined the common clinical trial methods. Clinical trials are studies to test whether a new drug is safe before doctors can prescribe it to patients. Prior to 1977, the Protection of Human Subjects Rule primarily regulated clinical drug trials, but it did not specify who could and could not be included in clinical trials. In the document, the FDA recommended that anyone who could become pregnant be excluded from early-phase clinical trials to minimize risks to a potential fetus. After the FDA published the document, investigators excluded women from clinical trials. The document ultimately prevented women of reproductive capacity from participating in early phase clinical trials, which affected women’s health research.