Physicians are cautioned that the two obstacles to reforming post-marketing clinical trials are the FDA's reluctance to revisit past approvals and its inability to enforce pharmaceutical companies' commitment to conduct Phase IV trials.
Cross-cultural ethics should be regarded by physicians as an area of medical expertise that can help resolve conflicts that arise between the health traditions of international patients and those traditions that are upheld in the United States.
Medical expertise includes knowledge of modern interventions as well as the incorporation of ethical considerations and patient goals as they relate to treatment decisions.