1. Considering both economic and ethical aspects, is it appropriate for companies like Novo Nordisk to conduct clinical trials in, for example, India? What exactly are the principles that should guide such a decision? 

2. If trials are conducted in an emerging economy, how should they be managed and which standards should apply? 

3. What interest groups are joining the public debate and why? How should businesses handle them? What is the role, respectively, of Danish, European, American and host country authorities and ethics committees in this process? 

4. How should Anders Dejgaard react when the journalist calls to discuss Novo Nordisk’s practices? What is the most effective way to communicate with the public?

The case discusses the complex ethical issues associated with the pharmaceuticals industry, and focuses on a company called Novo Nordisk based in Denmark. Novo operates globally and adopts a Triple Bottom Line approach, whereby the bottom line is measured in financial, environmental, and social terms. They subscribe to a higher level of ethical behaviour than is required. 

The case narrows in on the topic of clinical trials and placebo experiments, and the regulatory requirements surrounding them, especially as it relates to conducting trials outside of the EU, in more developing countries. In this case, the director of the company is contacted by a journalist who is researching clinical trials in the Third World. The end of the case is left with the question of if and how to respond, which requires a deeper look into the ethical issues surrounding the pharmaceutical practices in general, and of Novo specifically as well.