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As the healthcare industry weighs its obligations in Russia, the Russian people aren’t waiting around. They’re making a run on pharmacies, panic-buying everything from antidepressants to sleeping pills.

Over the two weeks from Feb. 28 to March 13, Russians bought 270.5 million medicinal items in pharmacies for 98.6 billion rubles, or $1.04 billion worth, Reuters reported Thursday. That’s roughly what they bought during all of January.

The data, compiled by DSM Group, showed a spike in demand for foreign- and domestic-produced drugs alike, including antidepressants, sleep aids, insulin, cancer and heart drugs, hormones and contraceptives.

The upsurge came as drugmakers wrestled with an ethical quandary, triggered by President Vladimir Putin’s Feb. 24 decision to send thousands of troops into Ukraine: whether to join the Russian boycott initiated by Western countries or to keep selling their wares in Russia. 

More than 450 companies — from tech giant Apple to fast-food chain McDonald’s and coffee purveyor Starbucks — have cut ties with Russia, either making a clean break or suspending activities. But, despite what multinational companies in industries such as luxury goods or oil and gas are doing, the pharma industry has so far carved out an exception for itself.

The European Federation of Pharmaceutical Industries and Associations, the trade group representing the European pharma industry, called for safe passage of medicines and vaccines to the country.

The sanctions levied by the West and targeting Russia’s banks or oligarchs usually exclude essential goods, namely food and medicine. That means drugmakers and medical device manufacturers are not legally bound to continue servicing Russia. In other words, it’s entirely up to the company whether to stay or go. 

Companies from GlaxoSmithKline and Pfizer to Bayer, Johnson & Johnson and Roche have issued statements justifying their decision not to join the Russian boycott when it comes to medicines, although many are pausing clinical trials and suspending advertising and other promotional activities. Some have cited their “patients first” principle, or the desire to avoid adding to the already heavy toll on human life. 

Considering the industry’s humanitarian role, some ethicists contend that such exceptions are justified. Tadhg Ó Laoghaire, a researcher in economic ethics at the University of Gothenburg, Sweden, pointed out that interrupting the flow of essential pharmaceutical goods to the country — while not technically illegal — would be tantamount to “instigating” human rights violations.

Others argue to the contrary, that pharma should get no hall pass when it comes to the Russian boycott. 

For one thing, claims about “amorality of product development” — or that medicine and science should not get involved in politics — “have always been hollow,” noted Dr. Milton Packer, a distinguished scholar in cardiovascular science at Baylor and visiting professor at London’s Imperial College. Packer cited the adage, “There is no such thing as ‘business ethics.’ There is only ethics.”

Nor does the pharma-as-humanitarian argument hold up to ethical scrutiny, opined the medical ethicist Arthur Caplan of NYU’s Grossman School of Medicine. In addition to “cheeseburgers and boutique coffee,” the Russian people should also be deprived of “products they use to maintain their well-being.” Caplan, in an opinion piece, urged that the boycott should extend to medicines and therapies, be they life-saving or consumer products, as well as to all research both ongoing and new.

War is indeed cruel, he reminded us, “but if you tolerate a government that is bombing and shelling a peaceful neighbor to oblivion, then pharma must ensure that efforts to make Putin and his kleptocratic goons feel the wrath of their fellow citizens.”

His position aligns with an open letter signed by hundreds of biotech leaders shortly after the Russian invasion began. The letter, which has since garnered about 900 signatories, called for “immediate and complete economic disengagement,” including halting trade in goods.

Some pharma companies, including Eli Lilly, have said they will only withdraw certain kinds of drugs. In Lilly’s case, that means “non-essential” medicines such as erectile dysfunction drug Cialis will be restricted, but not those for diabetes and cancer. Botox maker AbbVie has suspended its aesthetics products in Russia. Insulin giant Novo Nordisk said it will maintain supply.

Is the healthcare industry’s compassion misplaced? It may be worthwhile to consider that one of the beneficiaries of pharma’s raw materials and healing products will be Putin himself. As others have pointed out, he’s likely to divert such cargo to the military or to the black market. Shortages, as Ó Laoghaire noted, “tend to further entrench political elites.” Moreover, Putin may nationalize pharma corporate investments in Russia, anyway, regardless of the outcome in Ukraine.

Companies that question how the civilized world can punish a largely blameless Russian populace by withholding vital medicines and equipment may want to weigh that position against the further bloodshed it could indirectly cause.