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The Ethics Of Clinical Research In The Third World By Marcia Angell

1120 words - 4 pages

Third world countries and underdeveloped nations have become the new proverbial Petri dish of experimentation and offer particular conditions which researchers would never be able to find in their home countries. This only serves to highlight the problem that inherently faces all research studies, the ethical debate in regards to the protection and rights of their subjects. Is it feasible to expect the same standards to apply in certain countries where an economical imbalance between what is possible and what is not can be the largest hurdle to overcome? These are key issues examined in the New England Journal of Medicine by author Marcia Angell, M.D., and co-authors Harold Varmus, M.D. and David Satcher, M.D. in their respective articles that consider the ethical standards that should prevail in such circumstances. Should researchers be upheld to universal standards, or are the standards more applicable in a “local” sense, where the conditions and the constraints of the location provide the context for how the principles should be applied?
Ethical violations committed on underprivileged populations first surfaced close to 50 years ago with the discovery of the Tuskegee project. The location, a small rural town in Arkansas, and the population, consisting of black males with syphilis, would become a startling example of research gone wrong. The participants of the study were denied the available treatment in order further the goal of the research, a clear violation of the Belmont Report principle of beneficence. This same problem faces researchers today who looking for an intervention in the vertical transmission of HIV in Africa, as there is an effective protocol in industrialized nations, yet they chose to use a placebo-controlled study with no use of the current protocol. Researchers are committing the same mistake as Tuskegee argues Marcia Angell, M.D. in her article “The Ethics of Clinical Research in the Third World”, stating that it is only ethical to use placebo-controlled studies “when there is no known effective treatment” (Angell, 847). The current protocol consists of a lengthy treatment with costly drugs, but Angell argues that despite the logistics, beneficence still applies, and the available treatment should be the standard to which all others is measured against. There is also the guiding of issue of not only ensuring that subjects are not treated as just a minimal part of the ultimate goal, but ensuring that the subjects' well-beings be the primary concern for researchers as well. Yet, the available treatment is being withheld, leaving the placebo-controlled group without any treatment at all.
The justification is weak at best, Angell says, with researchers claiming that the placebo-group would not be receiving the necessary treatment anyway, so they are simply observing the natural manifestation of the infection in the mother and infant that would occur regardless of the study. Yet, if there is a shift in ethical reasoning...

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