Wednesday, November 15, 2006

New book on biomedical research in developing countries

It is no longer news that pharmaceutical companies are increasingly conducting clinical trials in many low-income (i.e. impoverished) countries, mostly in order to reap a greater profit margin. And the main ethical issues with the globalization of pharmaceutical research are also pretty well known, at least in the academic and development communities: the local participants, who often have little formal education, may not be in a position to give meaningful informed consent; the poor and sick may have no real option to refuse to join a study, especially when the trial offers a decent standard of medical care; and the trials may be testing drugs for conditions that are mainly of interest to the richer countries, while neglecting to do drug research for serious health conditions if they are not sufficiently marketable in the industrialized world. And so on. Every student who takes a course on international research ethics gets a steady earful of this: inequality, injustice, exploitation.

Familiarity with these issues may not breed contempt, but it can breed a certain level of indifference. This potential indifference is dangerous to the extent that ethically questionable trends and practices in international research continue to go on. That is why the new book by Sonia Shah (The Body Hunters: Testing New Drugs on the World's Poorest Patients) comes at a good time. The book has a Foreword by John Le Carre (of The Constant Gardener fame, among other accomplishments), and Ms. Shah has done some of her own investigations of research cultures in South Africa and India.

This blogger has ordered the book and eagerly awaits its arrival. Since scandal sells, and the theme of 'rich white corporation exploits poor black people' sells even more, will the book be an unbalanced diatribe against the pharmaceutical industry? Or a rich account that carefully explores the inherent ethical tensions when health research takes place in a world of inequality, and offers decent support for its claims and conclusions about the practices of pharmaceutical companies? Playing advocate for the vulnerable is both admirable and risky. In some articles, Ms. Shah's readiness to link international research with the Tuskegee Syphilis experiment seems to betray a taste for sensationalism. Hopefully the book is made of stronger stuff.


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