Global health research ethics in Vanity Fair

Vanity Fair, normally associated with glossy celebrity photo shoots next to swimming pools, is running something this month on ethics and the globalization of clinical trials. It really is. The basic thrust of the dramatically entitled article ('Deadly Medicine') is that pharmaceutical companies are guilty of a whole range of shady practices, from suppression of negative testing results to knowingly promoting products with serious side-effects or unknown efficacy, and there is little effective regulation to prevent or punish their irregularities and abuses. Furthermore, when pharmaceutical research takes place abroad in low- and middle- income countries, as it increasely does to cut costs, what goes on becomes even more obscure; when particular wrongdoings emerge from the global shadows, you can only guess how much exploitation, manipulation and harm is taking place on a regular basis.

What struck me reading the Vanity Fair article was a strong sense of deja vu. How essentially different is its content from those seminal Washington Post articles, the 'Body Hunters' series, written back a decade ago? Those were the exposes that blew the lid on the practices of global pharma and kick-started all manners of initiatives to raise consciousness about the ethics of global health research. So what happened in the meantime? A lot of activity in the public sector: the NIH consolidated its clinical ethics center, other bioethics centers popped up at universities around the country, new ethics journals were established, research ethics committees were established in developing countries, grants for research ethics projects were established, and so on. And yet, what did all this do in regard to the practices of for-profit multinational pharmaceutical companies as they scour the world for sites and populations favorable to their own economic interests? Did all this have any sort of impact?

From the looks of the Vanity Fair article, not much. The same sorts of 'irregularities' go on; what has changed through globalization is the quantity of institutions, investigators and researchers involved. Paradoxically, the bigger global health research becomes, the less visible its operations and effects seem to get.