The globalization of research ethics committees: paternalism, ethical imperialism or partnership

Research, the story goes, has become increasing global: there is more clinical and behavioral research involving human participants in more places in the world now than ever before in human history. These things don't just happen, so it is interesting to reflect on the meaning of the march of research to all points of the compass. Is it because there is an overwhelming humanitarian concern about those who are sick in the most impoverished areas of the world? Or is it because far-flung (at least, from North America and Europe) countries are a friendly business environment as health-related research becomes more and more about developing profitable interventions and devices?

As research projects and institutions are rapidly springing up around the world like mushrooms, the development of ethics committees to review such research globally is moving at a much more leisurely pace. In many places in Africa, for instance, there is no local body with the authority or expertise to conduct an adequate ethical review of a scientific protocol. In this month's issue of Tropical Medicine and International Health (subscribers only, alas) Ravinetto et. al. argue that there always ought to be a double ethics review of research conducted/sponsored by foreign institutions in developing countries. The requirement for 'local' review -- in addition to review in the sponsor's institution -- appears in some ethics guidelines, and it does happen a good percentage of the time. But why ought it to happen? According to Ravinetto et. al., it ought to happen in order to produce a more comprehensive and balanced review process, which in turn better fulfills the central mission of ethics committees, i.e. to protect research participants and benefit communities affected by the research. A collaborative double review can avoid ethical imperialism (imposition of ethical standards of the richer countries on the poorer ones) and paternalism (in the assumption that only ethics committees in richer countries can really review research adequately). The current problem with double review (according to Ravinetto et. al.) is not just the unpleasant fact that some ethics committees in developing countries may be operating at a low standard. The problem is that ethics committees involved in the review of research often do not correspond with one another at all, and the possible benefits of collaboration are missed.

The points are well taken, but the paper seems to underrepresent some of the ethical challenges of ethical review in a context of global inequality. It should be remembered, for example, that sponsoring countries hold the purse-strings, including the portion of the budget that is supposed to go to the local institutions for administrative support (including financial support for the local ethics committee). When there are conflicts between foreign and local ethics committees, which one is more likely to have the greatest say? The ethical playing field, parallel to the political and socio-economic playing fields, is very uneven. What might help, besides greater collaboration between ethics committees, is greater investment in local scientific institutions in order to prevent the vast majority of research being funded and conducted by developed world institutions.