Sunday, April 15, 2007

For a few dollars more: compensating the poor in international research

Takafira Mduluza has written a piece entitled Beyond ethics: biomed research and the poor on the always interesting Sci Dev website. I am not convinced that his views go 'beyond ethics', but reflecting a bit deeper on the implications of what Dr. Mdulza is saying -- particularly about compensation for participation in research -- is a worthwhile exercise. Let me explain.

Mdulza argues that the lack of fair compensation for research participants is the biggest problem facing clinical trials in the developing world. Compensation could be given to either individuals or communities or both (depending on the nature of the trial), and should take some appropriate form, such as financial donations to local institutes or organisations, or take the form of cash, goods, food or housing benefits for individual participants. Local ethics committees should act as brokers, negotiating fair and appropriate compensations. If a research organization is doing a malaria vaccine study, and the community agrees to participate, a fair compensation could be (for example) the distribution of free bednets to everyone in the community.

Mdulza is probably talking about research in low-income countries conducted by institutions or companies from the more affluent northern parts of the globe. When such institutions or companies come into town, rent upmarket apartments and office spaces, have their researchers drive around SUVs around, equipped with laptops and cellphones, it is hardly surprising that locals regard them as, well, rich. And that they think these expat researcher are in a position to offer generous forms of compensation to research subjects -- which they often are not. Many funding agencies --particularly in the US -- do not permit much latitude when it comes to offering compensation to research participants. Their budgets only permit a bare minimum required for the successful conduct of research: maybe enough to cover busfare, and maybe whatever an hour of their time is worth in dollars, but little more than that. Many researchers working with impoverished communities would like to offer more -- a new school, a water pump system, basic medicines -- because they can see the local needs. (Meeting some of these needs could easily have a greater impact on community health than the research itself.) International researchers working with poor populations often find themselves caught in middle: they are not part of a humanitarian or charity organization, but they cannot easily ignore the plight of their research participants either. They are, after all, supposed to be promoting health.

If research agencies are not permitted by their funders to address obvious and immediate needs of poor communities, but only to focus narrowly to what furthers the conduct of research, perhaps the whole idea of international health research has to be rethought. Starting with the funders, but working up the funding food chain, to where the deeper pockets are: governments of more affluent countries and multinational pharmaceutical corporations. The question is whether they want to embed international health research in a wider political and economic movement to actually improve the health of populations in the world's poorest countries. If the status quo on 'research compensation' is anything to go by, the answer is no.

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