Monday, December 28, 2009

Forced trials of drug users in Cambodia?

This is one of these stories in ethical flux. Human Rights Watch (HRW) has claimed that earlier this month the Cambodian police rounded up at least 17 drug users and brought them to a government-run drug detention center on the outskirts of Phnom Penh, where they were forced to participate in a drug study. The drug being tested is 'Bong Sen', a herbal substance that is alleged (by the company that makes it) to detoxify heroin/opiate users in 4-5 days. HRW lays out the ethical problems with the experiment: coercive recruitment and lack of informed consent; lack of review of the study by the ethical committee of the Ministry of Health; unknown (and possibly shoddy) study methodology, including apparent lack of follow-up of research participants.

The British Medical Journal put out a small piece on this story last week, providing some interesting details. Bong Sen is produced by a private Vietmanese company, with a very strange looking (and long) name: Ben Tre Fataco General Import-Export Trading Service Company (kor Ben Tre Fataco, for short). According to NGOs in Cambodia, Ben Tre Fataco has formed a group with four Vietmanese doctors, a company in Cambodia marketing Bong Sen, staff from Cambodia's National Authority for Combatting Drugs (NACD) and its Secretariat-General, the Ministry of Health and the Orkas Knhom drug treatment center, which is run by the Phnom Pehn municipality's Department of Social Affairs.

Just to show how deep the government is involved in the Bong Sen trial, the Cambodian prime minister is said to have given the Vietnamese doctors written permission to administer Bong Sen to drug users. When the Orkas Knhom drug treatment center could not come up with sufficient 'volunteers', staff from the NACD are said to have demanded that clients at local NGOs take the medicine. The NGOs hesitated, given that the herbal medicine being pushed did not seem to go through routine drug trial procedures. Staff from the NACD then threatened the NGOs with closures and withholding their licences for needle-exchange programs. That is apparently what went on before the police arrested drug users and had them enter the Bong Sen study. For its part, the NACD has denied everything: the drug users were volunteers; the herbal treatment is not really a drug, and does not have to go through drug approval procedures; there is no real trial at all. Just giving out medicine.

One thing is certain: the relationship between the Cambodian government and Cambodian citizens who happen to be drug users is not very warm and friendly. Earlier this year, the Soros Institute put out a report entitled At What Cost? HIV and Human Rights Consequences of the Global 'War on Drugs'. One chapter of the Soros report is dedicated to the arbitrary detention and police abuse of drug users in Cambodia. But this is nothing new. There have been reports about government abuse of Cambodian drug users (many of whom are HIV-positive) for at least a decade. If the allegations are true, the question is why the Cambodian government would be so interested in corralling drug users for this particular trial. Is it just because Bong Sen is a non-opiate treatment? What interests does the government have in the success of Bong Sen treatment that they are deeply involved promoting as effective despite there being no evidence of its efficacy? As the BMJ piece notes, no one is talking: Ben Tre Facaco is not answering its phone or email, and the Cambodian Ministry of Health has nothing to say.

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