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Date Posted: 12:37:47 05/16/02 Thu
Author: Anonymous
Subject: Ethics Body Says Drug Trials in Poor Countries May Have to Be Second Best

http://www.medscape.com/viewarticle/432617_print

Ethics Body Says Drug Trials in Poor Countries May Have to Be Second Best

Reuters Health Information 2002. � 2002 Reuters Ltd
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Introduction
LONDON (Reuters Health) Apr 24 - A leading British medical ethics body said this week that it is not always appropriate to offer participants in clinical trials conducted in poor countries the same standard of care offered to clinical trial participants in rich countries.

The Nuffield Council on Bioethics said that the issue was particularly controversial. Ideally, participants in developing countries should be offered the best standard of care available in the world.

"But this is not always appropriate or possible," said Professor Sir Kenneth Calman, Britain's former chief medical officer and chairman of a new Nuffield Council working party report on the ethics of research in poor countries.

"For example, sometimes the medical facilities to provide such treatment just don't exist in developing countries. In these situations, we recommend that, as a minimum, participants should be offered the best treatment available from the national public health system," Calman said in a statement.

The working party included specialists in medicine, healthcare, philosophy and public policy. Its report follows growing public concern about the huge gap in healthcare between rich and poor countries. Each year £35-40 billion is spent on healthcare research but, according to the authors, only 10% is directed to 90% of the world's population.

The report says more research in developing countries is crucial but it must be subject to rigorous ethical safeguards. "We want to ensure that there is no exploitation of those who take part," said Calman, now Vice-Chancellor of Durham University.

One worry highlighted by the report is that research into new treatments is being done in countries that may never be able to afford them.

"There are concerns that people in poorer countries will sometimes bear the risks of research, while those in wealthier countries will receive the benefits," said Dr. Fred Binka, a member of the working party and associate professor of epidemiology, at the University of Ghana,

"However this is not a straightforward issue. For example, sometimes the price of treatments can drop dramatically after research, or an agreement may be reached with a pharmaceutical company that the treatment will be provided for free for a certain period"

The report says it is not ethically acceptable for research to begin without first thinking about what will be provided once the research is completed. It also urges developing countries to produce their own national guidance to promote ethically sound research.

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