AIDS expert challenges ethical stance on drug trials

BMJ 2001; 323 doi: (Published 08 September 2001) Cite this as: BMJ 2001;323:531
  1. Bryan Christie
  1. Edinburgh

    Measures to protect people in developing countries from being exploited in medical research trials may prevent some projects going ahead that could improve the health of poor people, a leading scientist has warned.

    Professor James Whitworth of the Medical Research Council's programme on AIDS in Uganda said it may not always be practical to test new treatments against the best treatment currently available anywhere in the world.

    New ethical standards laid down in the revised Declaration of Helsinki last year stated that testing of drugs in developing countries should be done against the best current treatment and not against placebo. This was designed to ensure that local populations would benefit from trials by gaining access to the best current treatments.

    But Professor Whitworth, speaking at the British Association's Festival of Science this week in Glasgow, said this might prevent some ethical and necessary research from going ahead.

    “The central problem is trying to be as fair as possible in what is an unfair and unequal world,” added Professor Whitworth. “Of course the same treatment should be available in Nairobi as New York, but it isn't and it isn't going to be. The medical problems of the developing world are immense and urgent. We can't wait for politicians to create global equity.

    “It seems a strange sort of logic to stop doing trials in Africa that are trying to help improve the health of poor people so that people in rich countries can have peace of mind.”

    He also questioned the insistence that informed consent should be given in writing, when such a process may have little validity in some cultures.

    “Getting a signature on a piece of paper is nice and can be easily checked but is actually no guarantee of informed consent. Properly witnessed verbal consent can be much more valid and relevant,” he said.

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