Ethics and international research

Research standards are the same throughout the world; medical care is not

A recent commentary in the New England Journal of Medicine by Lurie and Wolfe criticised placebo controlled trials designed to identify simple and effective interventions to prevent maternal-infant HIV transmission in developing countries.1 Their commentary reflects a lack of understanding of the realities of health care in developing countries and ethical principles of research. The commentary and an accompanying editorial by Angell2 take a position that would prevent developed countries from collaborating with developing countries to identify practical and affordable health interventions.

Lurie and Wolfe propose that studies supported by the United States government should provide all participants with the same level of care that is available to Americans. This is a misinterpretation of the Council for International Organisation of Medical Sciences guidelines, which call for universal principles of ethical research, not universal standards of medical care.3 Under the guidelines, interventions must be appropriate for the country where the research is conducted and no research subjects may be denied care that would otherwise be available for them. The studies …