North-South research in developing countries must respond to community's prioritiesBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7223.1496a (Published 04 December 1999) Cite this as: BMJ 1999;319:1496
EDITOR—Edejer observes that North-South research collaboration is plagued by differing interpretations of ethical standards of doing research in developing countries, an example being the controversy over the Bangkok trial of short course zidovudine for perinatal transmission of HIV-1.1
One aspect of this controversy concerned the standard of care offered to patients participating in the study: should it be the best current treatment in the country of the sponsoring institution or the best local treatment? Médecins sans Frontières provides primary health care to patients with AIDS in Thailand and has reported that for one patient participating in the Bangkok trial no treatment of her symptomatic HIV infection was offered by the study hospital.2 It seems that neither side in the ethical debate was in touch with the real situation.
Two key documents to be considered are the Declaration of Helsinki and a set of guidelines developed by the Council for International Organisations of Medical Sciences in collaboration with the World Health Organisation. The Declaration of Helsinki was written by physicians and has been debated by the World Medical Association.3 The group that developed the guidelines of the Council for International Organisations of Medical Sciences was made up of representatives of ministries of health, members of medical and other health related disciplines, health policymakers, ethicists, philosophers, and lawyers.4 These guidelines are also under review. Consumer representatives are not members of either the council or the World Medical Association.
Guideline number 8 of the Council for International Organisations of Medical Sciences prohibits research that involves subjects in underdeveloped communities unless it is responsive to the health needs and priorities of the community in which it is to be carried out. The Helsinki Declaration is silent on this issue.
If research is to be responsive to the priorities of the community in which it is to be carried out then sponsoring institutions should ask community members what their priorities are. Edejer touches on this issue when she says “think local” when addressing inequalities in research funding, but the need for advocacy for those subjects taking part in research in developing countries is not mentioned. Advocacy groups in Thailand are developing a watchdog role in monitoring ethical practices in research,5 but there is a lack of institutional mechanisms for them to give feedback.