Day 40: Ethical Riddles in HIV research

Ever see the film, ‘The Constant Gardener’? In it, Rachel Weisz plays a British doctor who discovers the fatal side effects of a drug being tested in Kenya and uncovers an unethical alliance between pharmaceutical companies and the Kenyan and British governments.

‘The Constant Gardener is based on a fictional novel by John le Carre, but to use a cliché, the truth can be stranger than fiction. Development and sale of pharmaceuticals is big business throughout the world. Clinical trials include thousands of participants. Western ethical committees have notoriously strict criteria for approval of a study. Such criteria include the obtaining of informed consent and appropriate patient follow-up after the trial. According to Boghuma Kabisen, study participants in Africa aren’t so lucky.

Kabisen was in Cameroon when she met Celine, a woman who’d participated in a study of new anti-retroviral drugs at a clinic tens of kilometres from her home. Celine couldn’t tell her the purpose of the study and after its completion she was unable to continue with treatment as her costs were no longer being met. While she was able to get Celine enrolled in a treatment centre closer to her home, thousands of others aren’t so lucky.

So what are the attractions of running a clinical trial in a developing country? The lack of stringent ethical guidelines is certainly a factor, along with decreased accountability. Obviously a trial of anti- retroviral drugs will obtain more participants in a country where prevalence of HIV can be around the 10% mark. Added to the desperation of people to find a treatment, it becomes an appealing prospect for unscrupulous pharmaceutical companies to run cost effective trials how they see fit.

A change in this system must come and it’s something everybody can be a part of. Researchers should be held to a stronger ethical conscience; those from developing countries should hold governments to account. Nobody should have to enter into a trial where they don’t fully know what’s involved purely to receive a life saving medication.



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