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Books, Journals, New Media
December 22/29, 2004

Research Ethics

Author Affiliations

Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; Journal Review Editor: Brenda L. Seago, MLS, MA, Medical College of Virginia, Virginia Commonwealth University.

JAMA. 2004;292(24):3032-3038. doi:10.1001/jama.292.24.3036-b

There are good, bad, and gray-zone reasons for conducting clinical trials in developing countries. What kind of reason is the rationale that a study methodology can be used that would be rejected, for ethical reasons, back home? The answer is not as obvious as it seems. The most notorious example was the study of maternal-to-child HIV transmission, in which a placebo arm was used even though effective AZT treatment was available in industrialized countries where it would have been considered unethical not to compare the trial treatment against the best available “standard of care.” Those in favour argued that no treatment at all was the local standard of care, so the sample population were hardly being deprived of anything. And to complicate matters, some developing countries have called it imperialistic for an industrialized country to impose its own ethical standards on another.

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