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July 14, 2004

The Long Journey to Health Equity

Author Affiliations

Author Affiliations: Department of Medicine, Mount Auburn Hospital, Brigham and Women's Hospital and Harvard Medical School (Dr Brewer), and Department of Society, Human Development, and Health, Harvard School of Public Health (Dr Heymann), Boston, Mass.

JAMA. 2004;292(2):269-271. doi:10.1001/jama.292.2.269

A passionate public debate regarding the best way to conduct clinical trials ethically in low-income countries developed after studies to prevent mother-to-child transmission of human immunodeficiency virus (HIV) were initiated in Africa and Asia. Some of these studies had placebo-only treatment groups and generated concern after publication of the first US trial showing an effective way to prevent mother-to-child transmission.1 Even though this debate focused on research ethics, the underlying problem was and remains differences in available levels of resources.2 The debate over medical research ethics in the context of vastly unequal health care resources served in important ways to focus public attention on research that uses placebos or unproven treatments when effective interventions exist.3 However, a focus on the best way to conduct research in the midst of gross disparities in health care misses the more fundamental ethical imperative: how to achieve a more equitable distribution of health care and ensure that effective health care is brought to resource-poor countries as rapidly as possible.