Technology Review has an article by Amanda Schaffer which critiques the contents of two other articles. One is “Out of Control” by Celia Farber appearing in Harpers, March 2006, and the other is “A Nation of Guinea Pigs”, by Jennifer Kahn in Wired, March 2006. What they have in common is their subject, which is drug testing in developing or Third World countries, and the practical and ethical difficulties surrounding this enterprise. Schaffer is very tough on Farber, who is, according to this account, an HIV skeptic. That is to say, she does not accept the idea that the AIDS is caused by a viral agent, blaming instead a number of other possibilities, and implicating in the obviously poor health of AIDS victims the very medicines which are supposed to be treating them. Farber is especially critical of HIVNET o12, a drug trial conducted in Uganda, which, she says, yielded results that were spun by industry to exaggerate the benefits and play down the severity and frequency of side effects. The NIH admitted that HIVNET o12 had some flaws and asked the Institute of Medicine for a re-analysis of the data. The IOM agreed that the conclusions were generally valid. Jennifer Kahn’s piece is disturbing, in that it raises some thorny ethical issues about the whole idea of drug testing in poor countries. She writes about India, increasingly popular as a site for drug tests. Can anything like informed consent really be obtained from subjects in such trials? Do the inducements offered to potential subjects, given their circumstances, really amount to coercion? Do the agents tested have any relevance to the actual health needs of the recruits, or are the subjects just canaries in the mine shaft, whose participation is needed to discover toxicities before the agents are really used in an affluent, Western population? Are such studies morally compromised from the very start? No easy questions.
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Drug Tests