The social, political and economic conditions for medical
testing in the third world are radically different from those in the United
States. This coffee talk focused
on testing AZT, a drug used for AIDS therapy, in Africa.
Pharmaceuticals giant Merck & Co. tested AZT on AIDS patients in both
the United States and sub-Saharan Africa.
There were three groups of patients who underwent the therapy:
Long therapy: More expensive,
but potentially more effective. This therapy required patients to return
to the clinic periofically
Short therapy: Less expensive,
but not as much potential benefit as the long therapy
Placebo: Placebo patients still
received regular clinical check-ups, but were only given a placebo.
Without these placebo patients, the entire study would not have been
Before AZT was tested in Africa, the long therapy was tested on patients in
the United States. Written informed
consent was gained from all participants in the study. In Africa, however, it was much more difficult to clearly gain
informed consent. Many subjects
of the study in Africa could not read, and/or did not understand what would
be happening to them.
These studies offered potential health benefits to people who would otherwise
receive none, and were approved and condoned by the governments of the African
countries in which they occurred.
Assuming medical advances in the United States result from foreign studies
like this, will we even share these advances with the countries in which we
experimented? Are people of the
third world serving as guinea pigs for American interests?
From some philosophical perspective, any potential benefits of this study
are irrelevant. People were used
as a means to an end. This violates
Kant’s categorical imperative.
On the other hand, a utilitarian perspective would justify such studies, provided
they ultimately brought the greatest good for the greatest number of people.
In the end, there is evidence that this study helped more people than
if nothing had been done. Thus, this issue in bioethics could be
reduced to the philosophical debate of Kant vs. Mill.
Should we even attempt to test a medical treatment without gaining informed
No! Universal human rights must be upheld,
and engaging in any “therapy” without informed consent would violate
the principle of universal human rights.
Yes! As long as people know they’re going
to be helped (in the short run or the long run?), it’s okay to study
a therapy without full informed consent
The governments of these African countries approved the studies. In a way, the governments offered surrogate
consent. On the other hand, should
a government, whose actual representation of the people is often questionable,
be allowed to speak for individual consent?
When the government is corrupt, which is not uncommon, there is a fee (really
a bribe) that companies pay to perform research. Engaging in this research is problematic for two reasons:
It propagates the system of government corruption
It can be guaranteed that the government is not providing any sort of ethically
acceptable surrogate consent.
Americans were tested with the more expensive, long therapy. Africans were tested with the short therapy. Thus, it can be
argued that American test subjects received superior treatment to the African
test subjects. Does this mean
that the Pharmaceutical companies treated Africans inequitably?
Africa is radically different from the United States. In different parts of Africa, there are different health standards
(less water, more anemia, etc). A
group of Africans and a group of Americans might respond differently to the
same treatment. Since we are
dealing with two separate situations, this is not a double standard.
For example, because of the social situation in Africa, it might be more difficult
for test subject to make regular visits to the clinic over a long period of
time. Consequently, the short
therapy might be the most appropriate therapy for societies such as those
tested in Africa.
From an experimental standpoint, there was already sufficient data on the
long therapy after trials in the United States. Additional testing of the long therapy was not nearly as scientifically
useful as testing of the short therapy.
But why wasn’t the short therapy tested in the United States?
On the other hand, this study was also done in Thailand, and data from it
helped other people.
The placebo does no actual harm to test subjects. In fact, these subjects receive free medical check-ups that
they would not otherwise receive. Therefore,
it is valid to argue that all participants in the study are receiving at least
some health benefits
Is there some universal ethical standard for all people?
If so, can we throw out this standard in the name of science?
Should an international law protect the most basic of human rights?
How would we enforce it?
Because societies are different, what might be considered unethical in one
society is acceptable in another. For
example, coercion is frowned upon in the United States. In other countries, however, it is accepted
that people do what doctors tell them to do.
Are we saying that American standards of human rights are superior? How would we enforce American standards
in other countries?
This debate is generally confined to the United States because the United
States is almost entirely responsible for research abroad.
In the near future, much more medical experimentation will occur in foreign
countries. These issues will
continue to arise.