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.
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