Commentary on Ferreira & Novion

- Frank J. Leavitt, Ph.D.

Chairman, The Centre for International Bioethics

Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

Eubios Journal of Asian and International Bioethics 13 (2003), 208.

There is no doubt that too much medical research done by Western drug companies in developing countries is exploitative and probably a carry-over from social Darwinism. At the International Association of Bioethics World Congress in Brasilia in 2002, one speaker told about a drug company who wanted to do a certain research on children. The research they wanted to do was forbidden in Western companies for ethical reasons. It was discovered that company executives discussed the matter over the email. One wrote to another" "That is alright. We'll solve the problem in developing countries."

I do not know if the motivation is conscious social Darwinist racism or simply opportunism. It is easier to get away with things in countries that have few laws, or a less efficient system of law enforcement. But whatever the motive, it is clear that the exploitation goes on. Indeed there is an exploitative basis behind much of the so-called ethics of medical research in developing countries which gets published these days. Any trial of an expensive drug in an area where the facilities and funds do not exist to make such drugs easily available to the local population, is research performed not for the benefit of the local population but for the benefit of the drug company and its clients in rich countries. The Helsinki Declaration and similar codes of ethical medical research do not take this fact into consideration. Ethical research in medically deprived areas of developing countries would not be research into expensive drugs which the local people are not going to be able to get anyway. It would be research into methods to educate people to achieve and maintain health through practices which people can carry out in the absence of medical care. These things include proper nutrition, sanitation, healthy midwifery, proper disposal of human and animal waste (preferably by composting for organic fertilizer), first aid, etc.

Any drug research in areas which lack basic medical and nursing facilities will necessarily be unethical. I am sceptical, however, about the potential for Western bioethicists and other do-gooders to change this situation. We just don't have the power. Notice for example that the clause in the 2000 version of the Helsinki Declaration that required comparison with previously existing treatments when they exist, instead of placebos, was watered down by a "clarification" which essentially nullified the clause. I think that similar things will happen to other efforts to protect vulnerable research populations. Here is where we can see a certain truth in Social Darwinism and the survival of the fittest. People do not get rights as gifts. They have to fight for them. I do not mean that the fight has to be violent. But the struggle for rights has to be initiated by developing country people themselves. Then it will have a chance of succeeding. We can and should help them, once they initiate the movement. But in my humble opinion, it has to be their movement.

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