North-South research partnerships: the ethics of carrying out research in developing countries

The new phase of North-South research collaboration was caught in a snapshot published recently in a popular weekly newsmagazine.1 The picture is that of a participant in an AIDS study in Guatemala City. He looks jaunty, even confident. In 1997, he participated in a “life-and-death lottery,” as the article is entitled, and beat the odds to be entered into a Merck drug trial of different doses of a triple cocktail containing their new drug, Crixivan. He was one of only 59 patients who were lucky enough to be entered into a trial, among the many who join the “scramble for cutting edge medications in a country where there aren't nearly enough of them to go around.” The clinic caring for him “takes up the slack—for example, by enlisting its patients in drug studies.”

“I felt myself stabilizing [he said]. I had the energy to go back to work.” However, his future, as well as the futures of the rest of the participants who participated in and benefited from the study, is uncertain. “The year long study ended last September, and the leftover medicine will run out in the fall. Participants say they were led to believe that the company would supply them the drugs for the rest of their lives. Merck and the clinic doctors say the only promise was that the company would try to offer more drugs after the study, and the company did agree to provide Crixivan for five years But the patients have to come up with the other two components of the cocktail on their own. That won't be easy. Participants worry that if they go off the drugs the virus will emerge stronger and more resistant to the drugs.”