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Patients in HIV/AIDS research often come last
Barcelona IOL Website, 9 July, 2002.
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Medical researchers in HIV/AIDS are often putting the interests of the patient last. That's according to a seminar on ethics at the 14th International AIDS Conference in Barcelona.
Informed consent from patients, particularly to doctors and researchers performing clinical drug trials for major pharmaceutical companies and international research institutes, has become a mechanism to prevent doctors from being sued, not to protect consumers, Professor Anand Grover of the Lawyers Collective of India told the seminar.
South Africa, one of the world's most intensive sites for clinical drug trials, has on a number of occasions been cited locally and internationally for trials where ethical considerations have come under question.
Professor Dirceu Greco of the School of Medicine at the University of Minas Gerais in Brazil said informed consent should be an ongoing process.
Answering a question on whether the high sums doctors earned for clinical trials could persuade some to be less than rigorous in putting patient's rights first, he said: "Money given to doctors for clinical trials is the vulnerability of researchers. If a person comes with US1-million and I know I'm going to be published in the Lancet, it can pose difficulties."
The Rockefeller Foundation's Mary Bassett, who until recently worked in Zimbabwe, noted that "poverty creates vulnerabilities that create conditions for unethical research".
"Half of all Africans earn less than US1 a day, for the poor the possibility of something is better than the certainty of nothing. To the poor, any advantage, even a hypothetical advantage may induce participation (in clinical trials). The guarantees we offer research participants are paper guarantees."
Professor Quairrasha Abdool Karim of the University of KwaZulu-Natal said: "Imbalance of powers in countries and between countries meant that it was important how we do our research and that we try and redress inequities..."
Greco asked whether the use of placebos was justified even when efficacious drugs existed.
"Efficiency in using placebos is usually an economic consideration. This is a way of pretending that volunteer problems are not the researchers problems.
"If nothing is available then a placebo should be provided. In vaccine trials researchers are not obligated to treat any HIV reaction that occurs during the trial."
He made it clear that he believed the dictates of responsibility to science included those observing the rights of volunteers. Greco said that the Helsinki 2000 declaration on ethics had been watered down significantly against the interests of clinical trial participants.
Grover said ethics insisted that every adult had the right to determine what happened to his or her body. "Consent is taken when two or more persons agree upon the same thing in the same sense, but it requires equality of the persons taking and giving.
"Classic doctor patient relationships are unequal in favour of the doctor." |
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