Whether clinical drug trials should be conducted in the developing world is a thorny and intractable issue, says Slate columnist Amanda Schaffer in MIT's Technology Review. But solutions won't be found by demonising the pharmaceutical industry. Schaffer contrasts two recent reports, one in the March issue of the magazine Harper's, which suggests that drug companies are conspiring to promote toxic drugs, based on investigations into a badly-run trial for an anti-HIV drug. Overheated polemics, says Schaffer.

However, the other article, by Jennifer Kahn, in Wired (see BioEdge 194), says that India is in danger of becoming a nation of guinea pigs, because the financial incentives to participate in drug trials are too great for impoverished rural people to resist and because they tend to accept a doctor's advice without question, weakening the idea of informed consent. These are more substantial complaints, agrees Schaffer. In fact, a recent study in the journal IRB: Ethics and Human Research suggests that local ethics committees in African settings are handicapped by lack of expertise, training and resources.

Taken together, Schaffer concludes, the two articles are an uncomfortable reminder that "economic disparity between investigators and subjects in human research creates possibilities for abuse and coercion -- possibilities that we do not really know how to manage".