Outsourcing to Third World on trial

The state of healthcare in developing countries is in a bad way and Canada is doing what it can to help. But are we also profiting from their dismal situation? First World nations not only poach healthcare professionals from these countries (see "WHO report sheds light on why doctors and nurses leave poor countries"), but we also fob our risky trials off on them under the guise of offering treatment options to the less fortunate � and less informed. Sure, some treatment groups benefit, but what about those who wind up in worse shape than when they started? We can no longer ignore the tales of clinical trials being stopped halfway and drug studies done in Third World nations because they couldn't get ethics committee approval in the developed world. Even children aren't spared from this questionable practice (see "Air or pure O2 � the difference is life or death for hypoxic neonates").

Pediatric trials especially are on the rise. For obvious reasons it's difficult to get ethics committee approval for trials on kids, so most drugs used to treat them have never been officially tested on them. The FDA is facing just such a dilemma in a proposed trial for the ADHD drug dextroamphetamine � the study calls for healthy nine-year-olds without ADHD to be given the drug. To get around this problem will studies like this one get outsourced?

On the other hand, improper dosing due to inadequate testing can also put kids at risk. Clinical trials not only help us discover how effective a treatment is, they can also challenge certain accepted but unproven practices. This is an important function as a drug that's anticipated to help the patient in theory can actually cause harm in practice (turn to "Corticosteroids expected to heal but actually hurt head injury"). But is it OK to sacrifice the few to benefit the many? If not, then the 'out-of-sight, out-of-mind' approach of outsourcing them to developing countries isn't a valid solution. If we aren't comfortable performing these trials at home, then we shouldn't submit citizens of other countries to them � we're just sweeping the problem under the rug.

� Shereen Joseph, Editor

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