Volume 4, 1998
Bioethics and Medical Ethics
Dennis R. Cooley
Second Best: A Case for Lowering Testing Standards in Third World Countries
Recently, Sidney Wolfe, director of Public Citizen’s Health Research Group (PCHRG), charged the National Institute of Health (NIH) and Center for Disease Control (CDC) with sponsoring fifteen immoral HIV studies in sub-Saharan Africa. The trials are being conducted to determine if certain alternate medical procedures or a short course of treatment with AZT, zidovudine or other drugs prevent some mother-child HIV transmissions. Since the control group receives only placebos rather than AZT, Wolfe claims that the tests give suboptimal treatment that will result in more children contracting HIV and AIDS. Public Citizen’s Health Research Group and others are calling for an immediate cessation of these important experiments. Public Citizen raises an important moral question. Is it morally permissible to lower testing standards for the Third World? Unlike PCHRG, I contend that the answer to this question is yes, if the trials meet certain conditions. I explain both the First Best and Second Best Method (FBM and SBM, respectively) of testing new drugs and then compare the two. Next, I show the FBM’s impracticality in developing countries releases researchers from the moral obligation to use it. I then propose a new set of criteria — the Second Best Criteria (SBC) — that show if a test is moral or not. Finally, I argue that imposing a developed country’s moral standards for clinical trials in the Third World is immorally insensitive to the needs and conditions present in the latter area.