Ethics in international health research: a perspective from the developing world*
Zulfiqar Ahmed Bhutta1
Abstract Health research plays a pivotal role in addressing inequities in health and human development, but to achieve these objectives the research must be based on sound scientific and ethical principles. Although it is acceptedthat ethics play a central role in health research in developing countries, much of the recent debate has focused on controversies surrounding internationally sponsored research and has taken place largely without adequate participation of the developing countries. The relationship between ethical guidelines and regulations, and indigenously sponsored and public health research has not beenadequately explored. For example, while the fundamental principles of ethical health research, such as community participation, informed consent, and shared benefits and burdens, remain sacrosanct other issues, such as standards of care and prior agreements, merit greater public debate within developing countries. In particular, the relationship of existing ethical guidelines to epidemiological andpublic health research merits further exploration. In order to support health research in developing countries that is both relevant and meaningful, the focus must be on developing health research that promotes equity and on developing local capacity in bioethics. Only through such proactive measures can we address the emerging ethical dilemmas and challenges that globalization and the genomicsrevolution will bring in their wake. Keywords Research; Research design; Health services research; Ethics; Bioethics; International cooperation; Developing countries; Informed consent; Consumer participation (source: MeSH, NLM ). Mots cles Recherche; Projet recherche; Recherche en sante publique; Ethique; Bioethique; Cooperation internationale; Pays en ´ ´ ´ ´ developpement; Consentement eclaire;Participation consommateurs (source: MeSH, INSERM ). ´ ´ ´ ´ Palabras clave Investigacion; Proyectos de investigacion; Investigaciones sobre servicios de salud; Etica; Bioetica; Cooperacion ´ ´ ´ ´ internacional; Paı´ses en desarrollo; Consentimiento consciente; Participacion comunitaria (fuente: DeCS, BIREME ). ´
Bulletin of the World Health Organization 2002;80:114-120
Voir page 118 le resume enfrancais. En la pagina 119 figura un resumen en espanol. ´ ´ ¸ ´ ˜
Globally, there are wide disparities in economic development, in burden of disease, and in health outcomes (1) and it is likely that the accelerating trend towards globalization, without the requisite safeguards and protection of human rights, will only worsen these health inequalities. Health is the cornerstone ofdevelopment and ‘‘good health is a cornerstone of economic progress, a multiplier of society’s human resources, and, indeed, the primary objective of development’’ (2). Although the private sector has played an increasingly important role, public health programmes are the key to achieving health goals in most developing countries and decisions about these and other interventions must be based onscientific evidence. Research funding in developing countries has also been the subject of much attention recently. The Global Forum for Health Research has pointed out that less than 10% of the world’s research resources are earmarked for 90% of the health problems (3). Important steps in redressing this imbalance are to promote equity in health research globally and to strengthen the capacitywithin developing countries to undertake research that is relevant to them (4). The planning and execution of such research must be guided by the fundamental principles of human dignity and ethics.
Recently, there has been considerable debate about the ethical conduct and reviewing of health research, but this debate has largely taken place among ethicists and researchers in industrialized...