AZT Trials in Developing Countries (11)
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Source: procaare@usa.healthnet.org
One way of avoiding exploitation is having a 'moderating' body of in-
ternational representation. If the WHO was more active and empowered
they would form a natural forum since it is composed of member na-
tions' Ministries of Health represented.
You can not have similar strength of opinion when comparing two une-
qual entities. As an example, you can not negotiate with equal
strength regarding funding for foodstuffs with a partner who is
starving and hungry. The Maslow's hierarchical pyramid prevails on
the hungry party to dialogue on a differing plane than his partner.
Similarly, trying to avoid exploitation by Western Health Depts.
dealing with Third World Health Depts. which have basic 'survival'
instincts is certainly unethical inasmuch as stating that this pro-
vides equal representation and opportunity to protect the third
world. Recently, this truth was driven hard into my being as I ob-
served a group of starving folk eat contaminated grain (with affla-
toxin and possibly Cyanide metabolites that was condemned as unfit
for humans and destined to destruction) that was spilled accidentally
by a transporting truck en route to the incinerator. When informed
that their lives were at risk, and they must stop taking the grain;
the folk exclaimed "We are dying form hunger anyhow. Either we die of
hunger or take a risk to live. After all death is death whether from
hunger or from toxic grain. In fact a faster death from toxic grain
is freedom and relief from suffering!" I hope I have made a point
hereby:
Let no one fool themselves that dealing with us in Third World is
equivalent to allowing an objective equal representation of our
scene. Not when glaring inequities exist between us!
Humanity is the same as far as Health correlates of ethical consid-
erations are concerned. What is wrong and acceptable in UK, USA or
Canada is equally wrong and acceptable in Africa or Asia. Any attempt
to dichotomize the Western/Third World rationale for acceptable ethi-
cal trials is bad in faith, in bad taste, unacceptable and immoral to
say the least. Is that going too far?
Paul Wangai Jr MD, MPH, PhD
Consultant Physician
Nairobi, Kenya
mailto:100077.2020@compuserve.com
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