THE BODY HUNTERS; Perils of Placebos
Life by Luck of the Draw In Third World Drug Tests, Some Subjects Go Untreated
Friday, December 22, 2000
LAMPANG, Thailand -- In this small city in northern Thailand, a group of pregnant women signed up for an experiment overseen by a U.S. Army doctor who sought to monitor the transfer of HIV infection to newborns.
His passive, observational study offered the women no medicine to prevent HIV transmission in order to give researchers "a more efficient and effective means" of studying them, he wrote in a memorandum. Twenty-two infants were born HIV positive to the unprotected mothers.
At a spartan drug clinic in the heart of Bangkok, heroin addicts lined up on a recent morning to receive an experimental HIV vaccine produced by an American company. Drawn by small payments and offers of free rice, they signed on for a test in which they had a greater chance of receiving a placebo--or dummy shot--than would Americans taking part in the same research in the United States.
In Bangkok's two largest maternity wards, pregnant women infected with HIV, the virus that causes AIDS, enrolled in an American test aimed at reducing AIDS transmission from mothers to children. But half the Thai women were given placebos instead of a proven drug, and 37 babies who might have been spared were born HIV-positive.
Set against a staggering AIDS epidemic, the Thai cases highlight the unequal bargains underlying the recent boom in overseas drug testing by both private and public medical researchers: rich countries have the drugs and hypotheses, while poor countries have vast numbers of patients. Yet the trade-offs made in experiments do not always distribute burdens and benefits evenly.
Medical progress has always depended on some individuals bearing personal risk for society's benefit. Placebos give researchers a clearer view of which experimental therapies work and which do not, many scientists contend. Passive studies that track how a disease moves unimpeded through a population can provide insights into treatment and prevention.