Outsourcing of clinical trials raises ethical concerns

This is a big feature story, so here is my longish lede:

Deciding whether to participate in a clinical trial is not easy, no matter where the study takes place. Patients are faced with a mountain of information about the potential risks and uncertain benefits of becoming research subjects.

Add to that heady brew the stark disparity among patients in rich countries and those in developing nations, and concerns mount quickly about the growing number of global clinical trials tapping the poor as research subjects.

Compare, for example, the United States and India.

The average American income is $47,000 a year — 16 times what the average Indian takes home, according to the CIA World Factbook. There is one doctor for every 384 Americans, while there are 1,667 patients for each Indian doctor, the World Health Organization says. The average American patient consumes nearly $7,000 in medical care each year; the average Indian’s annual health care tally is $39. Nearly every American adult can read, but 39% of Indians are illiterate.

What does it mean for research subjects around the world to give informed consent when the playing field is so uneven?

The whole shebang.