How informed can consent really be in poor countries?
In an essay in Science in February, O. K. Doumbo stressed that researchers undertaking trials in developing countries should be sensitive to local cultures and customs (see Doing the right thing: research ethics in Africa).
A framework for medical ethics cannot simply be transported unchanged from a developed country to a developing one, said Doumbo, speaking from his experience as a doctor in Mali.
In a letter to this week's issue of the journal, Oby Obyerodhyambo refers to Doumbo's essay, adding that the issue of informed consent is also difficult to negotiate in poor countries.
Obyerodhyambo, who is based at PATH — a non-profit organisation working to improve the health of the poor — in Nairobi, Kenya, describes "the unavoidable reality that local communities may participate in research with the idea that, by becoming subjects, they are in fact buying 'insurance'".
He also questions whether participants who have little access to healthcare, and whose vulnerable social standing might mean they do not have enough autonomy to challenge the decisions of researchers, could genuinely provide 'informed' consent.