Question

There is not a cure for HIV yet, but there is an effective treatment for reducing the likelihood of transmission of HIV from an infected mother to her unborn child (or born child, through breast milk). In the absence of treatment, the likelihood of transmission averages about 25%. In collaboration with Eastern Mediterranean University Faculty of Pharmacy, a Cyprus based, private pharmaceutical company KuntePharma develop a new drug called HIV-OFF. Researchers from the university and KuntePharma, travel to X country in Africa and ask 200 pregnant HIV-positive mothers there to participate in a trial for a new drug that reduces, “from mother to child” HIV transmission. It is said that, the reasons of choosing Africa are: “Compared to Cyprus it would cost much less and the fact that laws and regulations allow more flexibility to conduct the research in the X country”. The give 100 women a placebo, and they give 100 women HIV-LESS. Of the 100 HIV-LESS children, only 1 contract HIV. Of the 100 placebo children, 44 do. In this study, 45 children contract HIV, when it is likely that, if all the participants were given HIV-LESS, less would have. Are the scientists morally responsible for the transmission of HIV to more children in this trial? Remembering the concepts Consent, Placebo, Risk-benefit-harm, The Rights of the Patients, exploitation; respect for persons and utilitarian approaches and others that you might think relevant to this case, which were discussed during the course, discuss if this trial is ethical? You might compare the dynamics of this case with historic examples that caused drastic changes in understanding of experimentations on human beings and formed the present day ethical principles and laws.

Answer 1

Placebo is anything that seems to be a real treatment. According to the question, placebo is given to 44/100 women whose children develops HIV. The scientists cannot be morally responsible for transmission of HIV to children because they use placebo to get an insight and understand what effect a new drug can have. Before conducting the study, the researchers definitely explain the possible outcomes of the study, risk and benefits to the participants. Some placebo treatment result in positive outcome, where the patient shows improved symptoms. For example : Placebo research began with study of pain in 1978, at University of California, where researcher gave placebo painkillers to patients after dental surgery and some felt free from pain. To other set of patients he prescribed a drug that prevents sensing of natural painkillers called opioids(endogenous). The pain increased suggesting that placebo effect had impact on chemical pathway responsible for opioid release. Drug blocking that route, eliminated the placebo effect.