Manufacturing mistrust: issues in the controversy regarding foster children in the pediatric HIV/AIDS clinical trials.
The use of foster children as subjects in the pediatric HIV/AIDS clinical trials has been the subject of media controversy, raising a range of ethical and social dimensions. Several unsettled issues and debates in research ethics underlie the controversy and the lack of consensus among professional researchers on these issues was neither adequately appreciated nor presented in media reports. These issues include (1) the tension between protecting subjects from research risk while allowing them access to the possible benefits of research; (2) the blurring of the potentially conflicting roles of investigator and physician and the boundaries between research and therapy; (3) the adequacy of Institutional Review Board oversight; and (4) trust and the relationships among physicians, investigators and industry. The media controversy about the pediatric HIV/AIDS clinical trials can be seen as a means of "manufacturing mistrust" in health care, research and social services that have not always met the needs and expectations of the public. In an era of emerging infections, it is critical to the public's health that people understand the role of rigorous and ethical research in the development of safe and effective care. Investigators, journalists and the public need to become knowledgeable about major ethical issues in the conduct of research in order to engage in dialogue about balancing research risks and benefits and to be able to distinguish fact from distortion in an era of multiple and rapid transmission of information.
Division of Health Promotion and Behavioral Sciences, School of Public Health,UCT 2530, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA. Jacquelyn.Slomka@uth.tmc.edu
Jacquelyn
J
Slomka
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D002648:Child; D002651:Child Advocacy; D002986:Clinical Trials as Topic / Q000941:ethics*; D016265:Conflict of Interest; D004345:Drug Industry / Q000941:ethics; D028744:Ethics Committees, Research / Q000592:standards; D032984:Ethics, Research; D005581:Foster Home Care; D015658:HIV Infections / Q000188:drug therapy; D006679:HIV Seropositivity / Q000188:drug therapy; D006801:Humans; D033181:Information Dissemination; D007258:Informed Consent; D007400:Interprofessional Relations / Q000941:ethics; D008402:Mass Media; D018579:Patient Selection / Q000941:ethics*; D010820:Physicians; D012108:Research Personnel; D035842:Research Subjects; D012306:Risk; D035502:Trust