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Hughes JH, Woo KH, Keizer RJ, Goswami S. Clinical Decision Support for Precision Dosing: Opportunities for Enhanced Equity and Inclusion in Health Care. Clin Pharmacol Ther 2023; 113:565-574. [PMID: 36408716 DOI: 10.1002/cpt.2799] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022]
Abstract
Precision dosing aims to tailor doses to individual patients with the goal of improving treatment efficacy and avoiding toxicity. Clinical decision support software (CDSS) plays a crucial role in mediating this process, translating knowledge derived from clinical trials and real-world data (RWD) into actionable insights for clinicians to use at the point of care. However, not all patient populations are proportionally represented in clinical trials and other data sources that inform CDSS tools, limiting the applicability of these tools for underrepresented populations. Here, we review some of the limitations of existing CDSS tools and discuss methods for overcoming these gaps. We discuss considerations for study design and modeling to create more inclusive CDSS, particularly with an eye toward better incorporation of biological indicators in place of race, ethnicity, or sex. We also review inclusive practices for collection of these demographic data, during both study design and in software user interface design. Because of the role CDSS plays in both recording routine clinical care data and disseminating knowledge derived from data, CDSS presents a promising opportunity to continuously improve precision dosing algorithms using RWD to better reflect the diversity of patient populations.
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Affiliation(s)
| | - Kara H Woo
- InsightRX, San Francisco, California, USA
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Strüver V, Ali S, Fneish F, Fortwengel G. Patient Benefit of Clinical Research in Diversely Advanced African Developing Countries. Curr Ther Res Clin Exp 2022; 96:100656. [PMID: 34976234 PMCID: PMC8688875 DOI: 10.1016/j.curtheres.2021.100656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background The globalization of clinical research should also benefit the population in developing markets. In this context, the approval of tested medicines and the associated expansion of medical care beyond clinical studies would be desirable as a possible long-term benefit. Objectives This study was designed to compare the development of the number of clinical trials with the number of marketing authorizations of medicines on the African continent. To contrast these 2 parameters, the data were analyzed using the model of an ecological study. Methods To reflect the broad spectrum of African developing countries with diverse levels of development, the data collection was based on 2 geographically selected sample countries each from Central, North, East, West, and Southern Africa. Based on the ClinicalTrials.gov registry, the first step was to collect trends data on the development of the clinical trials in the 10 selected countries of the country list of the African Region published by the World Health Organization for the period 2015 to 2018. Subsequently, data on the current number of marketing authorizations of medicines in the selected sample countries were identified using the online registries of the national authorities. The data were utilized in comparative analyses. Results Eight out of 10 model countries showed an increase in the number of clinical trials, with the exceptions of Cameroon and Libya, which showed an overall decline in research activity over the entire time. In direct comparison with drug registrations, the numbers indicate a similar development. The only exception here is Nigeria, a country with a solid performance in clinical research and yet a decrease in medicine registrations since 2015. Conclusions The expected increase in the development of clinical research as result of the globalization trend can basically be observed in most of the model countries. However, this increase does not guarantee an improvement in the number of medicine registrations. Although this is evident in some of the selected model countries, it cannot be projected to the entire African region. This may be linked to the diverse development of the individual countries due to the different political situations and the varying degrees of clinical research infrastructure. (Curr Ther Res Clin Exp. 2022; 82:XXX–XXX)
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Affiliation(s)
- Vanessa Strüver
- Department of Media, Information, and Design, Hochschule Hannover, University of Applied Sciences and Arts, Hannover, Germany
| | - Sheraz Ali
- School of Pharmacy and Pharmacology, College of Health and Medicine University of Tasmania, Sandy Bay, Tasmania, Australia
| | - Firas Fneish
- Biostatistics Department, Institute for Cell Biology and Biophysics, Leibniz University Hannover, Hannover, Germany
| | - Gerhard Fortwengel
- Department of Media, Information, and Design, Hochschule Hannover, University of Applied Sciences and Arts, Hannover, Germany
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Perehudoff K, Durán C, Demchenko I, Mazzanti V, Parwani P, Suleman F, de Ruijter A. Impact of the European Union on access to medicines in low- and middle-income countries: A scoping review. THE LANCET REGIONAL HEALTH. EUROPE 2021; 9:100219. [PMID: 34693391 PMCID: PMC8513155 DOI: 10.1016/j.lanepe.2021.100219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This Scoping Review synthesises evidence of the impacts of European Union (EU) law, regulation, and policy on access to medicines in in non-EU low- and middle-income countries (LMICs), and the mechanisms and nature of those impacts. We searched eight scholarly databases and grey literature published between 1995-2021 in four languages. The EU exerts global influence on pharmaceuticals in LMICs in three ways: explicit agreements between EU-LMICs (ex. accession, trade, and economic agreements); LMICs' reliance on EU internal regulation, standards, or methods (ex. market authorisation); 'soft' forms of EU influence (ex. research funding, capacity building). This study illustrates that EU policy makers adopt measures with the potential to influence medicines in LMICs despite limited evidence of their positive and/or negative impact(s). The EU's fragmented internal and external actions in fields related to pharmaceuticals reveal the need for principles for global equitable access to medicines to guide EU policy.
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Affiliation(s)
- Katrina Perehudoff
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector, University of Toronto, Canada
- Medicines Law & Policy, Amsterdam, the Netherlands
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Carlos Durán
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, Netherlands
| | - Ivan Demchenko
- Department of Forensic Medicine and Medical Law, Bogomolets National Medical University, st. Mechnikova, 5, Kyiv, 01133, Ukraine
| | - Valentina Mazzanti
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Pramiti Parwani
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Campus Westville, Durban, 4041, South Africa
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, University of KwaZulu-Natal, Campus Westville, Durban, 4041, South Africa
| | - Anniek de Ruijter
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
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Narsai K, Leufkens HGM, Mantel-Teeuwisse AK. Linking market authorizations of medicines with disease burden in South Africa. J Pharm Policy Pract 2021; 14:33. [PMID: 33795015 PMCID: PMC8017838 DOI: 10.1186/s40545-021-00314-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa is going through an epidemiological transition, including an impressive increase in non-communicable diseases. The introduction of medicines has not kept pace with the needs in developing countries. The objectives of this study were to (i) examine the correlation between the number of medicine approvals and disease burden and (ii) compare approval timelines of medicines with disease burden in South Africa in the period 2012-2017. METHODS The dataset was compiled from publicly available data on medicines registered in South Africa between 2012 and 2017. A correlation analysis was conducted to determine the level of alignment between the number and nature of medicines registered, as determined by the WHO ATC Classification and the Lancet Global Burden of Disease data. Median registration timelines were determined to assess whether medicines for diseases of higher burden were registered faster. RESULTS A total of 3059 registered medicines were included in the study, including 2779 generic medicines, 267 new chemical entities and 13 vaccines. There was a high level of alignment between the number of medicines registered to treat diseases with higher disease burden levels more effectively, except for lower respiratory tract infections and HIV/AIDS which showed less medicines registered as compared to expectations based on disease burden, respectively. HIV/AIDS showed a lower level of correlation with a much higher disease burden compared to number of medicines registered, but simultaneously also a much shorter median registration timeline (32 months) compared to the other disease areas. CONCLUSIONS There was generally a high level of alignment between disease burden and number of medicines authorised, except for HIV/AIDS and lower respiratory tract infections. Regulatory authorities should continue to consider burden of disease data to ensure that public health needs are met.
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Affiliation(s)
- K Narsai
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - H G M Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - A K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.
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Bentley C, Cressman S, van der Hoek K, Arts K, Dancey J, Peacock S. Conducting clinical trials-costs, impacts, and the value of clinical trials networks: A scoping review. Clin Trials 2019; 16:183-193. [PMID: 30628466 DOI: 10.1177/1740774518820060] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A significant barrier to conducting clinical trials is their high cost, which is driven primarily by the time and resources required to activate trials and reach accrual targets. The high cost of running trials has a substantial impact on their long-term feasibility and the type of clinical research undertaken. METHODS A scoping review of the empirical literature on the costs associated with conducting clinical trials was undertaken for the years 2001-2015. Five reference databases were consulted to elicit how trials costs are presented in the literature. A review instrument was developed to extract the content of in-scope papers. Findings were characterized by date and place of publication, clinical disease area, and network/cooperative group designation, when specified. Costs were captured and grouped by patient accrual and management, infrastructure, and the opportunity costs associated with industry funding for trials research. Cost impacts on translational research and health systems were also captured, as were recommendations to reduce trial expenditures. Since articles often cited multiple costs, multiple cost coding was used during data extraction to capture the range and frequency of costs. RESULTS A total of 288 empirical articles were included. The distribution of reported costs was: patient management and accrual costs (132 articles), infrastructure costs (118 articles) and the opportunity costs of industry sponsorship (72 articles). 221 articles reported on the impact of undertaking costly trials on translational research and health systems; of these, the most frequently reported consequences were to research integrity (52% of articles), research capacity (36% of articles) and running low-value trials (34% of articles). 254 articles provided recommendations to reduce trial costs; of these, the most frequently reported recommendations related to improvements in: operational efficiencies (33% of articles); patient accrual (24% of articles); funding for trials and transparency in trials reporting (18% of articles, each). CONCLUSION Key findings from the review are: 1) delayed trial activation has costs to budgets and research; 2) poor accrual leads to low-value trials and wasted resources; 3) the pharmaceutical industry can be a pragmatic, if problematic, partner in clinical research; 4) organizational know-how and successful research collaboration are benefits of network/cooperative groups; and 5) there are spillover benefits of clinical trials to healthcare systems, including better health outcomes, enhanced research capacity, and drug cost avoidance. There is a need for more economic evaluations of the benefits of clinical research, such as health system use (or avoidance) and health outcomes in cities and health authorities with institutions that conduct clinical research, to demonstrate the affordability of clinical trials, despite their high cost.
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Affiliation(s)
- Colene Bentley
- 1 Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,2 Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - Sonya Cressman
- 1 Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,2 Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - Kim van der Hoek
- 1 Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,2 Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - Karen Arts
- 3 Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Janet Dancey
- 3 Ontario Institute for Cancer Research, Toronto, ON, Canada.,4 Department of Oncology, School of Medicine, Queen's University, Kingston, ON, Canada.,5 The National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada
| | - Stuart Peacock
- 1 Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,2 Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada.,6 Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Sariola S, Jeffery R, Jesani A, Porter G. How Civil Society Organisations Changed the Regulation of Clinical Trials in India. SCIENCE AS CULTURE 2018; 28:200-222. [PMID: 31391707 PMCID: PMC6636898 DOI: 10.1080/09505431.2018.1493449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In 2005 India changed its pharmaceutical and innovation policy that facilitated a dramatic increase in international clinical trials involving study sites in India. This policy shift was surrounded by controversies; civil society organisations (CSOs) criticised the Indian government for promoting the commercialisation of pharmaceutical research and development. Health social movements in India fought for social justice through collective action, and engaged in normative reasoning of the benefits, burdens and equality of research. They lobbied to protect trial participants from structural violence that occurred especially in the first 5-6 years of the new policy. CSOs played a major role in the introduction of new regulations in 2013, which accelerated a decline in the number of global trials carried out in India. This activism applied interpretations of global social justice as key ideas in mobilisation, eventually helping to institutionalise stricter ethical regulation on a national level. Like government and industry, activists believed in randomised controlled trials and comparison as key methods for scientific knowledge production. However, they had significant concerns about the global hierarchies of commercial pharmaceutical research, and their impact on the rights of participants and on benefits for India overall. Pointing to ethical malpractices and lobbying for stricter ethical regulations, they aimed to ensure justice for research participants, and developed effective strategies to increase controls over the business side of clinical research.
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Affiliation(s)
- Salla Sariola
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Sociology, University of Turku, Turku, Finland
| | - Roger Jeffery
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Amar Jesani
- Independent Researcher and Teacher (Bioethics, Public Health)
| | - Gerard Porter
- School of Law, University of Edinburgh, Edinburgh, UK
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Strüver V. Which Benefits Are Mentioned Most Often in Drug Development Publications? Curr Ther Res Clin Exp 2017; 86:2-8. [PMID: 29234480 PMCID: PMC5717289 DOI: 10.1016/j.curtheres.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim was to identify theoretically expected as well as actually reported benefits from drug development and the importance of individual patient benefits compared to the collective benefits to society in general. Background Ethical guidelines require that clinical research involving humans offer the potential for benefit. A number of characteristics can be applied to define research benefit. Often benefit is categorized as being either direct or indirect. Indirect benefits can involve collective benefits for society rather than any benefits to the trial patient or subject. The purpose of this review was to examine which potential individual and societal benefits were mentioned as being expected in publications from government experts and which were mentioned in publications describing completed drug development trial results. Methods Literature on research benefit was first identified by searching the PubMed database using several combinations of the key words benefit and clinical research. The search was limited to articles published in English. A Google search with the same combinations of key words but without any language limitation was then performed. Additionally, the reference lists of promising articles were screened for further thematically related articles. Finally, a narrative review was performed of relevant English- and German-language articles published between 1996 and 2016 to identify which of several potential benefits were either theoretically expected or which were mentioned in publications on clinical drug development trial results. Results The principal benefits from drug development discussed included 2 main types of benefit, namely individual benefits for the patients and collective benefits for society. Twenty-one of an overall total of 26 articles discussing theoretically expected benefits focused on individual patient benefits, whereas 17 out of 26 articles mentioned collective benefits to society. In these publications, the most commonly mentioned theoretically expected individual patient benefit was the chance to receive up-to-date care (38.1%). A general increase in knowledge about health care, treatments, or drugs (70.6%) was the most commonly mentioned theoretically expected benefit for society. In contrast, all 13 publications reporting actual benefits of clinical drug development trials focused on personal benefits and only 1 of these publications also mentioned a societal benefit. The most commonly mentioned individual benefit was an increased quality of life (53.9%), whereas the only mentioned collective benefit to society was a general gain of knowledge (100.0%). Conclusions Both theoretically expected and actually reported benefits in the majority of the included publications emphasized the importance of individual patient benefits from drug development rather than the collective benefits to society in general. The authors of these publications emphasized the right of each individual patient or subject to look for and expect some personal benefit from participating in a clinical trial rather than considering societal benefit as a top priority. From an ethical point of view, the benefits each individual patient receives from his or her participation in a clinical trial might also be seen as a societal benefit, especially when the drug or device tested, if approved for marketing, would eventually be made available for other similar patients from the country in which the clinical trial was conducted.
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Affiliation(s)
- Vanessa Strüver
- Address correspondence to: Vanessa Strüver, MSc, Hochschule Hannover, University of Applied Sciences and Arts, Faculty III – Media, Information, and Design, Expo Plaza 12, 30539 Hannover, Germany.Hochschule Hannover, University of Applied Sciences and Arts, Faculty III – Media, Information, and Design, Expo Plaza 12Hannover30539Germany
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Ravinetto R, Tinto H, Diro E, Okebe J, Mahendradhata Y, Rijal S, Gotuzzo E, Lutumba P, Nahum A, De Nys K, Casteels M, Boelaert M. It is time to revise the international Good Clinical Practices guidelines: recommendations from non-commercial North-South collaborative trials. BMJ Glob Health 2016; 1:e000122. [PMID: 28588969 PMCID: PMC5321366 DOI: 10.1136/bmjgh-2016-000122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/04/2022] Open
Abstract
The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs). Based on our field experience in LMICs, we developed a non-exhaustive set of recommendations for the improvement of GCP. These cover 3 domains: ethical, legal and operational, and 8 specific issues: the double ethical review of 'externally sponsored' trials; the informed consent procedure in minors and in illiterate people; post-trial access to newly-developed products for the trial communities; the role of communities as key research actors; the definition of sponsor; and the guidance for contractual agreements, laboratory quality management systems, and quality assurance of investigational medicinal products. Issues not covered in our analysis include among others biobanking, standard of care, and study designs. The international GCP codes de facto guide national legislators and funding agencies, so the current shortcomings may weaken the regulatory oversight of international research. In addition, activities neglected by GCP are less likely to be implemented or funded. If GCP are meant to serve the interests of global society, a comprehensive revision is needed. The revised guidelines should be strongly rooted in ethics, sensitive to different sociocultural perspectives, and allow consideration for trial-specific and context-specific challenges. This can be only achieved if all stakeholders, including researchers, sponsors, regulators, ethical reviewers and patients' representatives from LMICs, as well as non-commercial researchers and sponsors from affluent countries, are transparently involved in the revision process. We hope that our limited analysis would foster advocacy for a broad and inclusive revision of the international GCP codes, to make them at the same time 'global', 'context centred' and 'patient centred'.
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Affiliation(s)
- Raffaella Ravinetto
- Public Health Department, Institute Tropical Medicine, Antwerp, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Ermias Diro
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Joseph Okebe
- Medical Research Council Unit, The Gambia, Fajara, Gambia
| | - Yodi Mahendradhata
- Faculty of Medicine, Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Suman Rijal
- B.P. Koirala Institute of Health Science, Dharan, Nepal
| | - Eduardo Gotuzzo
- Department of Medicine, Alexander von Humboldt Institute of Tropical Medicine and Infectious Diseases, Lima, Peru
| | - Pascal Lutumba
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Alain Nahum
- Centre des Recherches Entomologiques de Cotonou, Cotonou, Benin
| | - Katelijne De Nys
- Clinical Trial Center, Leuven University Hospital, KU Leuven, Leuven, Belgium
| | - Minne Casteels
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marleen Boelaert
- Public Health Department, Institute Tropical Medicine, Antwerp, Belgium
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Egharevba E, Atkinson J. The role of corruption and unethical behaviour in precluding the placement of industry sponsored clinical trials in sub-Saharan Africa: Stakeholder views. Contemp Clin Trials Commun 2016; 3:102-110. [PMID: 29736462 PMCID: PMC5935837 DOI: 10.1016/j.conctc.2016.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 11/28/2022] Open
Abstract
Clinical trials still represent the gold standard in testing the safety and efficacy of new and existing treatments. However, developing regions including sub-Saharan Africa remain underrepresented in pharmaceutical industry sponsored trials for a number of reasons including fear of corruption and unethical behaviour. This fear exists both on the part of pharmaceutical companies, and investigators carrying out research in the region. The objective of this research was to understand the ethical considerations associated with the conduct of pharmaceutical industry sponsored clinical trials in sub-Saharan Africa. Corruption was identified as a significant issue by a number of stakeholders who participated in semi-structured interviews and completed questionnaires. Additionally, fear of being perceived as corrupt or unethical even when conducting ethically sound research was raised as a concern. Thus corruption, whether actual or perceived, is one of a number of issues which have precluded the placement of a greater number of pharmaceutical sponsored clinical trials in this region. More discussion around corruption with all relevant stakeholders is required in order for progress to be made and to enable greater involvement of sub-Saharan African countries in the conduct of industry sponsored clinical trials.
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Affiliation(s)
- Efe Egharevba
- Glasgow University, Institute of Health & Wellbeing, 1 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom
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Pinxten W, Ravinetto R, Buvé A. Never Look a Gift Horse in the Mouth? Four Reasons Not to Blur the Line Between Research and Care in Low- and Middle-Income Countries. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:17-19. [PMID: 27216092 DOI: 10.1080/15265161.2016.1170244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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