The ethics of international research: The constant gardener

This chapter uses the film The Constant Gardener (2005) to set the stage for a discussion of research ethics in developing countries. The film tells the story of Justin Quayle (Ralph Fiennes), whose lawyer and activist wife Tessa, was found murdered in a remote part of northern Kenya. Tessa had uncovered the fraudulent research activities of a Swiss-Canadian pharmaceutical company and the Kenyan branch of a multinational firm. These companies had been conducting trials of the drug Dypraxa in the slums of Nairobi, which turned out to have serious side effects. The film portrays how, in the Dypraxa trial, the participants' consent was not fully informed or voluntary. The drug trial also illustrates that research in resource-limited settings raises concerns about exploitation. One would think that such research would not be exploitative if it is responsive to local health needs and priorities. But responsiveness to local needs does not safeguard against exploitation. For example, if an investigational drug proves to be safe and effective but is marketed at a high price worldwide, it would probably not be affordable in the country hosting the trial. Thus, hosting communities would assume the risks and burdens of testing the drug whereas its benefits would have accrued mostly to patients in more developed countries.