The Master of Arts in Medical Humanities & Bioethics
presents
A Montgomery Lecture
Setting Off an Outcry:
Maternal-Fetal Transmission of HIV Research in the 1990s
Sarah Rodriguez, PhD
Senior Lecturer, Global Health Studies, Weinberg College of Arts & Sciences
Lecturer, Medical Education, Feinberg School of Medicine
Faculty, Medical Humanities & Bioethics Graduate Program
Northwestern University Feinberg School of Medicine
On September 18, 1997, a New York Times cover story stated that for the past two years, the United States government had been funding and conducting “controversial” studies “on pregnant women infected with H.I.V.” with some women “given drugs that can prevent transmission of the deadly virus” while others received “only dummy pills.” The article was prompted by an editorial that threw “a harsh spotlight on the research” appearing that same day in the New England Journal of Medicine. In her editorial, Marcia Angell condemned as unethical 16 studies occurring in countries in Africa, Asia, and the Caribbean where rates of transmission of HIV from an HIV-positive pregnant woman to her fetus – so-called vertical transmission – were higher than in North America and Europe. The studies were designed to see if AZT reduced vertical transmission; fifteen of the studies compared a reduced course of AZT against a placebo rather than comparing a reduced course of AZT against the full course of AZT, the latter of which had been found to be highly efficacious in studies conducted in the United States and France. Angell’s editorial instigated a debate regarding both this particular study and regarding the ethics of conducting all international research, in particular regarding the use of placebos when an existing therapy exists and when the standard of care differed between the country sponsoring the research and the country hosting the research. In this talk, I consider the debate launched by Angell’s editorial, particularly why it focused on (and continues to be used as example of) the ethics of clinical research, before considering additional possibilities regarding how to see the maternal-fetal HIV prevention trials of the 1990s.
Cost: FREE