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If resources are planned to be expended to study a group that does not have access to an established standard of care, then it is the moral responsibility of the researchers to at least provide the current standard of care to participants. In the participant subset where it is unknown whether the standard is being provided (that is, the “treatment” group), full disclosure ought to be provided that the treatment administered may not be as effective as known standards. These two rules should be upheld, in general, even at the potential loss of research validity.

That is, Angell is correct in arguing that placebo trials are permissible only when there exists no established standard of care. She is correct because the implementation of studies in developing countries where the standard of care does not exist locally is an explicit exploitation of geographic misfortune. Such an exploitation should be considered nearly on par with negative discrimination based on race or sex, as for many individuals in developing countries, freedom to alter one’s country of residence is significantly limited by their absence of wealth.

While the fortunate (citizens and researchers in developed countries) are not strictly responsible for the care of the unfortunate (the ill in developing countries), they do assume a moral responsibility to treat fairly the residents of developing countries.

Instances in which a temporal sacrifice of these morals could result in a significant gain to the host population will have to be considered in a case-by-case basis, as it may be difficult to distinguish between the altruistic and self-serving motivations of the researchers. However, if the manner in which the study were implemented in the developing country were not permissible in the sponsor country, then in nearly every case, this would be an immoral act. This is true because the law makers of the developed country have determined a certain protection of their citizens, and therefore that nation as a whole is believed to uphold these protections for themselves, and thus they should be morally obligated to uphold these protections for the participants in their studies, independent of the legality.

Ideal research conditions must be sacrificed, in most cases, when the health of human subjects is at stake, even if when the results have the potential to benefit humanity as a whole. For every case, a balance must be found between standards of rigor in experimentation and the health of subjects. But ultimately, the tendency of researchers should always lean to the protection of human subjects over scientific rigor.