Human subjects research has always been rife with ethical concerns, especially when research is being conducted in the developing world. At first glance, demographic and health surveillance (DHS) research can appear to have less potential for harm than direct-intervention drug trials. Not so, says a recent bulletin from the World Health Organization.
DHS research is defined as “long-term monitoring of specifically defined populations, typically residing in a small geographic region.” The authors of the August 2008 bulletin article say that while DHS research has led to many life-saving findings, including vaccine development, the invention of oral rehydration solution, and the link between early cessation of breastfeeding and malnutrition, it comes with a special set of ethical complications.
For example, when a disease surveillance team with the resources to provide comprehensive health care to a community is stationed in a poverty-stricken area, what is their obligation to the community? Do they treat people for only those diseases that they study? Do they only treat study participants? How does project staff go about obtaining informed consent from the community members? If there are monetary gains to be made by study subjects, what consequences might that have? If the DHS group provides health care or other services in a community for a long period of time, what happens to the community when they leave?
Ethical quandaries are certainly not limited to DHS research. As global health and development topics increasingly capture the attention of resource-rich universities and researchers, it is important to remember that the potential for harm rises along with the potential for good.