Drug companies and ethicists in the US are troubled by the ethical dilemmas of conducting clinical trials overseas. A report in the New York Times says that American companies are increasingly turning to former Soviet bloc countries with good, but underpaid doctors and compliant patients where they can carry out their trials more cheaply. Because there are often no government subsidies for prescription drugs in these countries, few people can afford to buy them. Participating in a clinical trial can be a patient’s best chance for effective medication.

But what happens when the trials finish? Do the companies take special care of subjects who risked their health to take part in a study? In most cases, the answer is No. When the trial is over, patients have to give up medicines which may have vastly improved their quality of life. Sometimes companies do not sell their drugs in the countries where they were tested. And if they do sell them, few participants can afford them.

Bioethicist Ruth Faden, of Johns Hopkins University, is perplexed by this “parachute research”. “Do we have an obligation to everyone in the trial or to everyone in the community, the province, the nation, the region or the world?” she asks. “We haven’t really figured this out.”