Doubly disadvantaged: on the recruitment of diverse subjects for clinical trials in Latin America

Abstract

Due to its allegedly diverse population and strong doctor–patient relations, Latin America has become one of the most attractive locations for international clinical trials. In the paper, I examine the case of recruitment of women and minority patients to serve as subjects of international clinical trials, through CROs operating in Latin America. In particular, the paper examines some of the strategies that CROs use to expand their services in the Latin American medical market, illuminating the mechanisms through which the current organization of medical research contributes to power imbalances in the Global South. After analyzing the epistemic and ethical shortcomings of such endeavor, I show how Latin American patients participating in clinical trials are located in a position of double disadvantage. First, they suffer the consequences of a lack of appropriate understanding of symptoms and reaction to treatment. Second, they suffer the consequences of being subjects in clinical trials which are not designed to meet their needs, but the needs of patients in the Global North. Accordingly, I conclude by highlighting the importance of this double disadvantage and suggesting that the problem can be understood in terms of a misalignment of commercial, ethical, and epistemic concerns in clinical research.