What does justice require when industrialized countries sponsor or conduct research in developing countries? Diverse interpretations of the concept of justice are one source of controversy regarding what – if anything – industrialized country sponsors owe to research subjects, to the community, or country as a whole when research yields successful products or contributions to knowledge.

An even more problematic question asks why biomedical research should be the place to seek to redress the gross inequalities that characterize access to all sorts of goods and services in the world. This was a recurrent theme in meetings of the National Bioethics Advisory Commission in its international project. Some commissioners readily acknowledged the existence of pervasive global injustices, yet they rejected the idea that providing beneficial products resulting from clinical trials was an appropriate way to begin to address unequal distribution of resources – medical or otherwise. According to that viewpoint, pharmaceutical products are just one more commodity that is distributed inequitably in a global system in which market forces govern. A sharply contrasting view is that drugs and other items necessary for maintaining or improving the health of people in all societies should be removed entirely from the market system. This “radical” view could find support in a human rights analysis of obligations regarding public health (see chapter 7).

Concerns about justice in international research have focused mostly on worries about exploitation of research subjects or entire populations in developing countries in the process of recruiting subjects and conducting the study.