Ethics of placebo-controlled trials in developing countries

David B. Resnik has concluded that perinatal HIV transmission studies in developing countries are justified. He may have missed the essence of the criticism of the trials and may have missed the essence of the defense. To defend the trials, it is said that no other way of establishing the effectiveness of short-term AZT treatment exists. The controversy actually is over whether it is likely that the experimental treatment will cut perinatal transmission to that found in the AIDS Clinical Trial Group (ACTG) 076 regimen and whether reliable judgements about perinatal transmission rate if no treatment is given can be made. It is not ethical to knowingly design a trial in which some women get treatment less effective than is given to others.