Paper short abstract:

This paper explores the role played by a research organisation facilitating healthcare for TB in South Africa during a clinical trial. Its aim is to contribute to our understanding of the relationships between research ethics, epistemology and healthcare provision in the developing world.

Paper long abstract:

Since the 1980s there has been a substantial increase in the volume of biomedical research being conducted on vulnerable people and populations, particularly clinical trials to determine the safety and efficacy of pharmaceuticals. While the potential for exploitation has been well documented, a number of anthropologists have observed that clinical research organisations can become important actors in local therapeutic landscapes, making significant and easily overlooked contributions to the provision of healthcare among study populations. Based on ethnographic research with a South African research organisation that specialises in tuberculosis (TB) vaccines, this paper applies this perspective to the as yet deeply troubling issue of TB control in the developing world. I attempt to draw out the important role that the organisation played during a clinical trial facilitating healthcare for childhood TB - a role conferred upon the organisation by the trial's ethical regulations, and made possible by its long-standing relationships with local healthcare facilities. Paying particular attention to the dynamics between the trial's ethical and epistemological commitments, I will suggest that clinical research has much potential to make localised contributions to the control of TB in high-burden regions. However, in order for this potential to be fully realised, formal ethics structures must become more sensitive to the immersion of clinical trials in the very fields of power and inequality that make TB and other such diseases a continuing burden on the world's most poor and neglected.