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Published by: Harvard Kennedy School
Published in: 2004
Length: 8 pages
Data source: Field research

Abstract

In 1997, a small group of African American doctors and scientists on the staff of the Centers for Disease Control and Prevention (CDC) found themselves on the horns of a painful dilemma. For months, they had been making known their objections to clinical trials the CDC was sponsoring in Africa. The trials sought to reduce the rate of mother-to-infant transmission of the human immunodeficiency virus (HIV), the virus that causes AIDS, through short courses of treatment with the drug Zidovudine (AZT). While applauding the goal of the studies which, if successful, could potentially save the lives of millions of African newborns at risk of infection, the members of the group were troubled by the means to that end: placebo-controlled trials in which some mothers would be given no treatment at all. Because studies in the US and elsewhere had already shown that a longer course of treatment with AZT was effective in cutting HIV transmission rates, they argued, it was unnecessary, and unethical, to have a control group that would go untreated. The group had brought their concerns to the leadership of CDC; but while they had been granted a respectful hearing, they had not succeeded in altering the design of the clinical trials. Now, they faced the choice of making their objections public or acquiescing to the trials. Taking the latter course would, for them, raise the specter of complicity in the kind of research in which African Americans themselves had once been the victims, in a notorious study of syphilis. But taking the former course would bring them into open conflict with two prominent and respected officials in CDC, themselves African American and one of them, David Satcher, head of the agency and a rising star in the Clinton administration. Public sparring over ethical issues could be crippling to Satcher and compromise his chance of being named to the post of Surgeon General. With the clock ticking on the clinical trials, the group debated among themselves about how, or whether, they should proceed. This case can be used to explore the often-subtle dynamics that racial identity issues can create in the workplace and places them in a context of a professional ethics decision.

About

Abstract

In 1997, a small group of African American doctors and scientists on the staff of the Centers for Disease Control and Prevention (CDC) found themselves on the horns of a painful dilemma. For months, they had been making known their objections to clinical trials the CDC was sponsoring in Africa. The trials sought to reduce the rate of mother-to-infant transmission of the human immunodeficiency virus (HIV), the virus that causes AIDS, through short courses of treatment with the drug Zidovudine (AZT). While applauding the goal of the studies which, if successful, could potentially save the lives of millions of African newborns at risk of infection, the members of the group were troubled by the means to that end: placebo-controlled trials in which some mothers would be given no treatment at all. Because studies in the US and elsewhere had already shown that a longer course of treatment with AZT was effective in cutting HIV transmission rates, they argued, it was unnecessary, and unethical, to have a control group that would go untreated. The group had brought their concerns to the leadership of CDC; but while they had been granted a respectful hearing, they had not succeeded in altering the design of the clinical trials. Now, they faced the choice of making their objections public or acquiescing to the trials. Taking the latter course would, for them, raise the specter of complicity in the kind of research in which African Americans themselves had once been the victims, in a notorious study of syphilis. But taking the former course would bring them into open conflict with two prominent and respected officials in CDC, themselves African American and one of them, David Satcher, head of the agency and a rising star in the Clinton administration. Public sparring over ethical issues could be crippling to Satcher and compromise his chance of being named to the post of Surgeon General. With the clock ticking on the clinical trials, the group debated among themselves about how, or whether, they should proceed. This case can be used to explore the often-subtle dynamics that racial identity issues can create in the workplace and places them in a context of a professional ethics decision.

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