Fairhead James, Leach Melissa, Small Mary
Institute of Development Studies, University of Sussex, UK.
Soc Sci Med. 2006 Aug;63(4):1109-20. doi: 10.1016/j.socscimed.2006.02.018. Epub 2006 Apr 21.
This paper considers how internationally supported medical research is understood and interpreted by its actual and potential study subjects, exposing the limits to bioethical discourses amidst economic inequalities and contrasting socio-cultural worlds. It focuses on the Medical Research Council (MRC) Laboratories in The Gambia and particularly their Pneumococcal Vaccine Trial (PVT) that was conducted jointly with the Gambian government during 2001-2004. In many respects this was an exemplar of international best practice in trial communication and informed consent procedures. Yet ethnographic and survey research finds that Gambian parents' perspectives on participation are shaped not by trial specificities, but by broader, historically shaped views and experiences of the MRC as an institution. There is a pervasive view that the MRC offers good, free medication to participants, but that it also 'steals blood'. Widespread concerns with blood-stealing emerge from local frames of understanding in which blood is treated as a tradeable good, in which blood accumulation and depletion in bodily processes relates to its exchange in hospital and medical research practices, and in which transactions can be more or less (un)reasonable. Yet such thinking, rooted in an 'economy of blood', has been overlooked by medical research staff and indeed by historians and anthropologists of Africa whose analyses of blood-stealing have been overly transfixed on rumour and the occult. This paper argues that such cultural framings, which guide local critical commentary on trans-national research orders, require serious attention and need to inform open dialogues between scientists and the public if medical research in resource-poor settings is to continue to be sustainable and politically legitimate.
本文探讨了国际支持的医学研究如何被其实际和潜在的研究对象所理解和解读，揭示了经济不平等和社会文化差异背景下生物伦理话语的局限性。它聚焦于冈比亚的医学研究理事会（MRC）实验室，尤其是其在2001年至2004年期间与冈比亚政府联合开展的肺炎球菌疫苗试验（PVT）。在许多方面，这是试验沟通和知情同意程序方面国际最佳实践的典范。然而，人种志和调查研究发现，冈比亚父母对参与研究的看法并非由试验的具体情况决定，而是受对MRC这个机构更广泛的、历史形成的看法和经历影响。普遍的观点认为，MRC为参与者提供优质的免费药物，但也“偷血”。对偷血的广泛担忧源于当地的理解框架，在这个框架中，血液被视为一种可交易的商品，身体过程中血液的积累和消耗与其在医院和医学研究实践中的交换相关，而且交易或多或少可能是（不）合理的。然而，这种植根于“血液经济”的思维，被医学研究人员以及非洲的历史学家和人类学家所忽视，他们对偷血的分析过度纠结于谣言和神秘事物。本文认为，这种指导对跨国研究秩序进行本土批判性评论的文化框架需要得到认真关注，如果资源匮乏地区的医学研究要继续保持可持续性和政治合法性，就需要为科学家和公众之间的公开对话提供信息。
