What leads Indians to participate in clinical trials? A meta-analysis of qualitative studies.

BACKGROUND: With the globalization of clinical trials, large developing nations have substantially increased their participation in multi-site studies. This participation has raised ethical concerns, among them the fear that local customs, habits and culture are not respected while asking potential participants to take part in study. This knowledge gap is particularly noticeable among Indian subjects, since despite the large number of participants, little is known regarding what factors affect their willingness to participate in clinical trials. METHODS: We conducted a meta-analysis of all studies evaluating the factors and barriers, from the perspective of potential Indian participants, contributing to their participation in clinical trials. We searched both international as well as Indian-specific bibliographic databases, including Pubmed, Cochrane, Openjgate, MedInd, Scirus and Medknow, also performing hand searches and communicating with authors to obtain additional references. We enrolled studies dealing exclusively with the participation of Indians in clinical trials. Data extraction was conducted by three researchers, with disagreement being resolved by consensus. RESULTS: Six qualitative studies and one survey were found evaluating the main themes affecting the participation of Indian subjects. Themes included Personal health benefits, Altruism, Trust in physicians, Source of extra income, Detailed knowledge, Methods for motivating participants as factors favoring, while Mistrust on trial organizations, Concerns about efficacy and safety of trials, Psychological reasons, Trial burden, Loss of confidentiality, Dependency issues, Language as the barriers. CONCLUSION: We identified factors that facilitated and barriers that have negative implications on trial participation decisions in Indian subjects. Due consideration and weightage should be assigned to these factors while planning future trials in India.

The environmental justice dimensions of climate change

Nations around the world are considering strategies to mitigate the severe impacts of climate change predicted to occur in the twenty-first century. Many countries, however, lack the wealth, technology, and government institutions to effectively cope with climate change. This study investigates the varying degrees to which developing and developed nations will be exposed to changes in three key variables: temperature, precipitation, and runoff. We use Geographic Information Systems (GIS) analysis to compare current and future climate model predictions on a country level. We then compare our calculations of climate change exposure for each nation to several metrics of political and economic well-being. Our results indicate that the impacts of changes in precipitation and runoff are distributed relatively equally between developed and developing nations. In contrast, we confirm research suggesting that developing nations will be affected far more severely by changes in temperature than developed nations. Our results also suggest that this unequal impact will persist throughout the twenty-first century. Our analysis further indicates that the most significant temperature changes will occur in politically unstable countries, creating an additional motivation for developed countries to actively engage with developing nations on climate mitigation strategies. © 2011, Mary Ann Liebert, Inc.