The ethical canons haven't changed. But as the price of anti-HIV drugs has plummeted from $15,000 per person a year to a few hundred dollars, major international efforts are under way to bring these medicines to poor people. In essence, increased access to drugs revealed that the ethical quandary came down to cost, not right or wrong.
Researchers from wealthy countries typically provide research subjects in poor ones better health care. They also train colleagues and bring medical equipment that remains in use long after studies end. But there are financial and practical limits to what they can offer. No ethical manifesto, however, spells out precisely how much is enough. The unstated message of "Building Collaboration" is that researchers and communities that participate in clinical studies have to negotiate this bottom line.
AIDS has ushered in an ethos in which more and more people, especially in desperately poor countries, want to know what's in it for them to participate in a clinical trial. They want some say in establishing what researchers call the risk/benefit ratio. These are reasonable demands. But pharmanoia makes them harder to hear.