While international scientific research is seemingly beneficial to society as it generates new knowledge through collaboration, such collaboration is not always equitable, leading to exploitative, egregious outcomes for disadvantaged populations. This is explicated by a phenomenon called “helicopter research”, otherwise known as “neo-colonial” or “parachute science”, whereby scientists from developed countries travel to under-resourced nations to conduct research and extract samples and data with circumscribed to no engagement of local researchers1. Such practices fail to adequately address the needs of local participants, let alone permit them to reap the benefit, if at all, including academic authorship, thereby entrenching imbalances of power within the global community.
Unfortunately, parachute science has not been uncommon in various fields, from geoscience to paleontology; and its occurrence in medical research is no exception2. Historically, such practice has lopsidedly focused on the health needs of high-income countries at the expense of those of low- to middle-income nations, exacerbating the already-existing health inequities due to disparate access to healthcare. This is illustrated in many studies, with an instance being a placebo-controlled trial conducted by the pharmaceutical company Discovery Laboratories of Doylestown, Pennsylvania, to evaluate the effectiveness of Surfaxin, a novel surfactant drug, on premature Latin American neonates in 20013. Given its ability to enhance lung function, Surfaxin was used to treat respiratory distress syndrome (RDS)—a common breathing disorder and the leading cause of mortality in premature infants worldwide due to the lack of surfactant production in the lungs that led to insufficient absorption of oxygen3,4. However, instead of receiving available, effective comparator surfactants proven by the U.S. Food and Drug Administration (FDA), 325 infants in the control group received an inert placebo that had no therapeutic effect5,6.
The Surfaxin trial had been reprimanded as unethical and unjustified, and rightfully so. Distressingly, the study design was otherwise unapproved in Europe and the U.S. as it infringed the Declaration of Helsinki outlining the ethical principles governing human experimentation, specifically the use of the “best proven interventions” or current standard treatments for RDS in the control group in comparison to the novel intervention should they exist5–8. Such a trial imposed an undue risk of harm on Latin American placebo subjects with preventable death5. Indeed, placebos ought to be used as a control only if they are in clinical equipoise with the experimental treatment. Despite the removal of the placebo arm of the Surfaxin study ultimately, it begs the question of what constitutes “ethical” care. Should the standard of care for high-income countries or host nations be provided in the study9? Would the best care be affordable to the under-resourced countries? Would such solutions be sustainable?
Nonetheless, mutual respect, trust, and understanding are the building blocks of equitable, global partnership in science. Scientists must bear in mind that carrying out research abroad is not a right, but a humbling opportunity, and the objective of advancing new insights should never override the rights and interests of research subjects. With awareness enhancement serving as the springboard, synergistic conscious efforts from researchers, regulatory agencies, and governing bodies must be made to restrain parachute science. Potential solutions include involving local partners in processes ranging from study design to data collection and co-authorship, and establishing institutional safeguards against unethical research by rejecting papers involving helicopter research that fails to acknowledge the contributions of local collaborators, by scientific journals10. After all, the ultimate goal of international scientific research is to bridge the gulf in health disparities and ensure that all of humanity benefits from it.
References
- Odeny, B. & Bosurgi, R. Time to end parachute science. PLOS Medicine 19, (2022).
- Stefanoudis, P. V. et al. Turning the tide of parachute science. Current Biology 31, R184–R185 (2021).
- Lahey, T. The ethics of clinical research in low- and middle-income countries. Handbook of Clinical Neurology 118, 301–313 (2013).
- Kamath, B. D., MacGuire, E. R., McClure, E. M., Goldenberg, R. L. & Jobe, A. H. Neonatal mortality from respiratory distress syndrome: Lessons for low-resource countries. Pediatrics 127, 1139–1146 (2011).
- Charatan, F. B. Surfactant trial in Latin American infants criticised. BMJ 322, 575 (2001).
- Press Release: Placebo-Controlled Drug Trial in Latin America Redesigned. Public Citizen (2019). Available at: https://www.citizen.org/article/press-release-placebo-controlled-drug-trial-in-latin-america-redesigned/. (Accessed: 19th November 2023)
- WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. The World Medical Association (2022). Available at: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/. (Accessed: 19th November 2023)
- Lurie, P., Wolfe, S. M. & Klaus, M. Letter Requesting That HHS Halt Plans for Unethical Placebo-Controlled Study of Drug for Respiratory Distress Syndrome. Public Citizen (2019). Available at: https://www.citizen.org/article/letter-requesting-that-hhs-halt-plans-for-unethical-placebo-controlled-study-of-drug-for-respiratory-distress-syndrome/. (Accessed: 19th November 2023)
- Amerson, R. M. & Strang, C. W. Addressing the challenges of conducting research in developing countries. Journal of Nursing Scholarship 47, 584–591 (2015).
- Haelewaters, D., Hofmann, T. A. & Romero-Olivares, A. L. Ten simple rules for global north researchers to stop perpetuating helicopter research in the Global South. PLOS Computational Biology 17, (2021).
Irene Fang
