Conclusion
In summary, research is commonplace in short-term training programs in global health. This is true in medicine, public health, engineering, and many other disciplines.

By exploring this case, we have learned several important lessons regarding the ethical issues arising when trainees in short-term training programs conduct research.

1. Collaboration in advance of the research can help ensure it is scientifically valid, responsive to local needs, and ethically designed and conducted. Many times, research needs many months of advanced preparation for a successful collaboration.


2. This case involved several potentially competing aims: Bryce’s career goals, the interests of his home advisor, the sponsor’s funding choice, and the local priorities. In general, local priorities should take priority when designing a research project.


3. Lastly, trainees, sending and host institutions, and sponsors should all be aware that research is subject to IRB and local ethics committee oversight. When questions arise or changes to the research occur, it is imperative to contact these oversight bodies for advice and approval.

This case has not covered all the ethical issues arising when research is part of a short-term training experience abroad. However, it did emphasize one of the most critical ethical questions trainees, sending and host institutions, and sponsors face when conducting research in this setting: What is an appropriate research project, and how does one balance potentially competing priorities?

Additional Resources

A growing literature exists on the ethics of research conducted in international settings. For those interested in pursuing this topic in depth, we recommend the following:

• AIDS International Training and Research Program Research Ethics. John E. Fogarty International Center for Advanced Study in the Health Sciences. Web. 31 May 2011.
  
  
• Research in developing countries: The ethics of research related to healthcare in developing countries. Nuffield Council on Bioethics. Web. Accessed 31 May 2011.

In addition, several areas might be worth exploring in greater depth as case studies in the challenges of international research:

• HIV prevention trials continue to attract attention. For an original article raising the controversy, as well as more recent ethics guidance, see:
  
  
• Lurie, P. and Wolfe, Sidney. Unethical trials of interventions to reduce perinatal transmission of the Human immunodeficiency virus in developing countries. N Engl J Med. 1997; 337: 853-856.
  
  
• Research Ethics. HIV Prevention Trials Network. Web. 31 May 2011.
  
  
• A Pfizer study of an antibiotic during a meningitis epidemic in the mid-1990s continues to receive attention. For a recent discussion, see:

• Ezeome E.R., and Simon C. Ethical problems in conducting research in acute epidemics: the Pfizer meningitis study in Nigeria as an illustration. Dev World Bioeth. 2010; 10(1):1-10.

• Recently, the United States discovered a series of historical studies in which vulnerable populations in Guatemala were intentionally given sexually transmitted infections. This has prompted apologies from the U.S. government, and an examination by the Presidential Commission for the Study of Bioethical Issues. See:

• Frieden T.R. and Collins F.S. Intentional infection of vulnerable populations 1946-1948. JAMA 2010; 304(18):2063-2064.