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Reading the exchange between Halpin, Savulescu, Talbot, Turner and Talman reminds one starkly and uncomfortably of the issues AIDS activists faced in the 1980s and 1990s.1 Some of the trial designs in those days were sufficiently bad that patients could not be recruited in the numbers required to run them, the sacrifices they demanded from patients in terms of their very survival were simply too extreme.2 Anthony Fauci, at the time director of the US National Institute of Allergy and Infectious Diseases (NIAID), reportedly conceded that “the randomised clinical trial routinely asks physicians to sacrifice the interests of their particular patients for the sake of the study.”3 Mainstream bioethicists defended the coercive offers that were extended at the time to patients by the research establishment, pretending that the choice of joining a placebo-controlled trial with an experimental agent or having no chance to access an experimental agent were reasonable options in a reality absent of any gold standard of medical care.4 John Arras, for instance, argued that “[b]y entering a protocol, subjects enter into a moral …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.