There is a strong case to be made for testing drugs in the disease-endemic settings.
For example, a malaria drug tested on well-nourished participants in the US may prove less effective when put into practice in Kenya, where comorbidities like malnutrition are a real factor.  
But thus far, informed consent protocols have been designed around participants in wealthy countries. As researchers expand infection studies into high-poverty and low-literacy settings, concerns about exploitation abound.
Major funders have issued new guidelines for protecting participants—but compensation remains one the thorniest ethical issues as researchers seek to offer fair payments while not giving money undue influence.

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