Editorial Response: Reflections on Studies in Developing Countries The

article in this issue of Clinical Infectious Diseases by provided by the study of Heyderman et al. is no less painful when diluted by countless similar circumstances. One modelMayanja-Kizza et al. [1] and that by Heyderman et al. [2] provide clinicians with yet another opportunity to reflect on for improvement in access to care is the study by Mayanja-Kizza et al. Patients were provided with antifungal agentsdifficult ethical, political, and social dilemmas of the highest level of complexity. The study by Heyderman et al. documents through combined funding from a foreign country and a phar-maceutical company. In this way, the scientific communitythe natural history of cryptococcal meningitis (CM) in un-treated, HIV-infected patients in Zimbabwe. The cumulative provided a highly meritorious service while simultaneously meeting its own objectives of completing a useful study.median survival of 14 days after diagnosis and the 25 % survival rate at 30 days after diagnosis vividly and painfully demonstrate The complexities of performing investigative studies in de-veloping countries are formidable and have been the topic ofthe destructiveness of CM. Clinically experienced readers can imagine the discomfort, suffering, and distress among these extensive recent reflection [3–5]. Nevertheless, such studies, if designed with careful attention to technical detail and ethicalpatients during their final stages of the illness. considerations, could provide relatively large numbers of pa-tients with access to potentially curative therapies that wouldSee the article by Mayanja-Kizza et al. on pages 1362–6. be otherwise impossible for them to obtain. These studies coul