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The epidemiology of infectious diseases among South American Indians: A call for ethical research guidelines

Magdalena Hurtado
Kim Hill
Hillard Kaplan
Jane Lancaster

Introduction

Irresponsible neglect and abuses against native peoples throughout Latin American are phenomenally frequent, generally undocumented and in the few instances that individuals and national and international agencies learn about them, effective action is usually never taken. Questions concerning who is to blame for this plight, and what sorts of chronic insults are likely to cause the extinction of many South American groups during the 21st century may be simple to answer for some like Patrick Tierney in his recent book, Darkness in El Dorado (Tierney 2000). Unfortunately, Tierney’s journalistic enthusiasm for sensationalist allegations against a few individuals trivializes the complex causes of the plight of Indians, and has detracted attention from the sort of constructive analysis necessary for lasting solutions (Hurtado 1990). By placing blame on a few scientists, misrepresenting evidence in uncountable instances, and by promoting a witch hunt against medical scientists, anthropologists or sociobiologists, Tierney fails to get at the true causes of the enormous health problems that the Yanomamo and other native populations face.

In most instances, this sort of reckless reporting could be easily overlooked, and frequently, many frustrated victims of slanderous journalism do just that. However, in this case, such poor judgement is not only blatantly foolish but criminally irresponsible. In the end, Tierney’s allegations could have disastrous consequences for the Yanomamo and all other South American Indians. The uncritical acceptance of his allegations by governmental officials, indigenous non-governmental organizations and missionaries is likely to lead to the implementation of policies that will sabotage all attempts to promote partnerships between scientists, indigenous groups and others. As a consequence, South American Indians will be singled out and denied the right to public health, medical and anthropological research. Without this research, applied programs that affect indigenous groups are likely to be unsuccessful in preventing chronic neglect and its health consequences among them.

The important lesson to be gained from Darkness in El Dorado is that bleak epidemiological profiles are the most serious consequences of contact for indigenous people, and that those who work with these populations can no longer plead ignorance. Isolated peoples in South America and other places in the world, and the descendants of once remote populations should not suffer the same fate as those of the previous 500 years. Five hundred years since the arrival of Columbus have changed the nature of abuses against Indians throughout Latin America but not the ruthless complacency and racism that justifies the neglect and lack of help that today cause the continued deterioration of indigenous health. The hundreds of thousands of preventable deaths among South American Indians from the 1960s to the present can be attributed to the meager resources that governments allocate to indigenous programs and to the fact that government officials frequently embezzle these scanty funds. In addition, scientists and the international community have failed to respond in an effective manner to the serious health problems of indigenous people. To a large extent, poor health keeps South American Indians from being able to climb out of the bottom rung of social ladders. They are ethnically marked by disease, poverty, low economic productivity and unsanitary conditions (Psacharopoulos and Patrinos 1994). It is therefore not surprising to find that more and more indigenous groups who are well aware of this neglect have become increasingly hostile to all sorts of outsiders, including scientists.

A call for action by the American Anthropological Association (AAA) to address these issues and to develop guidelines for ethical research and interventions among native peoples is long overdue. The AAA ethics guidelines appear to be incomplete. A variety of ethical dilemmas that commonly face anthropologists are described in Darkness in El Dorado and certain difficult decisions are described by the author as leading to unethical conduct by anthropologists. The behaviors described and decisions faced by field anthropologists cut across all disciplines and theoretical perspectives. In our concluding statements we identify five areas of field research requiring careful consideration in future plans to expand on current guidelines.

Epidemiology of infectious disease

The epidemiological profiles of South American indigenous groups vary in complex ways across time and space. This diversity has to be viewed against host factors that their members share in common. Ironically, James Neel, a scientist accused by Tierney of genocide among the Yanomamo, is one of the main contributors to our current understanding of disease susceptibility in these populations (Neel 1977, Neel 1971, Neel 1974, Neel et al. 1968). Among other factors, susceptibility in these populations appears to be influenced by low genetic diversity (Black 1990, 1994) and macroparasite-induced immune defense (Sousa et al. 1997). Lack of genetic diversity is sometimes associated with higher rates of susceptibility to all sorts of illnesses (Carrington et al. 1999, McNicoll et al. 2000, Turner et al. 2000, Zlotogora 1997). On average, indigenous peoples have much less heterogeneity in highly polymorphic loci that control the immune system, the Class I and II histocompatibility antigens (MHC) and the immunoglobulin allotype genes (Black 1994).

The effects of homozygosity may be exacerbated in turn by the deleterious effects of parasite loads on immune defense against bacteria, mycobacteria and viruses. Most indigenous groups of South America tend to be chronically infested with macroparasites such as Necator americanus and Ascaris lumbricoides (Salzano 1988, Hurtado et al. 1997), and they also tend to produce immunoglobulin IgE at some of the highest levels ever reported anywhere in the world for individuals who do not suffer from extremely serious, and sometimes lethal anaphylaxis (Hurtado et al. 1999). Instead, indigenous persons with abnormally high levels of IgE are healthy and active members of their groups. IgE-driven defense against parasites competes with defense against infectious diseases such as malaria and tuberculosis because some pathways of immune defense against parasites vs. bacteria and viruses tend to be mutually exclusive (Beyers et al. 1998). These high levels of IgE production are only in part related to parasitic infestation since nonindigenous populations who are equally parasitized show much lower levels of IgE than do South American Indians. Even though some of these biological insights were published several decades ago (CIBA 1979), agencies and individuals who work with South American Indians have not considered this information in the process of planning public health programs in indigenous areas nor has it been used by ethics committees to develop research guidelines.

For the most part, enormous deficiencies in the public health systems of Latin American countries create conditions that further exacerbate the effects of susceptibility to infectious diseases on the health status of indigenous communities. Most Latin American countries invest much smaller percentages of the gross national product into health than do developed countries (PAHO 1994). Of this relatively small percentage, very small fractions are allocated to indigenous health, and tragically, the few remaining funds are oftentimes embezzled by government officials. One hears unfortunate stories such as that of a dedicated Venezuelan Indian Affairs official who quit his job after painstaking attempts to make progress without financial support for programs even though an enormous allocation of funds was supposedly made to his office over the period of his appointment.

Likewise, in Paraguay, international efforts sanctioned by the World Health Organization to control tuberculosis are having minimal if any effect in most indigenous communities. Paraguay is notorious for the very high rates of tuberculosis that indigenous communities suffer. Unfortunately, the sources of this information are rural and missionary nurses as opposed to the government-mandated national surveillance officials who are responsible for tracking these epidemics (see below). Cases are rarely treated or are treated in the inadequate ways that cause the emergence of drug resistance tuberculosis (Frieden et al. 1993, Farmer et al. 2000). When the National Commission of Tuberculosis Control of Paraguay receives large shipments of tuberculosis medications, these are kept stored in the capital city. Even if the medications were made available to rural and indigenous communities, Paraguay does not have a well-implemented direct observed treatment (DOTS) program that ensures completion of drug regimens (ATS, CDC 1992). Because of this, and other factors, prophylactic and prompt curative treatments of tuberculosis are not options for most Indians in Paraguay and other Latin American countries. As a consequence, in order to be treated, Indians have to wait until they develop active tuberculosis, that is, until after they have contaminated family and friends with airborne bacilli produced by chronic cough.

When scientists bring such disheartening observations to the attention of local officials, they often respond that their (inadequate) surveillance systems show no such pattern, and claim that in fact infectious disease rates are low among indigenous communities. Most officials either fail to realize, or are unwilling to admit that, while many sectors of Latin American society benefit from epidemiologic surveillance systems mandated to generate information that is used to justify public health expenditures, almost all indigenous communities are excluded from such national data collection networks due to their remote location and cultural barriers. As a consequence, the knowledge that scientists wish to share with officials about disease rates and the ways in which these outcomes could be prevented, are infrequently if ever used to inform policy.

Thus, it appears that host factors such as homozygosity and high IgE production, among others, in combination with social factors such as lack of epidemiological surveillance and limited, if any, access to well-timed vaccinations, sanitation and medical treatment, cause high rates of infectious diseases among South American indigenous groups. These factors influence epidemiological profiles of indigenous groups with little if any admixture regardless of the number of years that they have lived in close proximity to nonindians.

The devastating epidemiological effects of contact

Tierney is correct in stating that the last 500 years of contact between Native Americans and people of European descent have had disastrous consequences, with epidemics being responsible for killing millions of people. Typically, first face-to-face contacts result in the deaths of between one third and one half of the native population within the first five years of contact (Hill and Hurtado 1996, CIBA 1979). The majority of South American Indian groups were exterminated in this way during the first two centuries after European arrival in the Americas (Hemming 1978). Unfortunately, the lessons of half a millennium have not resulted in any significant improvements. If a group of native South Americans who have been living in isolation for some period of time were to make contact today, the result is likely to be equally catastrophic.

In Brazil alone, there are still some 30-50 groups who are still living isolated from face-to-face contact with peoples of European or African descent (FUNAI estimated 55 uncontacted tribes two years ago, Veja, June 10, 1998). Others exist in Peru and Bolivia, and perhaps in Venezuela, Ecuador and Colombia as well. Yet, there are no protocol with contingency planning for managing the medical, economic and social consequences of contact. Such contacts are inevitable, since global economic, social and population forces are driving increasing numbers of people into remote areas for the purposes of colonization and resource exploitation.

Remote peoples in South America face three major threats. First, wood-cutters, miners, colonists, missionaries and even government-sponsored bodies are entering their traditional ranges in increasing numbers. Face-to-face contacts with some members of remote groups will occur as a result of those incursions. Eventually one or more of those contacts will result in the transfer of disease organisms to individuals with little resistance to those diseases. Epidemics will then ensue, even among individuals who never actually come into contact with people of European descent, since the natural response to disease among mobile peoples is to flee to neighboring villages or camps. Second, the habitats of remote peoples are shrinking rapidly. As more areas are colonized, the available habitat to support subsistence is increasingly circumscribed. In some cases, the habitat is not sufficient to support the nutritional needs of the group. This loss of habitat creates problems over both the short and long term. In the short term, the resource pressure can lead to nutritional stress, disease, and both inter- and intra-group conflict. Over the long run, even after peaceful contact is established, those peoples may lose access to their traditional territories because colonists and others will have established either de facto or legal ownership of those areas. Third, many local groups have become isolated from other members of their larger ethnic groups, due to incursions into their territory. Those isolated groups can be small enough that they do not constitute viable mating populations (Baruzzi et al. 1979). As a result, small demographic shocks can lead to their physical extinction, even without significant disease epidemics (see recent case of how the El Niño and La Niña weather patterns may be exterminating the uncontacted Jarawas in the Andaman Islands.

Many anthropologists and indigenous rights activists believe that uncontacted Indians should be left alone. These people are well-meaning, but they are wrong because they base their position on three incorrect assumptions. First, they assume that the Indians have chosen to remain isolated. They have not. What they have chosen is to avoid those who they believe would kill, enslave and abuse them. There is little doubt that most would immediately opt for contact if instead they expected trade, affection, help and support. Humans are a social species by nature and enjoy productive interactions with neighboring groups. Most isolated tribes have difficult lives that include very high rates of child mortality (Hill and Hurtado 1996). All Indians that we have ever spoken to gladly accept improvements in their physical conditions and health situation if offered by true friends. None are content with the typical 30-50% child mortality rates that they experience without Western medicine. As soon as it becomes clear to isolated natives that those attempting to contact them are peaceful and friendly, and can provide them with technology to ease some of the burdens of their lives, they virtually always initiate a contact.

The second incorrect assumption by those who oppose contact is that the Indians will inevitably be decimated by virgin soil epidemics. This is not true. Two of us, Hill and Kaplan, have been present at contact sites within days of first contact and are good friends with others who have carried out first contacts in three different South American countries. If competent medical care is available and consistently present during the first five years following contact, few contact related deaths need occur. The last band of Northern Ache foragers of Paraguay was contacted in April of 1978 and Hill began medical care of that group in collaboration with two other missionary organizations within days of contact. Only two small children out of a group of 22 died within the first five years of contact, and both were in poor health at contact. In 1979 another band of Ache contacted a missionary family who then lived with them in their traditional home range from that time until the present. Only one child from a group of 37 died within the first five years after contact. The key to survival after contact for these two groups was competent medical care 24 hours a day, 365 days a year for several years.

The third incorrect assumption by those who oppose contact is that the isolated native groups will survive if not contacted. Population genetics and demographic models clearly show this is not true. Most isolated populations of less than several hundred people are destined to go extinct through accidental population fluctuations. This process is much more rapid in small groups and in situations where traditional territories have recently decreased in size. Almost certainly many isolated groups went extinct in the 20th century without ever making contact. In some cases one or two final survivors may be rescued at the end of such a decline.

Although there is a body of scientific literature on virgin soil epidemics among native peoples, a long period of missionary and governmental experience, and well-informed articles that provide specific advice on contact situations (e.g., Hill and Kaplan 1989), individuals and organizations making contact with isolated native groups at the end of the 20th century seem as uninformed as those a hundred years earlier. Even well meaning groups and individuals continue to ignore this accumulated body of knowledge. For example, the planned FUNAI contact of the Korubo in Brazil in October 1996 included 26 individuals who were not screened or quarantined including eight journalists and their assistants, but no medical personnel! When outsiders suggested that the original team may have infected the Korubo, government officials returned to the contact site for a few hours, but without qualified medical personnel (see http://www.nationalgeographic.com/features/96/contact/index.html). The previously contacted group appears to have turned hostile at a later date (due to deaths caused by the contact crew?) and has not been monitored since. All the Korubo at the 1996 contact could be dead from diseases introduced by the contact team and accompanying foreign journalists.

Steps to be taken. In order to avoid such disastrous consequences, several steps need to be taken in the immediate future. First, a commission must be established to evaluate the status of existing isolated peoples. There is a great deal of information already available through reports from private individuals and government bodies who have visited or live in remote areas. That information needs to be analyzed and the status of each group evaluated. Which groups are in immediate threat of contact? What are the likely sources of contact (miners, wood-cutters, colonists, etc.)? Which groups face probable extinction due to small population size in isolation? Such a commission should include experts in anthropology, physicians and public health administrators, and government officials who are responsible for policy development among native peoples. Second, policies regarding contact need to be developed. Which groups can be protected from contact? Which groups should be approached and offered contact due to their probable extinction in the immediate future? How should contacts be managed in both the long and short term? Third, medical protocols must be developed and financed. Rapid vaccination and outreach medicine could potentially bring contact-related mortality to less than 2-3% in the first year (Hill and Hurtado 1996, Baruzzi et al. 1979). Since newly contacted peoples have no experience with health posts and western medicines, a nontraditional medical program must be developed. It is necessary to deliver medical treatment when and wherever it is required without relying on the people themselves to seek and to follow prescriptions. Since isolated peoples remain highly susceptible to foreign antigens for a decade or so, such programs need to be sustained over several years.

There is now sufficient documentation of the consequences of first contacts that we can no longer plead ignorance. The remaining isolated peoples in South America and other places in the world should not suffer the same fate as those of the previous 500 years. The American Anthropological Association should form a panel of experts now to develop policy on this issue and advise pertinent government and missionary organizations. Failure to act will invariably lead to an enormous number of death that are preventable.

Disease after contact

Contact is only the beginning of problems faced by South American Indians. Sedentism, poverty, poor access to health care in addition to biological influences on disease susceptibility in many cases lead to an ever increasing deterioration in health status (Psacharopoulos and Patrinos 1994). It is not at always the case that after the initial period of contact, conditions improve immediately for South American Indians. Among the Ache of Eastern Paraguay, over a period of 10 years after contact, the infant mortality rate was higher in reservations than prior to contact, and only reached the lower pre-contact levels in the past 10 years (Hurtado and Hill 1996). In addition, the effects on health of novel infectious pathogens such as Mycobacterium spp., Plasmodium spp. and numerous intestinal parasites interact in ways that greatly undermine the robustness of the Ache at contact. Since contact, the Ache have experienced two malaria epidemics during which many adults were unable to provide for their dependents. Their diet has changed dramatically as well from one based on plentiful animal protein to a nutrient-poor manioc-based diet. The future looks bleaker still. In fewer than five years, tuberculosis became a major source of health problems among the Ache. Only a decade after contact, between 1985 and 1994, the lifetime prevalence of active cases of tuberculosis among Northern Aché increased from less than 1% to 16%. In addition, 50% of individuals over 15 years of age test positive for tuberculosis infection (Hurtado 2000). Other hunter-gatherers have fared equally poorly. Among the Hiwi of Venezuela who made contact in 1957, and who continue to depend on hunting and gathering for their subsistence, leprosy and violence (massacres and murders) have been some of the main causes of morbidity and mortality from the 1960s until the early 1990s.

Tuberculosis outcomes are an excellent example of how susceptibility to infectious diseases in combination with social factors play an important role many years after initial contact. The Native American case is well-documented (Rieder 1989). By 1900, tuberculosis was the most serious health problem among North American Indians. Even though mortality, morbidity and risk of infection have sharply decreased, the incidence rate among natives is still 4.4 times higher than the rate for Americans of European descent (CDC 1987). It has taken many South American Indians much longer to reach the levels of tuberculosis outcomes found among North American Indians in the 1900s. It will take time to gather the necessary data to describe the trends across the continent. However, in countries with the highest prevalence of tuberculosis in Latin America such as Bolivia and Peru, indigenous populations have been hardest hit by this disease. Data from other countries suggest that many communities will be devastated by tuberculosis over the next decade. By 1992, the prevalence rates of tuberculosis exceeded 1% among the Kuna Indians of Panama, and most were not receiving any treatment (Caminero Luna 1995). Even higher prevalence rates have been reported for indigenous groups of the Paraguayan Chaco over the past decade and the rates of compliance to treatment are dismal particularly among groups of hunter-gatherers (Meincke-Giesbrecht et al.1993). Lastly, prevalence rates of tuberculosis infection among Shuar Indians of Ecuador are comparable to those of the Ache, and become increasingly lower in communities that are furthest away from nonindigenous villages (Kroeger and Barbira-Freedman 1982).

The ways in which indigenous populations mount immune defenses against bacterial pathogens is one of many host factors that may help explain such high rates of tuberculosis among indigenous people. A recent study by Sousa et al. (1997) found that the Yanomamo of Brazil mount different immune defenses to tuberculosis infection than do other populations. First, a prevalence rate of 6.4% active cases of tuberculosis is considerably higher than one would expect for a population that has been exposed to tuberculosis for fewer than 15 years. Note, however, that this rate is still considerably lower than that observed among the Ache. Second, when compared to their Brazilian neighbors, the Yanomamo had higher titers of antibodies against M. tuberculosis glycolipid antigens (14% vs. >70%). Thus, relative to other populations with exposure to tuberculosis, the Yanomamo mount unusually high antibody responses at the expense of the more effective cell-mediated immune responses that are typically observed in nonindigenous people. Third, the rates of tuberculosis infection as measured by tuberculin tests show positive responses at much lower rates than one would expect in groups with as high a prevalence of active cases as found among the Yanomamo. The proportion of positive tuberculin reactors was extraordinarily low (27%) when compared to rates reported for Eskimos in the 1950s (90%) (ibid.) and only slightly lower than the rate found among the Ache (32%-all ages). In nonindigenous populations, lower than expected rates of positive tuberculin tests only tend to occur in immunosuppressed individuals such as HIV patients. Thus, if left unchecked, tuberculosis epidemics among the Yanomamo could have long term consequences as devastating as did measles epidemics in the 1960s particularly if active cases are left untreated or drug resistance tuberculosis is allowed to emerge as a consequence of intermittent treatment. In at least one case in South America, tuberculosis has already exacted a huge toll. Six hundred of the 800 Surui who were alive at contact in 1980 had died by 1986 due to concurrent tuberculosis and other disease epidemics (Fleming-Moran et al. 1991).

Data on indigenous groups who are considerably more acculturated than are some of the aforementioned show that the future of South American Indian populations many years after contact is very bleak indeed. Recent studies using large samples indicate that indigenous people very frequently have worse health than do their rural peasant neighbors (Psacharopoulos and Patrinos 1994). In Latin America, indigenous people make up about 27 percent of the rural, and poorest, population (IFAD 1992). Moreover, indigenous infants and children have much higher mortality rates than do their nonindigenous counterparts in every country where these rates have been measured (Psacharopoulos and Patrinos 1994 ). In Bolivia, monolingual urban indigenous peoples are two to four times as likely to be sick or injured in the past 30 days, to be kept from work for more than one week, to receive no medical help if sick and to have missed yellow fever vaccination campaigns (ibid: 68). In the same country, child mortality rates are three times as high among monolingual indigenous mothers living in poverty as that of nonindigenous mothers (ibid:89). In Peru, indigenous people are less likely to be vaccinated with BCG, polio, and measles and to have had diarrhea in the last 15 days than are the nonindigenous poor (ibid: 166).

These are only a few examples of how pathogens continue to have devastating consequences for many years and decades after contact. Thus, calls for guidelines that specify the ways in which indigenous people should be protected from the ravages of disease need to consider both contact and post-contact periods.

A call for action

The intent of international and national guidelines for research among native peoples should be to use fundamental scientific understanding of infectious disease epidemiology to serve humanitarian ends (Eades and Read 1999). Science can and should help indigenous people in the many ways that it has helped the rest of the world. As we look back and recognize that it took eighty years for antituberculosis campaigns to reduce death rates from 2 to 0.001 per thousand persons in the United States (Hopewell 1998), and that there are similar innumerable examples of how science has managed to reverse ills for all humanity, it is difficult to fathom why it is still the case that mortality rates among some South American Indians can be as high today as they were 100 years ago.

In spite of the enormous potential benefit to indigenous communities, many have become increasingly unwilling to participate in scientific projects. In fact, many Indians are suspicious that scientists are not really there to help but to exploit them. One of the most important reasons for this rejection and suspicion is that for decades scientists have not adhered to fieldwork ethics that natives can clearly identify as positive for their communities. This means that we need to reexamine fieldwork ethics and develop stronger guidelines in several key areas.

Current guidelines for fieldwork developed by the AAA ethics committee require only that an anthropologist should do no harm to a study population, thus leaving considerable room for interpretation as to what sorts of conduct are indeed harmless. We suggest that ethical behavior goes beyond simply "not harming" anthropological study populations to more proactive behavior. Five areas of field research requiring careful consideration in future plans to expand on current guidelines are as follows:

1) The responsibility to provide assistance when the study subjects experience health emergencies: Tierney criticizes scientists and journalists for not spending more time and resources fighting the Yanomamo measles epidemic, and not getting more involved in alleviating observed health problems while doing fieldwork. The same charge could be leveled at all observers (e.g., journalists, tourists, missionaries, those who become informed through secondary accounts, etc.) who encounter suffering but don’t take "sufficient" action to alleviate that suffering. Many anthropologists do provide health care for study populations and other forms of economic assistance sometimes at great cost to themselves. Other anthropologists feel uncomfortable with the notion that they are responsible for providing services that should be the job of other organizations supposedly dedicated to such things (e.g., governments, missionaries, health and human rights organizations). Some sincerely feel that it is their job to observe and not to interfere in events that affect study societies, and some simply fail to obtain the necessary training to be able to provide health assistance to study populations. If anthropologists are expected to provide health assistance, who will provide the funds for medicines, their medical training and transportation and pay for lost work time? Should anthropologists lobby major funding agencies such as the National Science Foundation and the National Institutes of Health to always provide some funds with each research project that can be diverted into such assistance? The AAA needs to seriously consider this issue, there are no clear cut answers and every anthropologist who has ever done fieldwork has been forced to make difficult choices in this area.

2) Fairness of renumeration for research cooperation: Tierney suggests that Chagnon did little to help the Yanomamo during his 25 years of research with them and that the organization he created, Yanomamo Survival Fund, intended to help only by providing data that might be useful to other groups assisting the Yanomamo. The lack of direct assistance to the Yanomamo community appears to be a complaint voiced by many Yanomamo critics of Chagnon. Again the same criticism could be aimed at non-anthropologists who make incomes off native peoples (e.g., journalists, missionaries, staff of indigenous rights organizations, etc.) Many anthropologists make their entire careers off work done in traditional study populations that are only paid direct informant fees during a fieldwork period. Because lifetime earnings of a professional anthropologist can be considerable (including salary, book and film royalties, etc) and informant fees are extremely small by comparison, this opens anthropologists up to a charge of exploitation of native peoples. This charge is reinforced by the commonly held anthropological belief that the value of specific research results to the target population is payment enough for access and cooperation received from the study population. Most traditional populations in contrast see little practical value to the research results produced by anthropologists and medical scientists regardless of theoretical perspective and research topic area. The AAA has never specifically provided guidelines on the level of renumeration (beyond informant fees) that is appropriate through time to study populations, and how that renumeration should be linked to the overall earnings of a researcher as a result of his/her focus on a particular population.

3) Considering the impact of material assistance: Tierney accuses Chagnon of fomenting violence by giving gifts to some Yanomamo communities. Since it is impossible to give equal material support to all communities or all individuals at any field site, should anthropologists be held responsible for jealousies and competition over resources that they distribute, or the acts committed by individuals who gain advantage through their material rewards? This is a general dilemma faced by all organizations and agencies who provide material assistance to groups (including national governments). The implication of the charges in the book is that anthropologists should give no gifts at all to avoid conflicts which may be exacerbated by that gift giving. Most study populations would find that suggestion cruel and self-serving (since it would save a lot of money to anthropological researchers), and the refusal to "pay" for services rendered would be considered unethical behavior by many. But all researchers who do fieldwork need to carefully consider the potential impacts of their gifts on study populations, and the AAA has no clear guidelines here.

4) The impact of factual data about a study population: Tierney criticizes Chagnon for publishing information and viewpoints about Yanomamo warfare that damage the reputation of the Yanomamo and can be used by enemies of the Yanomamo to justify denying them certain rights and privileges. Chagnon counters that he is simply publishing factual data and it would be deceitful and scientifically unethical to hide or change results. The AAA has not adequately addressed this dilemma, and as a result there are several other similar controversies in anthropology (e.g., reports of cannibalism in the Southwest). While anthropologists have a responsibility to publish the truth they also need to be sensitive to the fact that some truths about any target population can be potentially damaging. We suggest that a compromise can be struck whereby important scientific results are disseminated within a scientific community but not intentionally played up in the media to a wide public audience.

5) Informed consent: Tierney accuses a variety of researchers of collecting data without adequate informed consent. A similar charge has been leveled recently at other anthropological researchers using native DNA (see New Scientist, Sept 2000). Some scientists believe that informed consent consists only of an explanation of the methodology, procedures used on study subjects, and information about potential dangers of those procedures. As long as this information is provided and study subjects are not harmed or disenfranchised in any way, the consent is legitimate. Cultural anthropologists often obtain no informed consent for their studies, but assume that if the community tolerates their presence it implies informed consent. At the other end of the spectrum some people believe that informed consent includes not only an explanation of data collection methods but a detailed explanation of the research topics that will be examined with the data collected from a study subject (. If this view were taken literally many studies could never be carried out (because informing subjects will sometimes change the character of the data gotten from them), and no post facto analysis of any field data could ever be done (since subjects wouldn’t have been informed at the time that a particular use of the data was part of the research). This version of informed consent would probably eliminate all behavioral research in the world (since the behavior of study subjects would always be affected by knowing why they were being observed) and would eliminate a huge number of useful scientific studies done using data initially collected for a different purpose. The use of published data collected by others for analysis in a new topic would be considered unethical, essentially eliminating a huge fraction of current research. Finally, no scientifically sophisticated studies could ever be done on relatively uneducated populations because they could not give true informed consent (implying that they understood the purpose of the research). For example no DNA studies could be done on any population that didn’t know what DNA is and understand the basics of modern genetics. Both extremes of the informed consent debate seem unfair or unrealistic, but the AAA should provide some guidelines on what exactly constitutes valid informed consent in anthropological studies. The same standards that apply to material data collection (blood, DNA, etc.) should apply to the collection of any information about a study group.

The success of the programmatic development of future policies and guidelines will depend in large part on the international and interdisciplinary nature of the teams that are brought together in this effort. Members of indigenous communities, governmental and nongovernmental Indian affairs organizations from various continents, the World Health Organization and other major health organizations should be active participants in this process in addition to large funding agencies, ethic committees and anthropological associations. These efforts should be motivated by the realization that it is no longer tolerable for researchers who rely on First World know-how, technology and resources to offer little if any help in implementing solutions for indigenous health problems (Farmer 2000).

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