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David Wendler, PhD, Ezekiel J. Emanuel, MD, PhD and Reidar K. Lie, MD, PhD

The authors are with the Department of Clinical Bioethics, National Institutes of Health, Bethesda, Md. Reidar K. Lie is also with the Department of Public Health and Primary Health Care, University of Bergen, Norway.

Correspondence: Requests for reprints should be sent to David Wendler, PhD, Department of Clinical Bioethics, National Institutes of Health, Building 10, Room 1C118, Bethesda, MD 20892 (e-mail: dwendler@nih.gov).

	Because this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

We proposed conditions under which health investigators may provide research participants with less than the worldwide-best methods. Hyder poses a number of questions for this framework, and we consider his points in turn. First, as Hyder points out, current data suggest that social factors have a significant impact on health. Our claim that inequalities in health care have contributed to inequalities in health was not meant to deny the importance of the social determinants of health or to imply that inequalities in health care are more important than these factors.

Second, Hyder points out that it is important to develop . . . [Full Text]