U.S. pharmaceutical companies have moved their operations overseas in the past decade, testing their drugs on poor people in such lands as Russia, China, Brazil and Romania. It is a $30 billion business, and today around 105 countries are allowing such large corporations as Merck and AstraZeneca to conduct clinical trials on their soil.

One country that has experienced a boom like no other in this industry is India, with its widely spoken English, an established medical infrastructure and welcoming attitudes towards foreign industry. Most importantly, these pharmaceutical companies are exploiting the country’s vast number of illiterate and poor people who are willing to become guinea pigs.

Zeina Awad, a reporter for Al Jazeera’s “Fault Lines” program, traveled to India to investigate clinical research being conducted there. She explored what role the United States regulatory agencies are playing in overseeing the clinical trials, and whether the testing complies with international ethical standards.

Her report, “Outsourced: Clinical Trials Overseas,” aired on Al Jazeera English recently.

New America Media Health Editor Viji Sundaram interviewed Awad about what she found.

Viji Sundaram: Your report seems to suggest that a combination of poverty and inadequate public health care is what drives many Indians to enroll in clinical drug trials as guinea pigs. Do they actually know what they are getting into?

Zeina Awad: The growth of the clinical-trial industry in India needs to be seen within the social and economic context of the country. According to the United Nations, 40 percent of people in India are illiterate. The gap between rich and poor continues to grow. Many risk not knowing whether the treatment their doctor is prescribing is [a proven] treatment or a part of a clinical trial. That aside, it’s also important to remember that in certain societies – and India is one of them – doctors are respected to the point of being revered. Their word is rarely questioned, so the likelihood of a person questioning their doctor about specific treatments is low.

Economics plays a role in a person’s decision-making. We met a young man in the impoverished community of Dharavi (Asia’s largest slum) in Mumbai, who told us that he enrolls in clinical trials as a way to make a living because he makes more money that way then when he works as a laborer. He also told us that he has many friends who do the same. Most of them don’t tell their families because there is some shame associated with doing this.

Sundaram: You report that some U.S. pharmaceutical companies chose patients for their tests at a hospital in Bhopal that was built as a memorial to the 1984 victims of the Union Carbide gas leak. Satinath Sarangi, the activist who is working to get justice for the survivors and one of the people you interviewed, said that 100 Bhopal survivors in six trials enabled the hospital to earn a whopping $220,000. How long were trials allowed to go on there?

Awad: Yes, it is ironic — and sad. The hospital in Bhopal was built by Union Carbide as part of their compensation for the victims of the 1984 gas-leak disaster. But after the scandal about drug testing on the gas leak survivors broke last year, the government took over and banned all testing.

The drug trials ran from 2004 until 2008. The complete lack of empathy of both the doctors we secretly recorded stood out to me. In addition to what one of them says in our film, he also told us he believes the reason why his hospital has been singled out was because others were “jealous” of the hospital’s performance. Some of the pharmaceutical companies and CROs [Clinical Research Organizations] who ran the trials refused to speak to us. Meanwhile, people who are almost always poor and often illiterate fell by the wayside.