As Marcia Angell, editor of The New England Journal of Medicine , observed in an editorial, such a study would be impermissible in an industrialized country. Of course, if you do all that, it becomes hard to tell whether the microbicide works. While the clinical trials process plods slowly along, much of the basic science has yet to be settled, and basic microbial design issues remain unclear. It seems that it will take a long time to arrive at a marketable microbicide. Still, the idea has growing appeal and could be embodied in a soft-tech approach feasible throughout the world.
Many possible agents are already available.
Toxicities and cost need not present much of an obstacle even for a microbicide with broad-spectrum activity. Although the details are unsettled, the technological hurdles do not appear that difficult given sufficient political will.