Clinical research by academic institutions and pharmaceutical companies has followed the general trend of globalization and has moved inexorably towards low- and middle-income countries (LMIC). This trend has raised various concerns, including whether the research being conducted is of value to public health in these countries or whether economically disadvantaged populations are being exploited for the benefit of patients in rich countries. Nevertheless, clinical trials and the research and health care that accompany them can directly benefit patients, in particular those who would otherwise have no or only little access to health care services. It is therefore a matter of striking a fine-tuned balance between the economic and research interests of pharmaceutical companies and academia and the needs of patients in LMIC to make sure that all sides benefit.Clinical trials are a necessary step in drug development and are conducted throughout the world, both in developed and in developing countries. Trials themselves are thus not per se immoral, and there are a variety of reasons to conduct responsible clinical trials in LMIC. Doing so, for example, is often the only way to test drugs and vaccines for diseases that predominantly afflict people in these countries; trying to test the safety and efficacy of a malaria vaccine in Europe or North America would be relatively futile given the lack of patients. Beyond the obvious and direct public health benefits—in terms of both new knowledge and new treatments—clinical research also helps to build research and health care capacity and can improve local infrastructure and boost the economy. In fact, many developing countries have been actively trying to attract clinical research for these reasons.