There is a trend for pharmaceutical companies to contract third parties to conduct the clinical trials that are needed to test their drugs. This trend is referred to as outsourcing, and the companies that carry out the work are called contract research organisations. In addition, clinical trials are increasingly conducted in non-traditional trial regions, which are mainly low-and middle-income countries. This trend is called offshoring. The combination of outsourcing and offshoring poses serious risks for the ethical treatment of participants in clinical trials.