Wednesday, July 30, 2008
Friday, July 25, 2008
Has the IMF helped to spread tuberculosis?
Saturday, July 19, 2008
Defining 'responsiveness' in global health research
This moral intuition, in turn, gave rise to the idea that health research should be 'responsive' to the needs of communities in which the research was conducted. The idea of responsiveness has found expression in different international ethics documents, including later versions of the Helsinki Declaration, CIOMS' International Ethical Guidelines for Biomedical Research Involving Human Subjects, and UNAIDS documents. Inevitably, the multiple formulations of 'responsiveness' in all these documents, as well as its variant uses among ethicists, has rendered the concept ambiguous. When is a research project responsive, and when not? Since all research projects typically include some benefits for individual participants or communities, aren't all of them 'responsive' in a sense? So where is the problem? If the concept of responsiveness stays indeterminate, it has no teeth to criticize actual research projects and hence to help counteract the '90/10 gap' . At worst, it just ends up being another stock phrase in global research ethics circles, bounced around at conferences, and ignored (or paid lip service to) by those with power in international research.
In the July 5th issue of the Lancet, Alex John London and Jonathan Kimmelman attempt to give a definition of responsiveness that aims to do some work for global justice. According to London and Kimmelman, " . . . [research] protocols should be defined as responsive to the health needs of the host community only if they are part of a program of inquiry that will expand the capacity of health-related social structures in the host community to meet urgent health needs." Some research -- the authors cite gene transfer studies in Brazil -- going on in low-income countries does not pass the criterion of responsiveness, and at least by this measure, are unethical. There will be inevitably discussions about whether such-and-such study passes or does not meet the responsiveness definition. But the proposed definition will at least do away with arguments that an international research project is 'responsive' because (for example) a laboratory has been set up or a couple of field workers have been hired to faciliate a project that has, in fact, little to do with urgent health needs of the local population.
Thursday, July 10, 2008
A well-intentioned amputation?
Back in April, in Kaju (Nigeria), Dr. Allison amputated the arms of Saratu Yusuf after she had been hit by a truck, and -- according to Dr. Allison and some witnesses -- her arms were already effectively severed. Had he not intervened rapidly, she might have faced serious medical complications. But the amputation was performed without permission of her parents, and Saratu seems to dispute the claim that her arms could not be viably reconnected. She claims the doctor asked for money up front for medical aid, and that he amputated her arms against her explicit wishes. The Yusuf family is seeking compensation for the fact that Saratu will not be able to work, in the order of almost half a million US dollars -- in a country where the average income is roughly $300 per year.
Dr. Allison's problems do not end there. Refusing to pay the compensation landed him in jail for a week. His clinic has been closed, and his medical instruments seized. Besides being discussed in the press, he is accused by community members of amputing the arms for purposes of 'black magic', the real or imagined stealing of body parts being a familiar theme in sub-Saharan Africa. He has received death threats; a mob threatened to burn down his clinic. The sad picture of Saratu, all-too-reminiscent of child victims of war crimes, is bound to affect public opinion of Dr. Allison.
Dr. Allison claims that his actions were motivated purely by his Hippocratic Oath. If this is so, this is a case of 'no good deed goes unpunished.' The usual story in sub-Saharan Africa is that the notion of patient rights need to be strengthened to counteract potential abuses of medical practitioners (and researchers). And this is largely true. But the case of Dr. Allison suggests that doctors also need some level of protection from families and communities hellbent on retribution.