Showing papers by "Jerome Amir Singh published in 2007"
TL;DR: The authors argue that there have been few systematic attempts to determine the effectiveness of community engagement in research.
Abstract: Health (GCGH) initiative, discussed in the fi rst article in this series [3], we are exploring a range of ESC issues identifi ed by the GCGH investigators and developing world key informants, discussed in the second article in this series [4]. The investigators and key informants placed particular emphasis upon the importance of community engagement, and therefore we prepared a conceptual paper on this topic, which we distributed as a working paper to GCGH investigators and program staff at the 2nd Annual GCGH Meeting. In this article, we summarize this conceptual paper. We fi rst examine the concept of CE in research in developing countries, then we describe published models of CE, and fi nally we discuss two relevant examples of CE in research from Africa. What Is a Community?
340 citations
TL;DR: The threat to regional and global public health posed by XDR-TB in KwaZulu-Natal is discussed, and new measures to control the outbreak are proposed.
Abstract: On September 1, 2006, the World Health Organisation (WHO) announced that a deadly new strain of extensively drug-resistant tuberculosis (XDR-TB) had been detected in Tugela Ferry (Figure 1), a rural town in the South African province of KwaZulu-Natal (KZN) [1], the epicentre of South Africa's HIV/AIDS epidemic. Of the 544 patients studied in the area in 2005, 221 had multi-drug-resistant tuberculosis (MDR-TB), that is, Mycobacterium tuberculosis that is resistant to at least rifampicin and isoniazid. Of these 221 cases, 53 were identified as XDR-TB (see Table 1 and [2]), i.e., MDR-TB plus resistance to at least three of the six classes of second-line agents [3]. This reportedly represents almost one-sixth of all known XDR-TB cases reported worldwide [4]. Of the 53, 44 were tested for HIV and all were HIV infected.
Figure 1
Map of South Africa Showing Tugela Ferry in the Province of KwaZulu-Natal, the Epicentre of South Africa's HIV/AIDS Epidemic
Table 1
Characteristics of Patients in South Africa With XDR-TB
The median survival from the time of sputum specimen collection was 16 days for 52 of the 53 infected individuals, including six health workers and those reportedly taking antiretrovirals [2]. Such a fatality rate for XDR-TB, especially within such a relatively short period of time, is unprecedented anywhere in the world.
209 citations
TL;DR: It is shown how legal measures have been used to attain health and human rights with case examples from India and South Africa that resulted in large public-health benefits.
81 citations
TL;DR: The Grand Challenges initiative has 44 projects worldwide aimed at addressing diseases of the poor and what are the ethical, social, and cultural issues that the initiative faces?
Abstract: The Grand Challenges initiative has 44 projects worldwide aimed at addressing diseases of the poor. What are the ethical, social, and cultural issues that the initiative faces?
49 citations
TL;DR: The authors discuss the different types of civil society organizations, their role in biomedical research, and the advantages and challenges of working with them.
Abstract: In October 2005 the Bill & Melinda Gates Foundation announced an approximately US$450 million sponsorship of 44 innovative projects under the auspices of its Grand Challenges in Global Health (GCGH) initiative. As described in the opening article in this series we serve as an advisory service on ethical social and cultural (ESC) issues for these projects. We are exploring a range of ESC issues identified by the GCGH investigators and independently by developing world key informants in a study published as the second paper in this series. The investigators and key informants placed particular emphasis on the importance of engaging with CSOs in research and therefore we prepared a conceptual paper on this topic which we distributed as a working paper to GCGH investigators and program staff at the 2nd Annual GCGH Meeting held in Washington D. C. in October 2006. This work represents the final version of our analysis. Our article aims to delineate different types of CSOs their role in biomedical research and the advantages and challenges of working with them. We stress that despite the challenges it is in the best interests of science and researchers working in the developing world to identify and engage with CSOs. We also argue that there is a need for empirical research on best practice models of CSO-researcher engagements and for evaluation of these models. (excerpt)
44 citations
TL;DR: The authors interviewed key informants from the developing world and the Grand Challenges investigators to explore their ethical, social, and cultural concerns about the program.
Abstract: In 2005 we launched the Ethical Social and Cultural (ESC) Program for the Grand Challenges in Global Health (GCGH) initiative as described in the first article in this series. To identify key ESC issues we conducted group discussions with investigators and program officers from the GCGH projects as well as interviews with developing world experts. Our approach is shown in Box 1. This compilation of views from investigators and developing world experts is the first description of ESC issues for the GCGH initiative. To our knowledge it is also the first analysis of ESC issues related to a large-scale science program in the developing world. In this article we outline the ESC issues identified by these key informants. (excerpt)
26 citations
TL;DR: It is argued that in the long term there should be comprehensive law reform for child research, but in the short term amendments should be made to the Act to narrow the scope of this requirement for ministerial consent for low-risk research without direct benefits.
Abstract: The new National Health Act has clarified that children may take part in ‘non-therapeutic’ research (NTR) and the age at which they may provide independent consent to such research, viz. at legal majority. However, the Act will require consent from the Minister of Health for all research classed as NTR and involving minors regardless of the level of risk. This requirement is overly broad. It will require that low-risk research without direct benefits, which might be adequately reviewed by an accredited research ethics committee (REC), must also be reviewed by the Minister. As it currently stands this requirement serves no plausible ethical purpose, will cause delays and discourage essential research on the needs of children, and may inspire researchers and RECs alike to ‘foil the system’. We argue that in the long term there should be comprehensive law reform for child research. However, in the short term, amendments should be made to the Act to narrow the scope of this provision. The amendment should require ministerial consent for research that is currently not approvable by an REC in terms of national ethical guidelines, namely, research that does not hold out direct benefit but presents more than a minor increase over minimal risk. If our law reform recommendations are rejected, we favour the delegation of this task to RECs because, if they receive appropriate training, they should be competent to conduct it. We accept the disadvantages, namely that the same body will review protocols twice from slightly different perspectives and that certain categories of research will remain unapprovable. S Afr Med J 2007; 97: 200-202.
10 citations
TL;DR: If faced with a conflict between following national policies and following universally accepted, multilateral principles of international law and ethics, military physicians should consider themselves ethically bound to follow the latter.
Abstract: Several international legal instruments and ethical guidelines bestow rights and impose duties on detainees and military physicians, respectively. Ideological totalism, moral disengagement, and victim blame can facilitate the abuse of detainees, and this mindset must be avoided by military physicians. Physicians should report suspected violations of detainee rights to the U.N. Special Rapporteur on Torture or organizations such as the International Committee of the Red Cross, Medecins Sans Frontieres, Amnesty International, Physicians for Human Rights, or Human Rights Watch. To discourage victimization of physician whistleblowers on detainee abuse, domestic medical associations should pressure their respective governments to explicitly endorse their codes of ethics. Domestic medical communities should regard it as their ethical duty to pressure their respective governments to accede to the Optional Protocol to the Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment, if their governments have not already done so. They should also regard it as their ethical duty to pressure their governments to afford "prisoner of war" status to persons they detain. If faced with a conflict between following national policies and following universally accepted, multilateral principles of international law and ethics, military physicians should consider themselves ethically bound to follow the latter. The duty of care must supercede any blanket notion of loyalty, obligation, allegiance, or patriotism that the physician may feel is owed to his or her station. This is the true ethos of service to humankind.
9 citations
Journal Article•
TL;DR: It is shown how legal measures have been used to attain health and human rights with case examples from India and South Africa that resulted in large public-health benefits.
1 citations