政治自由主义 = Political liberalism

http://depts.washington.edu/sphnet/wp-content/uploads/2013/01/Coovadia.pdf

The health and health system of South Africa: historical roots of current public health challenges

Biomedical engineers have traditionally developed technologies in response to the needs of the developed world's medical community. As a result, the diagnostic systems on which they have worked have met the requirements of well-funded laboratories in highly regulated and quality-assessed environments. However, such approaches do not address the needs of the majority of the world's people afflicted with infectious diseases, who have, at best, access to poorly resourced health care facilities with almost no supporting clinical laboratory infrastructure. A major challenge for the biomedical engineering community is to develop diagnostic tests to meet the needs of these people, the majority of whom are in the developing world. We here review the context in which the diagnostics must operate, some of the appropriate diagnostic technologies already in distribution, and some emerging technologies that promise to address this challenge. However, there is much room for innovation, adaptation, and cost reduction be...

https://www.annualreviews.org/doi/pdf/10.1146/annurev.bioeng.10.061807.160524

Point-of-care diagnostics for global health.

http://sa.indiaenvironmentportal.org.in/files/Multidrug-resistant.pdf

Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances. However, countries are responding far too slowly. Of the estimated 440 000 cases of MDR tuberculosis that occurred in 2008, only 7% were identifi ed and reported to WHO. Of these cases, only a fi fth were treated according to WHO standards. Although treatment of MDR and XDR tuberculosis is possible with currently available diagnostic techniques and drugs, the treatment course is substantially more costly and laborious than for drug-susceptible tuberculosis, with higher rates of treatment failure and mortality. Nonetheless, a few countries provide examples of how existing technologies can be used to reverse the epidemic of MDR tuberculosis within a decade. Major improvements in laboratory capacity, infection control, performance of tuberculosis control programmes, and treatment regimens for both drug-susceptible and drug-resistant disease will be needed, together with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to prevent drug-resistant strains from becoming the dominant form of tuberculosis. New diagnostic tests and drugs are likely to become available during the next few years and should accelerate control of MDR and XDR tuberculosis. Equally important, especially in the highest-burden countries of India, China, and Russia, will be a commitment to tuberculosis control including improvements in national policies and health systems that remove fi nancial barriers to treatment, encourage rational drug use, and create the infrastructure necessary to manage MDR tuberculosis on a national scale.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60410-2.pdf

Tuberculosis 2 Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

Jerome Singh considers how regulatory mechanisms can allow access to experimental interventions in humanitarian emergencies such as the Ebola epidemic.

/pdf/humanitarian-access-to-unapproved-interventions-in-public-8rt9sgbhin.pdf

Humanitarian Access to Unapproved Interventions in Public Health Emergencies of International Concern

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.

Treating War Detainees and Terror Suspects: Legal and Ethical Responsibilities of Military Physicians

The ethics of national tuberculosis programmes in low-income countries not rolling out Xpert ® MTB/RIF.

Participant safety and data integrity, critical in trials of new investigational drugs, are achieved through honest participant report and precision in the conduct of procedures. HIV prevention post-trial access studies in middle-income countries potentially offer participants many benefits including access to proven efficacious but unlicensed technologies, ancillary care that often exceeds local standards-of-care, financial reimbursement for participation and possibly unintended benefits if participants choose to share or sell investigational drugs. This case study examines the possibility that this combination of benefits may constitute an undue inducement for some participants in middle-income countries, where economic challenges are prevalent. A case study is presented of a single participant in a cohort of 382 participants who used concealment, fabrication and deception to ensure eligibility for a post-trial access study of an unlicensed HIV prevention technology at potential risk to her health and that of her fetus. A root cause analysis revealed her desire to access HIV prevention during an unplanned pregnancy with a partner whose faithfulness was in question. Researchers should consider implementation of systems to efficiently identify similar cases without inconveniencing the majority of participants Trial registration number NCT01691768.

/pdf/undue-inducement-a-case-study-in-caprisa-008-4sifef4llq.pdf

Undue inducement: a case study in CAPRISA 008.

Background
Reproductive technologies have been extensively debated in the literature. As well, feminist economists, environmentalists, and agriculturalists have generated substantial debate and literature on gender. However, the implications for women of health biotechnologies have received relatively less attention. Surprisingly, while gender based frameworks have been proposed in the context of public health policy, practice, health research, and epidemiological research, we could identify no systematic framework for gender analysis of health biotechnology in the developing world.

/pdf/sex-gender-and-health-biotechnology-points-to-consider-51r6gkn857.pdf

Jerome Amir Singh

Papers

Humanitarian Access to Unapproved Interventions in Public Health Emergencies of International Concern

Treating War Detainees and Terror Suspects: Legal and Ethical Responsibilities of Military Physicians

The ethics of national tuberculosis programmes in low-income countries not rolling out Xpert ® MTB/RIF.

Undue inducement: a case study in CAPRISA 008.

Sex, gender, and health biotechnology: points to consider