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

World Health Organization Guidance on Ethical Considerations in Planning and Reviewing Research Studies on Sexual and Reproductive Health in Adolescents.

Background
Post-September 11, 2001, the U.S. government has labeled thousands of Afghan war detainees "unlawful combatants". This label effectively deprives these detainees of the protection they would receive as "prisoners of war" under international humanitarian law. Reports have emerged that indicate that thousands of detainees being held in secret military facilities outside the United States are being subjected to questionable "stress and duress" interrogation tactics by U.S. authorities. If true, American military physicians could be inadvertently becoming complicit in detainee abuse. Moreover, the American government's openly negative views towards such detainees could result in military physicians not wanting to provide reasonable care to detainees, despite it being their ethical duty to do so.

/pdf/american-physicians-and-dual-loyalty-obligations-in-the-war-vrbtrrcdfi.pdf

American physicians and dual loyalty obligations in the "war on terror"

Recruiting nurses from other countries is a long-standing practice. In recent years many countries in the developed world have more frequently recruited nurses from the developing world, causing an imbalance in the health services in often already impoverished countries. Despite guidelines and promises by developed countries that the practice should cease, it has largely failed to do so. A consortium of authors from countries that have experienced significant nurse poaching consider the ethical aspects behind this continuing practice.

The Ethics of Nurse Poaching from the Developing World

While governments have been focusing on the unprecedented disruption to the global economy caused by coronavirus disease 2019 (COVID-19) and the urgent need for COVID-19 research, other health research has become a casualty of the pandemic. Major research operations that are unrelated to COVID-19 have been significantly diminished or suspended entirely because of either COVID-19-related legal restrictions or logistical, staffing or operational concerns. Billions of people globally are currently affected by lockdowns or curfews. Since the timescale of such restrictive measures is unknown and subject to change, many studies are now in limbo and the welfare of tens of thousands of study participants is at risk. These circumstances have introduced complex ethical challenges that merit urgent attention from international sponsors, researchers and regulators. Certain sponsors and regulators have published guidelines on how the COVID-19-related disruptions to clinical research should be managed. Although these guidelines provide a good starting point in navigating the challenges of the evolving pandemic, they only apply to those researchers funded or governed by these bodies. Here, we provide guidelines on managing such disruptions that apply beyond these specific settings. We highlight some of the effects of the COVID-19 pandemic on other ongoing research projects that are unrelated to COVID-19 and provide practical guidance on how the welfare of affected study participants should be managed. We conclude that policy-makers, sponsors, researchers and regulators must adopt a more flexible approach to ensure participant safety, while maintaining data integrity and complying with good clinical practices.

The impact of the COVID-19 pandemic response on other health research.

Responding to drug-resistant tuberculosis is possibly one of the most profound challenges facing global health. Leading experts have used apocalyptic language in describing the scope of the challenges posed by extensively drug-resistant TB (XDR-TB), even suggesting that we resort to prayer as a solution.1,2 Recent reports indicating that aggressive treatment confers benefit raise hope that the situation may not be so dire.3 However, the structural and political changes and resources needed to prevent and treat XDR-TB on a large scale are not sufficient to assure that the tide of XDR-TB will be stemmed any time soon.

Drug-resistant TB is not the result of catastrophic natural forces such as earthquakes, tsunamis and hurricanes. It is not caused by malign human intent, as are terrorism and war, nor is it fostered by our dysfunctional relationship with the animal kingdom as are severe acute respiratory syndrome (SARS) and avian influenza. The locus of risk and control is entirely within the human domain. Our response to the emergence of drug-resistant TB is profoundly ethical as it raises issues of how justice and human rights are realized in our collective response to a disease. It also underscores how the global community responds to its most disadvantaged members.

The progressive worsening of resistance of TB to pharmacotherapy has raised the spectre of a response to TB without medication – what some have labelled the dawn of the post-antibiotic age. The combination of high rates of TB infection with high seropositivity rates for HIV in sub-Saharan Africa adds new levels of complexity to diagnosis and treatment and has raised the ante of global TB control.4

WHO has launched an eight-point plan to respond to XDR-TB.5 This paper provides an elaboration of these recommendations and adds some additional considerations as moral correlates to the current WHO plan (Box 1).

Box 1The WHO eight-point plan and additional considerations
WHO recommendations
1. Strengthen quality of basic TB and HIV/AIDS control

2. Scale up programmatic management of MDR-TB and XDR-TB

3. Strengthen laboratory services

4. Expand MDR-TB and XDR-TB surveillance

5. Develop and implement infection control measures

6. Strengthen advocacy, communication and social mobilization

7. Pursue resource mobilization at all levels

8. Promote research and development of new tools


Additional considerations
1. Adherence research

2. Building the evidence-base for infection control practices

3. Supporting communities

4. Enhancing public health response while addressing the social determinants of health

5. Embracing palliative care

6. Advocacy for research

/pdf/apocalypse-or-redemption-responding-to-extensively-drug-9t7wqltfp8.pdf

Jerome Amir Singh

Papers

World Health Organization Guidance on Ethical Considerations in Planning and Reviewing Research Studies on Sexual and Reproductive Health in Adolescents.

American physicians and dual loyalty obligations in the "war on terror"

The Ethics of Nurse Poaching from the Developing World

The impact of the COVID-19 pandemic response on other health research.

Apocalypse or redemption: responding to extensively drug-resistant tuberculosis