Showing papers by "Thomas E. Novotny published in 2006"

US Department of Health and Human Services: a need for global health leadership in preparedness and health diplomacy.

Abstract: More than ever before the US Department of Health and Human Services (DHHS) needs to be a global health agency working to protect the health economic and security interests of US citizens through global collaboration and commitment to the public good. Public health preparedness extends beyond public health surveillance preparation for bioterrorism and political policy. Preparedness involves understanding the 21st-century world--its changing disease burden its changing demographics and its changing political and environmental substrata. It is the moral responsibility of the US government particularly through its lead health entity to address the high-disease burden global health challenges. DHHS agencies must work within multinational and bilateral structures to build consensus respond to global health threats and cultivate science to build a strong global public health infrastructure. Global health is both an economic priority and a security priority of the United States. Therefore the collective expertise of multiple disciplines must be harnessed to support the best approaches to the major global health challenges. The disciplines of epidemiology health policy economics law environmental science and certainly bioethics can make essential contributions to a comprehensive global health strategy. (excerpt)

The "ultimate prize" for big tobacco: opening the Chinese cigarette market by cigarette smuggling.

Abstract: Novotny discusses a new study in PLoS Medicine that documents how British American Tobacco has exploited China's large cigarette smuggling problem.

Bioethical Implications of Globalization: An International Consortium Project of the European Commission

Abstract: Policy Forum Bioethical Implications of Globalization: An International Consortium Project of the European Commission Thomas E. Novotny*, Emilio Mordini, Ruth Chadwick, J. Martin Pedersen, Fabrizio Fabbri, Reidar Lie, Natapong Thanachaiboot, Elias Mossialos, Govind Permanand T he term “globalization” was popularized by Marshall McLuhan in War and Peace in the Global Village. In the book, McLuhan described how the global media shaped current events surrounding the Vietnam War [1] and also predicted how modern information and communication technologies would accelerate world progress through trade and knowledge development. Globalization now refers to a broad range of issues regarding the movement of goods and services through trade liberalization, and the movement of people through migration. Much has also been written on the global effects of environmental degradation, population growth, and economic disparities. In addition, the pace of scientific development has accelerated, with both negative and positive implications for global health. Concerns for national health transcend borders, with a need for shared human security and an enhanced role for international cooperation and development [2]. These issues have significant bioethical implications, and thus a renewed academic focus on the ethical dimensions of public health is needed. Future developments in science and health policy also require a firm grounding in bioethical principles. These core principles include beneficence; nonmaleficence (to do no harm); respect for persons and human dignity (autonomy); and attention to equity and social justice. According to the World Health Organization [3], global ethical approaches should (1) monitor and update ethical norms for research, as necessary; (2) anticipate The Policy Forum allows health policy makers around the world to discuss challenges and opportunities for improving health care in their societies. PLoS Medicine | www.plosmedicine.org ethical implications of advances in science and technology for health; (3) apply internationally accepted codes of ethics; (4) ensure that agreed standards guide future work on the human genome; and (5) ensure that quality in health systems and services is assessed and promoted. Box 1. The Delphi Method Delphi is a group communication technique designed to obtain opinions from a panel of selected experts on specific issues through the sending of questionnaires to be completed within a specified time. The experts are contacted individually and they do not know other group participants and their opinions—the aim is to submit the group participants to the same conditions. Participants do not meet personally, thereby avoiding undue influence. The process foresees the following points: • Identification of the problem • Selection of the relevant questions • Preparation and delivery of the first questionnaire • Analysis of the answers and elaboration of the first synthesis; preparation and delivery of a second questionnaire containing reformulated questions based on such elements as results from analysis of and comments upon the first questionnaire, illustrative of how other participants have answered previous questions • Analysis and synthesis of answers • Delivery of further questionnaires as required The process is repeated a number of times, until a convergence of all group members is obtained. The process ends with analysis of the answers and formulation of the final report. (Adapted from http://www.bigproject. org/dephi.htm) The Bioethical Implications of Globalization Project The Bioethical Implications of Globalization (BIG) Project is a 42-month dialogue funded by the European Commission that involves a series of expert panel discussions on four specific globalization and health subject areas: (1) mobility of people; (2) technological globalization; (3) liberalization of trade; and (4) new global health threats (bioterrorism). In addition, BIG includes a multiple- round Delphi Process (Box 1) to solicit input on these issues from a broad, interdisciplinary audience. The project’s purpose is both to raise short-term, practical considerations about globalization and health and Citation: Novotny TE, Mordini E, Chadwick R, Pederson JM, Fabbri F, et al. (2006) Bioethical implications of globalization: An international consortium project of the European Commission. PLoS Med 3(2): e43. Copyright: © 2006 Novotny et al. This is an open- access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abbreviations: BIG, Bioethical Implications of Globalization; GM, genetically modified Thomas E. Novotny is at Global Health Sciences, University of California San Francisco, San Francisco, United States of America. Emilio Mordini is at the Centre for Science, Society, and Citizenship, Rome, Italy. Ruth Chadwick and J. Martin Pedersen are at the University of Lancaster, Lancaster, United Kingdom. Fabrizio Fabbri is at the International Society of Doctors for the Environment, Rome, Italy. Reidar Lie and Natapong Thanachaiboot are at the University of Bergen, Bergen, Norway. Elias Mossialos and Govind Permanand are at the London School of Economics and Political Science, London, United Kingdom. Competing Interests: This project is supported by the European Commission (contract QLRT-2001- 01796). Thomas E. Novotny is on the editorial board of PLoS Medicine. * To whom correspondence should be addressed: tnovotny@psg.ucsf.edu DOI: 10.1371/journal.pmed.0030043 February 2006 | Volume 3 | Issue 2 | e43

Bioethical Implications of Globalization: an international consortium project of the European Commission.

Abstract: Policy Forum Bioethical Implications of Globalization: An International Consortium Project of the European Commission Thomas E. Novotny*, Emilio Mordini, Ruth Chadwick, J. Martin Pedersen, Fabrizio Fabbri, Reidar Lie, Natapong Thanachaiboot, Elias Mossialos, Govind Permanand T he term “globalization” was popularized by Marshall McLuhan in War and Peace in the Global Village. In the book, McLuhan described how the global media shaped current events surrounding the Vietnam War [1] and also predicted how modern information and communication technologies would accelerate world progress through trade and knowledge development. Globalization now refers to a broad range of issues regarding the movement of goods and services through trade liberalization, and the movement of people through migration. Much has also been written on the global effects of environmental degradation, population growth, and economic disparities. In addition, the pace of scientific development has accelerated, with both negative and positive implications for global health. Concerns for national health transcend borders, with a need for shared human security and an enhanced role for international cooperation and development [2]. These issues have significant bioethical implications, and thus a renewed academic focus on the ethical dimensions of public health is needed. Future developments in science and health policy also require a firm grounding in bioethical principles. These core principles include beneficence; nonmaleficence (to do no harm); respect for persons and human dignity (autonomy); and attention to equity and social justice. According to the World Health Organization [3], global ethical approaches should (1) monitor and update ethical norms for research, as necessary; (2) anticipate The Policy Forum allows health policy makers around the world to discuss challenges and opportunities for improving health care in their societies. PLoS Medicine | www.plosmedicine.org ethical implications of advances in science and technology for health; (3) apply internationally accepted codes of ethics; (4) ensure that agreed standards guide future work on the human genome; and (5) ensure that quality in health systems and services is assessed and promoted. Box 1. The Delphi Method Delphi is a group communication technique designed to obtain opinions from a panel of selected experts on specific issues through the sending of questionnaires to be completed within a specified time. The experts are contacted individually and they do not know other group participants and their opinions—the aim is to submit the group participants to the same conditions. Participants do not meet personally, thereby avoiding undue influence. The process foresees the following points: • Identification of the problem • Selection of the relevant questions • Preparation and delivery of the first questionnaire • Analysis of the answers and elaboration of the first synthesis; preparation and delivery of a second questionnaire containing reformulated questions based on such elements as results from analysis of and comments upon the first questionnaire, illustrative of how other participants have answered previous questions • Analysis and synthesis of answers • Delivery of further questionnaires as required The process is repeated a number of times, until a convergence of all group members is obtained. The process ends with analysis of the answers and formulation of the final report. (Adapted from http://www.bigproject. org/dephi.htm) The Bioethical Implications of Globalization Project The Bioethical Implications of Globalization (BIG) Project is a 42-month dialogue funded by the European Commission that involves a series of expert panel discussions on four specific globalization and health subject areas: (1) mobility of people; (2) technological globalization; (3) liberalization of trade; and (4) new global health threats (bioterrorism). In addition, BIG includes a multiple- round Delphi Process (Box 1) to solicit input on these issues from a broad, interdisciplinary audience. The project’s purpose is both to raise short-term, practical considerations about globalization and health and Citation: Novotny TE, Mordini E, Chadwick R, Pederson JM, Fabbri F, et al. (2006) Bioethical implications of globalization: An international consortium project of the European Commission. PLoS Med 3(2): e43. Copyright: © 2006 Novotny et al. This is an open- access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abbreviations: BIG, Bioethical Implications of Globalization; GM, genetically modified Thomas E. Novotny is at Global Health Sciences, University of California San Francisco, San Francisco, United States of America. Emilio Mordini is at the Centre for Science, Society, and Citizenship, Rome, Italy. Ruth Chadwick and J. Martin Pedersen are at the University of Lancaster, Lancaster, United Kingdom. Fabrizio Fabbri is at the International Society of Doctors for the Environment, Rome, Italy. Reidar Lie and Natapong Thanachaiboot are at the University of Bergen, Bergen, Norway. Elias Mossialos and Govind Permanand are at the London School of Economics and Political Science, London, United Kingdom. Competing Interests: This project is supported by the European Commission (contract QLRT-2001- 01796). Thomas E. Novotny is on the editorial board of PLoS Medicine. * To whom correspondence should be addressed: tnovotny@psg.ucsf.edu DOI: 10.1371/journal.pmed.0030043 February 2006 | Volume 3 | Issue 2 | e43

Marked improvement in survival among adult Croatian AIDS patients after the introduction of highly active antiretroviral treatment.

Abstract: We compared the survival of patients following the first AIDS event in Croatia from the period 1986-1996 to the period 1997-2000. A total of 72 (81.8%) out of 88 patients from 1986-1996 and 18 (32.1%) out of 56 from 1997-2000 died. Survival following the first AIDS-defining illness markedly improved in the period 1997-2000 compared to the period 1986-1996 (adjusted Hazard Ratio (HR) for patients surviving more than 6 months: 0.11, 95% confidence interval (95% CI) = 0.04-0.29). A CD4+ cell count of < 100 x 10(6)/L was an independent risk factor for patients surviving up to 2 years (adjusted HR = 1.96, 95% CI = 1.1-3.43, p = 0.02). Patients with tuberculosis or fungal infections had a longer survival when compared to other diagnosis (adjusted HR = 0.53, 95% CI = 0.32-0.90, p = 0.01). However, despite dramatic survival benefit of combination antiretroviral therapy, mortality at six months following the first AIDS event was similar in the two study periods and the one-year probability of death was still substantial (27.2%) in the period 1997-2000.