Designs on Nature: Science and Democracy in Europe and the United States.BySheila Jasanoff. Princeton (New Jersey): Princeton University Press. $35.00 (hardcover); $18.95 (paper). xv + 374 p.; ill.; index. 0‐691‐11811‐6 (hc); 0‐691‐13042‐6 (pb). 2005.

One manifestation of globalization is medical tourism. As its implications remain largely unknown, we reviewed claimed benefits and risks. Driven by high health-care costs, long waiting periods, or lack of access to new therapies in developed countries, most medical tourists (largely from the United States, Canada, and Western Europe) seek care in Asia and Latin America. Although individual patient risks may be offset by credentialing and sophistication in (some) destination country facilities, lack of benefits to poorer citizens in developing countries offering medical tourism remains a generic equity issue. Data collection, measures, and studies of medical tourism all need to be greatly improved if countries are to assess better both the magnitude and potential health implications of this trade.

Medical tourism today: What is the state of existing knowledge?

Designs on Nature: Science and Democracy in Europe and the United States

https://perso.univ-rennes1.fr/antoine.gravot/index.htm/M1%20BiotecVeg%202011-2012/SYNTHESEBIBLIO-BIOTEC/2009-Tiwari-PlantOralVaccine.pdf

Plants as bioreactors for the production of vaccine antigens.

Past themes and future trends in medical tourism research: A co-word analysis

There is a “revolving door” between federal agencies and the industries regulated by them. Often, at the end of their industry tenure, key industry personnel seek employment in government regulatory entities and vice versa. The flow of workers between the two sectors could bring about good. Industry veterans might have specialized knowledge that could be useful to regulatory bodies and former government employees could help businesses become and remain compliant with regulations. But the “revolving door” also poses at least three ethical and policy challenges that have to do with public trust and fair representation. First, the presence of former key industry personnel on review boards could adversely impact the public’s confidence in regulatory decisions about new technology products, including agrifood biotechnologies. Second, the ‘‘revolving door’’ may result in policy decisions about technologies that are biased in favor of industry interests. And third, the ‘‘revolving door’’ virtually guarantees industry a voice in the policy-making process, even though other stakeholders have no assurance that their concerns will be addressed by regulatory agencies. We believe these three problems indicate a failure of regulatory review for new technologies. The review process lacks credibility because, at the very least, it is procedurally biased in favor of industry interests. We argue that prohibiting the flow of personnel between regulatory agencies and industry would not be a satisfactory solution to the three problems of public trust and just representation. To address them, regulatory entities must reject the traditional notion of objectivity. Instead they should adopt the conception of objectivity developed by Sandra Harding and re-configure their regulatory review on the basis of it. That will ensure that a heterogeneous group of stakeholders is at the decision-making table. The fair representation of interests of different constituencies in the review process could do much to inspire warranted public confidence in regulatory protocols and decisions.

The “Revolving Door” between Regulatory Agencies and Industry: A Problem That Requires Reconceptualizing Objectivity

Recently, in increasing numbers, citizens of wealthy nations are heading to poorer countries for medical care. They are traveling to the global South as medical tourists because in their home nations either they cannot get timely medical care or they cannot afford needed treatments. This essay offers a robust, particularist ethical assessment of the practice of citizens of richer nations traveling to poorer countries for healthcare.

A robust, particularist ethical assessment of medical tourism

For the purposes of conservation or suppression of species, gene drive technology has significant potential. Theoretically speaking, with the release of even relatively few animals with gene drive ...

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Regulating animals with gene drive systems: lessons from the regulatory assessment of a genetically engineered mosquito

Like any technology, agricultural biotechnologies that use genetically modified organisms (GMOs) have their opponents and supporters. For their proponents, the significant benefits of GMOs for humans, animals and the environment clearly outweigh any risks that are inherent with new technologies (Jauhar, 2006; Reis et al , 2006). For example, crops could be genetically engineered to grow more quickly and more densely to use less land, feed the increasing world population and slow environmental degradation. These new crops could also be engineered to reduce the need for pesticides and herbicides, thus decreasing the contamination of soil and water. Similarly, animals could be engineered, for example, to lack the traits that account for their suffering in large‐scale, intensive animal farming environments.

> …ethical concerns are reduced to technical questions and, of course, technical questions beg for technical answers

Critics of GMOs and other agricultural biotechnologies do not find such claims compelling, and see the balance between risk and benefit as less clear‐cut (Margulis, 2006; Seralini et al , 2007). They contend that GM plants might have an allergenic potential that would render them unsafe for human consumption, that their nutritional value could be altered for the worse and that they could contribute to the spread of antibiotic resistance. Opponents also question the potential benefits of GMOs for the environment and animals. They worry that genetically altered plants could transfer recombinant DNA to other plants—thus threatening biodiversity—or that they might create superweeds or kill unintended organisms. Detractors also point out that GMO crops alone could not feed the world's population without serious social, economic and political changes.

These concerns about GMOs—although not a complete list—also indicate that previous and current discussions about the ethics of developing and using agricultural biotechnologies have focused solely, or at least primarily, on narrow assessments of risks and possible …

Beyond risk. A more realistic risk-benefit analysis of agricultural biotechnologies.

Genetically engineered (GE) insects, such as the GE OX513A Aedes aegypti mosquitoes, have been designed to suppress their wild-type populations so as to reduce the transmission of vector-borne diseases in humans. Apart from the ecological and epidemiological uncertainties associated with this approach, such biotechnological approaches may be used by individual governments or the global community of nations to avoid addressing the underlying structural, systemic causes of those infections [1]. For instance, the rise in the number of Zika infections in northeastern Brazil is the product of the interaction of multiple factors. A key element is the 2015 El Nino climate phenomenon (in the context of global warming). A recent Human Rights Watch Report identified other factors responsible for the spread of the infection as the failure of the state to make adequate investment in piped water and waste services for the indigent segments of its population and to address racism and socioeconomic health disparities [1]. The report also criticized the violation of sexual and reproductive rights in Brazil. However, a detailed discussion of these structural, systemic factors lies beyond the scope of this Policy Platform, which is based on our expertise in healthcare ethics, political philosophy, feminist philosophy, medical entomology, insect–pathogen interactions, innovations in the control of vector-borne diseases, risk assessment, and environmental ethics.

We discuss here key ethical questions raised by the use of GE insects, with the aim of fostering discussion between the public, researchers, policy makers, healthcare organizations, and regulatory agencies at the local, national, and international levels. We affect that goal by outlining a procedural approach to decision-making about the use of the “biotechnology” that goes beyond “community engagement.” The protocol we advocate for entails informed deliberations and decision-making at the community level. It is designed to ensure that the voices of the marginalized and vulnerable groups that would be disproportionately affected by the decision are heard during the community-wide discussions. Moreover, we make the case that the values embedded in the risk assessment should be identified so that the community can make an informed decision about the use of GE insects. In addition, we advocate for the involvement of a variety of actors whose responsibility would be to ensure that the community has the opportunity to make an informed decision based on deliberations about the use of the “biotechnology.”

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Zahra Meghani

Papers

The “Revolving Door” between Regulatory Agencies and Industry: A Problem That Requires Reconceptualizing Objectivity

A robust, particularist ethical assessment of medical tourism

Regulating animals with gene drive systems: lessons from the regulatory assessment of a genetically engineered mosquito

Beyond risk. A more realistic risk-benefit analysis of agricultural biotechnologies.

Genetically engineered mosquitoes, Zika and other arboviruses, community engagement, costs, and patents: Ethical issues