This chapter contains sections titled: AIDS as a Gay Disease? Features of the Bareback Video Cultural Responses to the Bareback Video The Language of the Bareback Experience Plenitude and the Death Drive in Bareback Porn Notes.

For most of the 20th century, the condom in the United States was a cheap, useful, but largely unmentionable product. Federal and state statutes prohibited the advertising and open display of condoms, their distribution by mail and across state lines, and their sale for the purpose of birth control; in some states, even owning or using condoms was illegal. By the end of World War I, condoms were increasingly acceptable for the prevention of sexually transmitted disease, but their unique (...) dual function—for disease prevention and contraception—created ongoing ambiguities for sellers, consumers, and distributors as well as for legal, political, health, and moral leaders. Not until the 1970s did condoms emerge from the shadows and join other personal hygiene products on open drugstore and supermarket shelves and in national advertisements. Then came the 1980s and AIDS when, despite the rise of Ronald Reagan, the radical right’s demonization of condoms, and the initial reluctance of condom merchants to market to gay constituencies, the HIV/AIDS epidemic slowly but inexorably propelled the condom to the top of the prevention agenda. The condom’s journey from lewd device to global superstar was fitful, but colorful. The Comstock Act of 1873, prohibiting birth control information and devices, created a vast underground operation—periodically illuminated, however, by arrests, protests, legal proceedings, and media coverage. This essay chronicles one such moment of illumination: the legal battle in the 1920s and 1930s over the legitimacy and legality of the Trojan Brand condom trademark and the unusual series of advertisements produced by the Youngs Rubber Corporation, makers of Trojans, to dramatize the ethical and economic issues of the trademark battle. Culminating in Youngs Rubber Corporation v. C.I. Lee & Co., Inc. , this landmark case in trademark law established the right of the Trojan Brand condom, despite its ambiguous dual function, to the protection of a federal trademark. I seek to show how the Youngs antipiracy ad series illuminates the paradox of visibility by illuminating the paradox of any binary division: to establish the one depends inevitably on invoking or making visible—even if to suppress—the other. This essay is a case study in the negotiation of such a dialectic. (shrink)

Since 1981 AIDS has illuminated, like a roving searchlight, a series of ethical questions, which extend far beyond the apparently narrow limits of one disease. It has revealed, one by one, human attitudes and behaviours that were previously unquestioned, or unobserved - based on unidentified but shaky pre-suppositions.This commentary offers two contrasting perspectives on the problems facing developing countries. In the first part, I comment on the preceding article, from the perspective of a clinician who has worked for many (...) years in Africa, and who witnessed the emergence of AIDS in the early 1980s and its medical, social, political and economic consequences.1 In the second, I comment on a conference in Lusaka in September 1999 that addressed many of the issues.Narrowing the gap?“Narrowing the gap” raises questions about truth or transparency in the activities of multinational companies, the ethics and economics of health care in global society and the distribution of responsibility for unwanted side effects of new treatments. The scale of HIV infection in developing countries draws attention to weaknesses or instability in theoretical and practical structures, which serve - or should serve - human wellbeing, whenever it is disturbed by disease.Truth and transparencyDuring the last 60 years, combined with improved standards of living, the products of pharmaceutical effort and ingenuity have resulted in large gains in life expectancy. These were most marked in rich northern societies, but even poor southern countries had seen it extended by 15 to 20 years, until recently.However, “the costs of drug development are not small”.2 A detailed study of costs of clinical trials found that the total cost of new drug development can be as high as $500 million per drug.3 Patent laws allow a temporary monopoly for the production and sale for a number of years. During this “protected” …. (shrink)

The current COVID-19 pandemic and the previous SARS/MERS outbreaks of 2003 and 2012 have resulted in a series of major global public health crises. We argue that in the interest of developing effective and safe vaccines and drugs and to better understand coronaviruses and associated disease mechenisms it is necessary to integrate the large and exponentially growing body of heterogeneous coronavirus data. Ontologies play an important role in standard-based knowledge and data representation, integration, sharing, and analysis. Accordingly, we initiated the (...) development of the community-based Coronavirus Infectious Disease Ontology in early 2020. -/- As an Open Biomedical Ontology (OBO) library ontology, CIDO is open source and interoperable with other existing OBO ontologies. CIDO is aligned with the Basic Formal Ontology and Viral Infectious Disease Ontology. CIDO has imported terms from over 30 OBO ontologies. For example, CIDO imports all SARS-CoV-2 protein terms from the Protein Ontology, COVID-19-related phenotype terms from the Human Phenotype Ontology, and over 100 COVID-19 terms for vaccines (both authorized and in clinical trial) from the Vaccine Ontology. CIDO systematically represents variants of SARS-CoV-2 viruses and over 300 amino acid substitutions therein, along with over 300 diagnostic kits and methods. CIDO also describes hundreds of host-coronavirus protein-protein interactions (PPIs) and the drugs that target proteins in these PPIs. CIDO has been used to model COVID-19 related phenomena in areas such as epidemiology. The scope of CIDO was evaluated by visual analysis supported by a summarization network method. CIDO has been used in various applications such as term standardization, inference, natural language processing (NLP) and clinical data integration. We have applied the amino acid variant knowledge present in CIDO to analyze differences between SARS-CoV-2 Delta and Omicron variants. CIDO's integrative host-coronavirus PPIs and drug-target knowledge has also been used to support drug repurposing for COVID-19 treatment. -/- CIDO represents entities and relations in the domain of coronavirus diseases with a special focus on COVID-19. It supports shared knowledge representation, data and metadata standardization and integration, and has been used in a range of applications. (shrink)

Membrane damage induced by haemolytic agents does not necessarily lead to lysis: the pores that are formed at low concentration of agent are formed at low concentration of agent are not large enough to allow leakage of cytoplasmic proteins, and in many instances the lesions become repaired with time. Quite different agents induce a similar type of lesion: in each case leakage is reduced at low ionic strenth, and is prevented by divalent cations such as Ca2+ or Zn2+, suggesting a (...) possible therapeutic approach to the containment of several membrane‐damaging diseases. (shrink)

This paper examines the debate over the human immunodeficiency virus (HIV) as the cause of acquired immunodeficiency syndrome (AIDS) from an historical perspective. The changing criteria for proving the link between putative pathological agents and diseases are discussed, beginning with Robert Koch's research on anthrax in the late nineteenth century. Various versions of 'Koch's postulates' are analyzed in relation to the necessity and sufficiency arguments of logical reasoning. In addition, alterations to Koch's postulates are delineated, specifically those required (...) by the discovery of rickettsiae and viruses in the early twentieth century and by the immunological testing developed after midcentury to demonstrate the links between elusive viral agents and two diseases, hepatitis B and infectious mononucleosis. From this perspective, an examination of the AIDS debate is constructed. Molecular biologist Peter Duesberg's argument that HIV is not the cause of AIDS is analyzed in light of his contention that a version of Koch's postulates has not been satisfied. Additional research findings through 1990 relating to the etiology of AIDS are also noted. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Have We Been Careless with Socrates' Last Words?:A Rereading of the PhaedoLaurel A. Madison (bio)In section 340 of The Gay Science, Nietzsche offers what he believes will be received as a scandalous interpretation of Socrates' last words. "Whether it was death or the poison or piety or malice—something loosened his tongue at that moment and he said: 'O Crito, I owe Asclepius a rooster.' This ridiculous and terrible 'last (...) word' means for those who have ears: 'O Crito, life is a disease.'"1 Nietzsche might be surprised, however, to discover just how many readers "have ears" to hear the pessimism and resentment in Socrates' voice as he bids farewell to his life. Indeed, this interpretation has become standard among both Plato scholars and non-scholars, taking on the air of orthodoxy.2Not only is this "Nietzschean" reading widespread, it also has a significant impact on how we understand Plato's project in general and, ultimately, whether or [End Page 421] not we believe that Plato still has something to teach us. This commonly accepted interpretation reinforces the view that Socrates and Plato were ascetics of the worst kind, hostile to life and the body in particular. As a consequence, significant portions of Plato's thought are treated as woefully unenlightened. Indeed, how can we take seriously the views of such a dualist who denigrates our earthly existence and urges us to deny and repress our passions, instincts, desires, and drives—i.e., to live for death?It is assumed correctly, I think, that Socrates' last words speak volumes about both his and Plato's view of the nature and task of human existence. However, the meaning of these words, I will argue, has been seriously misinterpreted and their intended significance fundamentally obscured. Thus it is time to take another, closer look at what is arguably Socrates' most important statement—a statement uttered with his last breath:Crito, we owe a cock to Asclepius; make this offering to him and do not forget.3How are we, as readers of this dialogue, to interpret Socrates' last words? What is the meaning of his final thought, his dying wish and command? According to the standard reading of this passage, Socrates awaits the termination of his life with gratitude and relief. As death closes in on him, he asks Crito to make an offering to Asclepius, the god of healing. By invoking this god, Socrates appears to be calling attention to the recovery from an illness. But what is the illness and what is the cure? At the moment these words are uttered, Socrates is on the brink of death and it is assumed that he views his death as the cure to the illness of life. This reading is substantiated by an earlier passage where Socrates argues that "the one aim of those who practice philosophy in the proper manner is to practice for dying and death" (64a3-4). The body, Socrates argues, obscures our pursuit of the truth and the sooner we can separate our soul from this hindrance (i.e., in death) the better off we will be, for "as long as we have a body and our soul is fused with such an evil we shall never adequately attain what we desire, which we affirm to be the truth" (66b3-5). From the philosopher's perspective, then, the body is something to "disdain" (, 65d1) and "despise" (, 68c11)—indeed, to "flee" from (, 65d1). Thus given the disparagement of our bodily existence in this earlier passage, how else can we interpret Socrates' final statement?4Because this "Nietzschean" reading of Socrates' last words appears to be based in large part upon the discussion of philosophy as preparation for death, any examination of it must include an analysis of the earlier passage as well.5 However, [End Page 422] to adequately interpret the discussion of philosophy as preparation for death (or any passage in the dialogues, for that matter), we must first place it in its context within the drama of the dialogue, the philosophical significance of which has been argued at length elsewhere.6 Let us then turn to the opening scene of the dialogue, for... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Have We Been Careless with Socrates' Last Words?:A Rereading of the PhaedoLaurel A. Madison (bio)In section 340 of The Gay Science, Nietzsche offers what he believes will be received as a scandalous interpretation of Socrates' last words. "Whether it was death or the poison or piety or malice—something loosened his tongue at that moment and he said: 'O Crito, I owe Asclepius a rooster.' This ridiculous and terrible 'last (...) word' means for those who have ears: 'O Crito, life is a disease.'"1 Nietzsche might be surprised, however, to discover just how many readers "have ears" to hear the pessimism and resentment in Socrates' voice as he bids farewell to his life. Indeed, this interpretation has become standard among both Plato scholars and non-scholars, taking on the air of orthodoxy.2Not only is this "Nietzschean" reading widespread, it also has a significant impact on how we understand Plato's project in general and, ultimately, whether or [End Page 421] not we believe that Plato still has something to teach us. This commonly accepted interpretation reinforces the view that Socrates and Plato were ascetics of the worst kind, hostile to life and the body in particular. As a consequence, significant portions of Plato's thought are treated as woefully unenlightened. Indeed, how can we take seriously the views of such a dualist who denigrates our earthly existence and urges us to deny and repress our passions, instincts, desires, and drives—i.e., to live for death?It is assumed correctly, I think, that Socrates' last words speak volumes about both his and Plato's view of the nature and task of human existence. However, the meaning of these words, I will argue, has been seriously misinterpreted and their intended significance fundamentally obscured. Thus it is time to take another, closer look at what is arguably Socrates' most important statement—a statement uttered with his last breath:Crito, we owe a cock to Asclepius; make this offering to him and do not forget.3How are we, as readers of this dialogue, to interpret Socrates' last words? What is the meaning of his final thought, his dying wish and command? According to the standard reading of this passage, Socrates awaits the termination of his life with gratitude and relief. As death closes in on him, he asks Crito to make an offering to Asclepius, the god of healing. By invoking this god, Socrates appears to be calling attention to the recovery from an illness. But what is the illness and what is the cure? At the moment these words are uttered, Socrates is on the brink of death and it is assumed that he views his death as the cure to the illness of life. This reading is substantiated by an earlier passage where Socrates argues that "the one aim of those who practice philosophy in the proper manner is to practice for dying and death" (64a3-4). The body, Socrates argues, obscures our pursuit of the truth and the sooner we can separate our soul from this hindrance (i.e., in death) the better off we will be, for "as long as we have a body and our soul is fused with such an evil we shall never adequately attain what we desire, which we affirm to be the truth" (66b3-5). From the philosopher's perspective, then, the body is something to "disdain" (, 65d1) and "despise" (, 68c11)—indeed, to "flee" from (, 65d1). Thus given the disparagement of our bodily existence in this earlier passage, how else can we interpret Socrates' final statement?4Because this "Nietzschean" reading of Socrates' last words appears to be based in large part upon the discussion of philosophy as preparation for death, any examination of it must include an analysis of the earlier passage as well.5 However, [End Page 422] to adequately interpret the discussion of philosophy as preparation for death (or any passage in the dialogues, for that matter), we must first place it in its context within the drama of the dialogue, the philosophical significance of which has been argued at length elsewhere.6 Let us then turn to the opening scene of the dialogue, for... (shrink)

In this view from 2007–2009, the ethical challenges facing a potential global effort to control infectious disease are explored; they provide sobering insight into the challenges of later decades. Despite the devastating pandemic of HIV/AIDS that erupted in the early 1980s, despite the failure to eradicate polio and the emergence of resistant forms of tuberculosis that came into focus in the 1990s, and despite newly emerging diseases like Severe Acute Respiratory Syndrome (SARS) in 2003 and the fearsome prospect of (...) human-to-human avian flu, it is nevertheless a time of some excitement over prospects for effective control of much of infectious disease. Funded by national and international governmental and nongovernmental organizations (NGOs), private foundations, and even popular entertainers, large-scale new efforts are under way to address global killers like AIDS, tuberculosis, and malaria, among others. This “marvelous momentum” can be seen as part of a continuing effort from the time of Jenner onward. Extrapolating from this, we explore the notion of a “comprehensive global effort for the eradication, elimination or control of infectious disease”, with particular attention to the ethical issues that arise. This is to “think big” about disease-control efforts that are now often done in piecemeal ways. This chapter identifies five tracks along which such efforts need to be pursued: (1) national and international organizations and the development of collective will; (2) epidemiological and health care infrastructure; (3) scientific development; (4) religious, social, and cultural considerations; (5) legal and social protections for individuals and groups. Each of these poses significant ethical issues which, we argue, should be viewed in a comprehensive way, to ensure that practice, research, and policy in each of these areas understands the person with communicable infectious disease as both victim and (potential) vector. (shrink)

BackgroundPublic health guidelines have recommended that elective medical procedures, including deep brain stimulation surgery for Parkinson’s disease, should not be scheduled during the coronavirus pandemic to prevent further virus spread and overload on health care systems. However, delaying DBS surgery for PD may not be in the best interest of individual patients and is not called for in regions where virus spread is under control and inpatient facilities are not overloaded.MethodsWe administered a newly developed phone questionnaire to 20 (...) consecutive patients with PD who received DBS surgery in Ruijin Hospital in Shanghai during the COVID-19 pandemic. The questionnaire was designed to gather the patients’ experiences and perceptions on the impact of COVID-19 on their everyday activities and access to medical care.ResultsMost of the patients felt confident about the preventive measures taken by the government and hospitals, and they have changed their daily living activities accordingly. Moreover, a large majority of patients felt confident obtaining access to regular and COVID-19-related health care services if needed. Routine clinical referral, sense of security in the hospital during the outbreak, and poor control of PD symptoms were the three main reasons given by patients for seeking DBS surgery during the COVID-19 pandemic.ConclusionThe COVID-19 pandemic has considerably impacted medical care and patients’ lives but elective procedures, such as DBS surgery for PD, do not need to be rescheduled when the health care system is not overloaded and adequate public health regulations are in place. (shrink)

This study investigated the relationship between cultural value orientations and country-specific changes in mobility during the Covid-19 pandemic. The aim was to understand how cultural values relate to mobility behavior during the initial stages of the pandemic. The aggregated data include Schwartz's cultural orientations, Gross Domestic Product (GDP) per capita, number of Covid-19 cases per million, and mobility change during the Covid-19 pandemic (Google Mobility Reports; percentage decrease in retail and recreation mobility, transit station mobility, workplace mobility and percentage mobility (...) increase in residential areas). Regression analyses showed that, after controlling for economy and severity of disease, hierarchy was the primary factor reducing mobility, such as staying at home, and mobility in public spaces, such as avoiding retail and recreation sites (marginally significant). The results are discussed in the light of previous literature and the implications for social distancing measures. (shrink)

The Cold War has ended and the post-Cold War world is often presented as one in which democracy and market economies are victorious. Francis Fukuyama goes so far as to claim that democratic politics has triumphed on a global scale.[ii] At least from a statistical point of view, most nations now declare themselves to be democracies, and a majority of the global population lives in these countries.[iii] However, the claim that the West won the Cold War too easily occludes recognition (...) that the victory of democracy is restricted to the political sphere. While the dissolution of the Soviet Union has made the world “safe for democracy” in the political sphere, it has also made the world “safe for capitalism” in the economic sphere. In other words, the victory of democracy is partial since market economies remain largely undemocratic. (shrink)

Summary Many people were involved in producing the seven volumes that make up the fourth series of the Royal Society catalogue of scientific papers. Included were about two hundred volunteers and about one hundred people working either on short-term contracts or carrying out piece work. At the Royal Society there was a small, largely female, secretariat working full-time. It included both clerical and bibliographic staff. Coordinating all the work was the chemist Herbert McLeod, appointed director of the catalogue in (...) 1901. As is discussed, the position of director was created especially for him after his forced retirement from the Royal Indian Engineering College. The paper shows the complexity of the work involved in producing the catalogue, as well as something of the office culture at the Royal Society in the early twentieth century. The working conditions of the women employees, and prevailing attitudes toward the largely female clerical and bibliographic staff, are briefly discussed. (shrink)

The Nietzsche Reader brings together in one volume substantial selections from the entire body of Nietzsche’s writings, together with illuminating commentary on Nietzsche’s life and importance, and introductions to his major works and philosophical ideas. • Includes selections from all the major texts, including The Birth of Tragedy, The Gay Science, Thus Spoke Zarathustra, Beyond Good and Evil, The Anti-Christ, and Ecce Homo • Offers new translations of key pieces from Nietzsche’s unpublished “Lenzer Heide” notebook • Provides a wealth of (...) pedagogical features, such as editorial sections on Nietzsche’s life and importance, an opening introduction to his philosophical ideas, introductions to each major section, and a comprehensive guide to further reading. (shrink)

The plays written about AIDS in the past dozen years form a radical canon establishing gay men as the locus for public attention. These plays have been all but silent in their representation of women with AIDS. This article examines the marginalized women in early plays such as The Normal Heart and As Is, and the women more central to later plays such as The Baltimore Waltz, Before It Hits Home, and Patient A. It foregrounds some of the (...) most problematic issues surrounding the AIDS virus: the perception of women as vectors of disease for men and unborn children, the insistent representation of women as mothers and caregivers, and the denial of patterns of abuse, sexual exploitation, and poverty which contribute to the marginalization of woman and people of color. (shrink)

The plays written about AIDS in the past dozen years form a radical canon establishing gay men as the locus for public attention. These plays have been all but silent in their representation of women with AIDS. This article examines the marginalized women in early plays such as The Normal Heart and As Is, and the women more central to later plays such as The Baltimore Waltz, Before It Hits Home, and Patient A. It foregrounds some of the (...) most problematic issues surrounding the AIDS virus: the perception of women as vectors of disease for men and unborn children, the insistent representation of women as mothers and caregivers, and the denial of patterns of abuse, sexual exploitation, and poverty which contribute to the marginalization of woman and people of color. (shrink)

Jared Diamond and other leading scholars have argued that the domestication of animals for food, labor, and tools of war has advanced the development of human society. But by comparing practices of animal exploitation for food and resources in different societies over time, David A. Nibert reaches a strikingly different conclusion. He finds in the domestication of animals, which he renames "domesecration," a perversion of human ethics, the development of large-scale acts of violence, disastrous patterns of destruction, and growth-curbing epidemics (...) of infectious disease. Nibert centers his study on nomadic pastoralism and the development of commercial ranching, a practice that has been largely controlled by elite groups and expanded with the rise of capitalism. Beginning with the pastoral societies of the Eurasian steppe and continuing through to the exportation of Western, meat-centered eating habits throughout today's world, Nibert connects the domesecration of animals to violence, invasion, extermination, displacement, enslavement, repression, pandemic chronic disease, and hunger. In his view, conquest and subjugation were the results of the need to appropriate land and water to maintain large groups of animals, and the gross amassing of military power has its roots in the economic benefits of the exploitation, exchange, and sale of animals. Deadly zoonotic diseases, Nibert shows, have accompanied violent developments throughout history, laying waste to whole cities, societies, and civilizations. His most powerful insight situates the domesecration of animals as a precondition for the oppression of human populations, particularly indigenous peoples, an injustice impossible to rectify while the material interests of the elite are inextricably linked to the exploitation of animals. Nibert links domesecration to some of the most critical issues facing the world today, including the depletion of fresh water, topsoil, and oil reserves; global warming; and world hunger, and he reviews the U.S. government's military response to the inevitable crises of an overheated, hungry, resource-depleted world. Most animal-advocacy campaigns reinforce current oppressive practices, Nibert argues. Instead, he suggests reforms that challenge the legitimacy of both domesecration and capitalism. (shrink)

Guest Editors' introductionFor this special issue of the Journal of Medical Ethics we have assembled articles that reflect some of the newer issues or fresh perspectives. There is a mix of approaches including forward looks, present dilemmas and reflections on the past, now that sufficient time has elapsed to allow a considered view. We are most grateful to our wide range of contributors for their thoughtful analyses of several key areas of contemporary debate. Our own contributions include the following editorials (...) in which each of us has considered, from his own perspective, the impact of AIDS on medical ethics, a case study and a lexicon that allows brief probing of some topics.The impact of aids on medical ethics -1ANTHONY J PINCHINGMedical ethics has been matured through being tested and refined through the multifaceted challenge of AIDS. As with the society and social values from which its moral framework is derived, so medical ethics has been subjected to intense scrutiny by the emergence of this new disease. Few areas of ethical discourse have been untouched. This infection is so intensely private in its transmission, the disease so isolating and so personally devastating in its impact, it readily distinguishes the reality of what people are and do, from the rhetoric of what others may feel they should be and do. AIDS has forced us to recognise that respecting individual rights is a critical safeguard for the health of the community, as well as for the person. These issues are well illustrated by the interweaving issues of patient empowerment, respect for confidentiality, and patient advocacy and activism.EMPOWERMENTPhysicians in this field have been struck by the way in which people affected have wanted to be involved in decision making. While this has often been ascribed to their social groups, it probably was more a reflection of their younger age and a generation change …. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Ecology is usually described as the study of organisms interacting with one another and their environments. From this view of ecology, viruses – not usually considered to be organisms – would merely be part of the environment. Since the late 1980s, however, a growing stream of micrographic, experimental, molecular, and model-based (theoretical) research has been investigating how and why viruses should be understood as ecological actors of the most important sort. Viruses, especially phage, have been revealed as participants in the (...) planet's most crucial food webs, even though viruses technically consume nothing (they do not metabolize by themselves). Even more impressively, viruses have been identified as regulators of planetary biogeochemistry, in which they control cycles such as carbon, nitrogen and phosphorus – cycles on which all life depends. Although much biogeochemical research black-boxes the entities filling functional roles, it is useful to focus a little more closely to understand how viruses can be held responsible for the global processes of life. This paper will give a brief overview of the history of virus ecology and tease out the implications of large-scale ecological modelling with viruses. This analysis suggests that viruses should be conceptualized as ecological actors that are at least comparable and possibly equal to organismal actors. Ecological agency can therefore be distinguished from standard interpretations of biological agency. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Non-communicable diseases are no longer largely limited to high-income countries and the elderly. The burden of non-communicable diseases is rising across all country income categories, in part because these diseases have been relatively overlooked on the global health agenda. Historically, communicable diseases have been prioritized in many countries as they were perceived to constitute the greatest disease burden, especially among vulnerable and poor populations, and strategies for prevention and treatment, which had been successful in high-income settings, were considered feasible (...) and often affordable in low-income settings. This prioritization has reduced the communicable diseases burden globally but has left non-communicable diseases largely neglected. A new approach is urgently needed to tackle non-communicable diseases. Based on an analysis of potential features which may have underlain the different approaches to non-communicable diseases and communicable diseases until now, including acuity of disease, potential for control or cure, cost, infectiousness, blaming of individuals and logistical barriers, little ethical or rational justification can be found to support continued neglect of non-communicable diseases. Justice demands access to quality and affordable care for all. An equitable approach to non-communicable diseases is therefore strongly mandated on medical, ethical, economic, and public health grounds. Funding must not however be diverted away from communicable diseases, which continue to require attention—but concomitantly, funding for non-communicable diseases must be increased. International and multi-sectoral action is required to accelerate progress towards true universal health coverage and towards achievement of all of the sustainable development goals, such that prevention and access to care for non-communicable disease can become a global reality. (shrink)

In this article I read textual metaphors of ‘untouchability’ in ‘post-AIDS’ representation as an erasure of structures that condition HIV stigmatization in India. Throughout, my discussion is contextualised by the political economy of HIV and AIDS, which has been productive of particular modern sexual subjects. In the film My Brother…Nikhil, the stigmatization of Nikhil, a gay Indian man living with HIV, is constituted through visual and verbal caste metaphors, which draw on existing subject positions that are elided as (...) ‘traditional’, residual, and receding. This stigma is resolved textually through parental acceptance of the gay protagonist and his partner, projecting stigma as traditional and modernity as the resolution. Such metaphors of ‘untouchability’ prevent the representation of queer Dalit subjects in contexts of HIV and AIDS. Yet if addressing shame and social stigma are key to HIV treatment and prevention programmes, caste cannot be set aside simply as a metaphor. Expanding to include textual representations of queer Dalit subjectivity, the article reads a novel, The Boyfriend, and a poem, “Gandu Bagicha,” to show ways in which caste stigma and homophobia intersect in contexts of seroconversion risk. (shrink)

BackgroundFew studies have examined factors associated with willingness of people living with HIV to participate in HIV treatment clinical trials in Sub-Saharan Africa. We assessed the factors associated with participation of PLHIV in HIV treatment clinical trials research at a large urban clinical and research facility in Uganda.MethodsA mixed methods study was conducted at the Infectious Diseases Institute, adult HIV clinic between July 2016 and January 2017. Data were collected using structured questionnaires, focused group discussions with respondents categorised as either (...) participated or never participated in clinical trials and key informant interviews with IDI staff. A generalized linear model with a logit link function was used for multivariate analyses while the qualitative data were summarized using a thematic approach.ResultsWe enrolled a total of 202 and analysed 151 participants, 77 of whom were male with mean age of 41 years. The majority 127 expressed willingness to participate in treatment clinical trials if given an opportunity. At bivariate analysis, willingness to participate was significantly associated with respondents’ perception of a satisfactory compensation package, special status accorded and belief that their health status would improve while on the clinical trial. At multivariate analysis, a satisfactory compensation package and special status accorded in clinical trials remained significant. The qualitative data analysis confirmed these findings as participants valued the privilege of jumping the clinic waiting queues and spending less time in clinic, the wide range of free tests offered to trial participants, unrestricted access to senior physicians and regular communication from study team. Additionally, free meals offered during clinic visits meant that participants were not in a hurry to go back home. Barriers to participation included the perception that new drugs were being tested on them, fear of side effects like treatment failure and the uncertainty about privacy of their data.ConclusionWe found overwhelming willingness to participate in HIV treatment clinical trials. This was largely extrinsically influenced by the perceived material and health-related benefits. Investigators should pay attention to participants’ concerns for benefits which may override the need to understand study procedures and risks. (shrink)

Modern medicine has done much in the fields of infectious diseases and emergencies to aid cure. In most other fields, it is mostly control that it aims for, which is another name for palliation. Pharmacology, psychopharmacology included, is mostly directed towards such control and palliation too. The thrust, both of clinicians and research, must now turn decisively towards prevention and cure. Also, longevity with well-being is modern medicine's other big challenge. Advances in vaccines for hypertension, diabetes, cancers etc, deserve attention; (...) as also, the role of meditation, yoga, spirituality etc in preventing disease at various levels. Studies on longevity, life style changes and healthy centenarians deserve special scrutiny to find what aids longevity with wellbeing. A close look at complementary and alternative medicine is needed to find any suitable models they may have, cutting aside their big talk and/or hostility towards mainstream medical care. Medicine is a manifestation of the human eros, and should not become a means of its thanatos. It must realise its true potential, so that eros prevails, and thanatos prevails only ultimately, not prematurely. (shrink)

In little more than a decade, the AIDS epidemic has exerted a profound effect on morbidity and mortality among young adults and children in many parts of the world. One of the more dramatic aspects of AIDS is that it seems to have arisen almost spontaneously as a new epidemic, spreading rapidly within at-risk populations in a way that is unprecedented for the serious infectious diseases of recent memory. Tuberculosis, on the other hand, had only recently been considered (...) a disease of historical importance but of diminishing relevance to current public health priorities, especially in industrialized countries. Over the past decade, however, and in parallel with the AIDS epidemic, there has been a resurgence of tuberculosis in many of the same populations most affected by HIV infection. This has had important implications for clinical practice, public health, and the development of appropriate health policy. A number of elements have converged to promote the development of HIV-related tuberculosis, including biologic, social, and environmental factors. These will be discussed both to provide a context for understanding the relationship between the two epidemics, and as a basis for suggesting strategies for tuberculosis control in the AIDS era. (shrink)

In little more than a decade, the AIDS epidemic has exerted a profound effect on morbidity and mortality among young adults and children in many parts of the world. One of the more dramatic aspects of AIDS is that it seems to have arisen almost spontaneously as a new epidemic, spreading rapidly within at-risk populations in a way that is unprecedented for the serious infectious diseases of recent memory. Tuberculosis, on the other hand, had only recently been considered (...) a disease of historical importance but of diminishing relevance to current public health priorities, especially in industrialized countries. Over the past decade, however, and in parallel with the AIDS epidemic, there has been a resurgence of tuberculosis in many of the same populations most affected by HIV infection. This has had important implications for clinical practice, public health, and the development of appropriate health policy. A number of elements have converged to promote the development of HIV-related tuberculosis, including biologic, social, and environmental factors. These will be discussed both to provide a context for understanding the relationship between the two epidemics, and as a basis for suggesting strategies for tuberculosis control in the AIDS era. (shrink)

Disease transmission is a fruitful domain in which to examine how scientific and folk theories interrelate, given laypeople’s access to multiple sources of information to explain events of personal significance. The current paper reports an in-depth survey of U.S. adults’ causal reasoning about two viral illnesses: a novel, deadly disease that has massively disrupted everyone’s lives, and a familiar, innocuous disease that has essentially no serious consequences. Participants received a series of closed-ended and open-ended questions probing their reasoning about disease (...) transmission, with a focus on causal mechanisms underlying disease contraction, transmission, treatment, and prevention; non-visible biological processes; and ontological frameworks regarding what kinds of entities viruses are. We also assessed participants’ attitudes, such as their trust in scientific experts and willingness to be vaccinated. Results indicated complexity in people’s reasoning, consistent with the co-existence of multiple explanatory frameworks. An understanding of viral transmission and viral replication existed alongside folk theories, placeholder beliefs, and lack of differentiation between viral and non-viral disease. For example, roughly 40% of participants who explained illness in terms of the transmission of viruses also endorsed a non-viral folk theory, such as exposure to cold weather or special foods as curative. Additionally, participants made use of competing modes of construal when explaining how viruses operate, such as framing the immune system response as cells trying to fight off the virus. Indeed, participants who displayed greater knowledge about viral transmission were significantly more likely to anthropomorphize bodily processes. Although comparisons of COVID-19 and the common cold revealed relatively few differences, the latter, more familiar disease elicited consistently lower levels of accuracy and greater reliance on folk theories. Moreover, for COVID-19 in particular, accuracy positively correlated with attitudes, self-protective behaviors, and willingness to be vaccinated. For both diseases, self-assessed knowledge about the disease negatively predicted accuracy. The results are discussed in relation to challenges for formal models of explanatory reasoning. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

One proposal to significantly reduce cardiovascular disease is the idea of administering a ‘polypill’—a combination of drugs that reduce the risk of heart disease and carry few side effects—to everyone over the age of 55. Despite their promise, population strategies like the polypill have not been well-accepted. In this article, I defend the polypill by appealing to fairness. The argument focuses on the need to fairly distribute the costs to individuals. While the fact that population strategies like the polypill impose (...) minor costs on everyone has primarily been used to criticize such strategies, I argue that it gives us a reason to support them. I argue that implementing a population strategy with the polypill contributes to the public good of ‘health system capacity’. I then explain that public goods have widely accepted obligations: they carry an obligation to fairly distribute the costs of the goods and prevent free-riding. Thus, we have at least one pro tanto moral reason to implement the polypill. As such, this article challenges the current literature on the topic, which has largely held adopting population strategies like the polypill to be unjustifiable. (shrink)

In the nineteenth century natural history was widely regarded as a rational and ‘distracting’ pursuit that countered the ill-effects, physical and mental, of urban life. This familiar argument was not only made by members of naturalists’ societies but was also borrowed and adapted by alienists concerned with the moral treatment of the insane. This paper examines the work of five long-serving superintendents in Victorian Scotland and uncovers the connections made between an interest in natural history and the management of mental (...) disease. In addition to recovering a significant influence on the conduct of several alienists the paper explores arguments made outside the asylum walls in favour of natural history as an aid to mental health. Investigating the promotion of natural history as a therapeutic recreation in Scotland and elsewhere reveals more fully the moral and cultural significance attached to natural history pursuits in the nineteenth century. (shrink)

"My work has had nothing to do with gay liberation," Michel Foucault reportedly told an admirer in 1975. And indeed there is scarcely more than a passing mention of homosexuality in Foucault's scholarly writings. So why has Foucault, who died of AIDS in 1984, become a powerful source of both personal and political inspiration to an entire generation of gay activists? And why have his political philosophy and his personal life recently come under such withering, normalizing scrutiny by commentators (...) as diverse as Camille Paglia, Richard Mohr, Bruce Bawer, Roger Kimball, and biographer James Miller? David M. Halperin's Saint Foucault is an uncompromising and impassioned defense of the late French philosopher and historian as a galvanizing thinker whose career as a theorist and activist will continue to serve as a model for other gay intellectuals, activists, and scholars. A close reading of both Foucault and the increasing attacks on his life and work, it explains why straight liberals so often find in Foucault only counsels of despair on the subject of politics, whereas gay activists look to him not only for intellectual inspiration but also for a compelling example of political resistance. Halperin rescues Foucault from the endless nature-versus-nurture debate over the origins of homosexuality ("On this question I have absolutely nothing to say," Foucault himself once remarked) and argues that Foucault's decision to treat sexuality not as a biological or psychological drive but as an effect of discourse, as the product of modern systems of knowledge and power, represents a crucial political breakthrough for lesbians and gay men. Halperin explains how Foucault's radical vision of homosexuality as a strategic opportunity for self-transformation anticipated the new anti-assimilationist, anti-essentialist brand of sexual identity politics practiced by contemporary direct-action groups such as ACT UP. Halperin also offers the first synthetic account of Foucault's thinking about gay sex and the future of the lesbian and gay movement, as well as an up-to-the-minute summary of the most recent work in queer theory. "Where there is power, there is resistance," Michel Foucault wrote in The History of Sexuality, Volume I. Erudite, biting, and surprisingly moving, Saint Foucault represents Halperin's own resistance to what he views as the blatant and systematic misrepresentation of a crucial intellectual figure, a misrepresentation he sees as dramatic evidence of the continuing personal, professional, and scholarly vulnerability of all gay activists and intellectuals in the age of AIDS. (shrink)

The effects of religion, population sub-division and geography on the prevalence of deaf-mutism were investigated using information collected in the 1921 Census of Punjab. The total sample size was 9·36 million, and comprised data on thirteen Hindu castes, seventeen Muslim biraderis and two Sikh castes. A two-way analysis of variance comparing males in Hindu castes in which consanguineous marriage was prohibited, with males in Muslim biraderis which favoured first cousin marriage, indicated major differences with respect to the patterns of deaf-mutism (...) within each religion. In the Muslim population 9·1% of the relative variation in the prevalence of deaf-mutism was inter-biraderi, 36·8% between geographical regions, and 48·8% an interaction between biraderi and region, whereas among Hindus 46·8% of the observed variation was inter-caste, 12·8% inter-region and 33·6% due to caste–region interaction. From a wider disease perspective the results obtained with the Hindu community indicate the significant genetic differentiation associated with caste endogamy. As the overwhelming majority of Hindu marriages continue to be within-caste, it can be predicted that similar levels of inter-caste differences in disease frequency currently exist. By comparison, the lower level of inter-biraderi variation among Muslims is probably indicative of the dissolution of pre-existing caste boundaries and the resultant gene pool mixing that followed the large-scale conversion of Hindus to Islam during Muslim rule in North India from the 13th to the 19th centuries. (shrink)

Over the past century, animal agriculture in the United States has transformed from a system of small, family farms to a largely industrialized model—often known as ‘industrial farm animal production’ (IFAP). This model has successfully produced a large supply of cheap meat, eggs and dairy products, but at significant costs to animal welfare, the environment, the risk of zoonotic disease, the economic and social health of rural communities, and overall food abundance. Over the past 40 years, numerous critiques of (...) IFAP have been published, for both academic and non-academic audiences, mostly focusing on our obligations to animals. Here we offer a comprehensive critique of IFAP, focusing not only on our obligations to animals, but also important environmental, social, economic, and public health concerns. Our cumulative argument proceeds in five steps: (1) we briefly review the structure and key characteristics of IFAP; (2) we review the adverse effects of IFAP; (3) we review the historical development and positive rationale for IFAP; (4) we summarize previous moral critiques of IFAP, as well as defenses of it; and (5) we offer a moral critique of IFAP based on the common morality, and in particular on a principle of nonmaleficence, which we take to be the least controversial argument. (shrink)

Observing the practical situation of the techniques of assisted procreation in European societies, one is allowed to affirm that these techniques are largely in use in our societies, it did not find resistance among the secular groups of the society. It is not the case of the representatives of the Catholic church, hostile to each intervention on the reproductive mechanisms as being a violation against natural law, the most virulent opposition is linked to intervention on embryos or to each (...) way of reproduction outside of the canonic marriage, considering therefore artificial insemination as immoral and anti-juridical.The opposition between secular and the catholic groups is of unequal intensity in the different European countries, it did not stop the application and the use of these reproductive techniques although it made the adoption difficult of measures in some states, and even in the European Parliament. However, they could not oppose the scientific and medical corporation and their arguments of treatment of diseases and of sterility of men or women. This way to present these reproductive techniques in terms of lowering of suffering of couples not able to reproduce naturally received a full social acceptance and legitimation, acceptation because the origin of these techniques is incontestably scientific and legitimation because the goal is essentially medical. (shrink)

Herpes simplex virus (HSV)‐derived vectors are currently being developed for the introduction of foreign DNA into neurons. HSV vectors can facilitate a range of molecular studies on postmitotic neurons and may ultimately be used for somatic cell gene therapy for certain neurologic diseases. In this article, the salient features of the pathogenesis and molecular biology of HSV relevant to its use as a vector are described, along with an overview of the methods used to derive these vectors. The accomplishments (...) which have been made to date using the HSV vector system are discussed, with emphasis on the issues of this technology which remain to be addressed. HSV has the potential to be a most useful tool for neuronal cell transgenesis and it is likely that important neurobiological questions will be answered using this vector system. (shrink)

In attempting to determine the text of Sophocles in the places presently to be discussed, it is notmy purpose to put forward a series of novelties which, though more or less plausible, are essentially incapableof proof. I seek rather to plead for the reception of certain ascertained but neglected variants, and to establish their claims by a survey of the relevant evidence. After a somewhat prolonged study of the data, I am convinced that the chief hope of progress— apart from (...) the discovery of fresh material—lies in a more methodical use of the ancient scholia and lexicographers. Although their value has long been acknowledged, they have been employed unintelligently or at haphazard, largely because the character of their information and its sources have been imperfectly understood. One of the chief aids which they afford is in passages where the genuine reading has been displaced by an explanatory gloss. This is a possibility which critics have always recognized, but, while ready enough to suggest that the word selected for expulsion is a gloss on some other, they frequently fail to demonstrate that it is used as a gloss at all. Leaving such guess–work aside, we shall still find various grades of probability. It should be a minimum requirement that the word removed from the text is, either itself or as one of a class, a well-attested gloss of the proposed substitute. Thus in El. 800, where LA with most other MSS. have καταξως but four of the recentiores κατ' ξιαν, I think that Bothe and Monk were right in preferring κατάξι' ν. (shrink)

Over the course of the year 2020, the global scientific community dedicated considerable effort to understanding COVID-19. In this review, we discuss some of the findings accumulated between the onset of the pandemic and the end of 2020, and argue that although COVID-19 is clearly a biological disease tied to a specific virus, the culture–mind relation at the heart of cultural psychology is nonetheless essential to understanding the pandemic. Striking differences have been observed in terms of relative mortality, transmission (...) rates, behavioral responses, official policies, compliance with authorities, and even the extent to which beliefs about COVID-19 have been politicized across different societies and groups. Moreover, many minority groups have very different experiences of the pandemic relative to dominant groups, notably through existing health inequities as well as discrimination and marginalization, which we believe calls for a better integration of political and socioeconomic factors into cultural psychology and into the narrative of health and illness in psychological science more broadly. Finally, individual differences in, for example, intolerance of uncertainty, optimism, conspiratorial thinking, or collectivist orientation are influenced by cultural context, with implications for behaviors that are relevant to the spread and impact of COVID-19, such as mask-wearing and social distancing. The interplay between cultural context and the experience and expression of mental disorders continues to be documented by cultural-clinical psychology; the current work extends this thinking to infectious disease, with special attention to diseases spread by social contact and fought at least in part through social interventions. We will discuss cultural influences on the transmission, course, and outcome of COVID-19 at three levels: cross-society differences; within-society communities and intergroup relations; and individual differences shaped by cultural context. We conclude by considering potential theoretical implications of this perspective on infectious disease for cultural psychology and related disciplines, as well as practical implications of this perspective on science communication and public health interventions. (shrink)

Xenotransplantation is defined as “any procedure that involves the transplantation, implantation, or infusion into a human recipient of either live cells, tissues, or organs from a nonhuman animal source, or human body fluids, cells, tissues or organs that have had ex vivo contact with live nonhuman animal cells, tissues, or organs.” Xenotransplantation has been viewed by desperate patients and their surgeons as a solution to the problem of the paucity of human organs available for transplantation. Foes of xenotransplantation argue that (...) the use of animal organs degrades the human race and should be avoided.In this paper, we briefly review the cultural context of xenotransplantation and explore the infectious disease risk of xenotransplantation. The United States Code of Federal Regulations requires life-long surveillance of a xenotransplantation recipient due to the largely unknown risk of novel infectious disease transmitted across species, known as xenogeneic infectious disease. We argue that despite being in the interest of protecting the public health, the imposition of lifelong surveillance requirements on xenotransplant recipients effectively abrogates the right to withdraw from a clinical trial after the transplantation has taken place. Moreover, we argue that a waiver of the right to withdraw should be made explicit in the interest of full disclosure, out of respect for the research subject’s right of self-determination. (shrink)

Large scale DNA-mutation screening in patients with hereditary retinal diseases greatly enhances our knowledge about retinal function and diseases. Scientists, clinicians, patients, and families involved with retinal disorders may directly benefit from these developments. However, certain aspects of this expanding knowledge, such as the correlation between genotype and phenotype, may be much more complicated than we expect at present.

Neglected and tropical diseases, pervasive in developing countries, are important contributors to global health inequalities. They remain largely untreated due to lack of effective and affordable treatments. Resource-poor countries cannot afford to develop the public health interventions needed to control neglected diseases. In addition, neglected diseases do not represent an attractive market for pharmaceutical industry. Although a number of international commitments, stated in the Millennium Development Goals, have been made to avert the risk of communicable diseases, tropical diseases still (...) remain neglected due to delays in international assistance. This delay can be explained by the form international cooperation has generally taken, which is limited to promoting countries’ national interests, rather than social justice at a global level. This restricts the international responsibility for global inequalities in health to a humanitarian assistance. We propose an alternative view, arguing that expanding the scope of international cooperation by promoting shared health and economic value at a global level will create new opportunities for innovative, effective and affordable interventions worldwide. It will also promote neglected diseases as a global research priority. We build our argument on a proposal to replace the patenting system that currently regulates pharmaceutical research with a global fund to reward this research based on actual decreases in morbidity and mortality at a global level. We argue that this approach is beneficent because it will decrease global health inequalities and promote social justice worldwide. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:These Things I BelieveA. M. ShuhamI am a health care professional who has worked in the field for two decades. I have been part of small miracles and heartbreaking events, which kept me up at night. Although I do not [End Page 120] provide direct patient care, my advanced education and expertise allows me to advise members of the health care team when difficult questions arise about the goals (...) of treatment, questions about competency and interpreting patient preferences. I believe my interest in the field was shaped by my family’s experience dealing with the challenges that come with terminal illness and advancing age. I am humbled to have been part of their journey as they faced death with dignity and grace.Living in a small community presents significant challenges that may never occur in a large urban setting. The team you work with knows your family or the names of your children because in their spare time they are the piano teacher or soccer coach for your children, friends that knew you growing up. This close knit atmosphere can be a blessing when things go well and unbearable when mistakes are made or professionals disagree, because you still interact with one another outside the context of your professional role and this is when moral distress begins.I began working with A. J. ten years ago to facilitate the completion of a health care directive. At the time A. J was beginning to show the signs of a neuro–muscular disease experienced by other members of the family. In early 2000 most directives were fairly straightforward with the option to choose artificial nutrition and hydration or not. A. J. very specifically checked “none.” Years went by living independently for A. J. but as most illnesses progress so did A. J’s, and admission to a health care institution became necessary. In many situations medically assisted nutrition and hydration would be indicated, but in this case the wishes of the patient were known in the form of a health care directive. The decision makers inability to honor the directive was the purpose for my involvement almost a decade after my initial work with A. J.No matter where you stand in the debate regarding medically assisted nutrition and hydration being burdensome or ordinary care, most people believe in the importance of a health care directive given the histories of Nancy Cruzan, Karen Quinlan and Terri Schiavo. My objective was to compile the legal information that would elucidate the patient preferences and help staff and the decision maker understand it was time to honor the directive given the advanced stage of disease. Numerous attempts were made with the surrogate and health care professionals to help them understand state statutes on health care directives supporting a patient’s right to chose. It became clear that some of the team seemed disinterested in my concerns or my responsibility as a professional, and I began to believe the difficulty was a failure on my part to communicate clearly.During that first year conversations and meetings were scheduled with the patients decision makers and they felt unable to make a decision and requested the entire family provide input. Although they understood A. J’s wishes, they felt everyone should be in agreement. In my experience when leaving decisions of this magnitude to a large extended family, communications deteriorate and little can be accomplished. Some members in the family held fundamental religious beliefs and thought a miracle could change the prognosis. While I believe as health care professionals we must respect individual religious beliefs and values, we are also morally obligated to advocate on behalf of our patients a fundamental principle I hold dear.The health care team was no more eager to address the issue than the family. I had produced specific state statutes regarding the health care directive of a previously competent person and even in light of this information, some individuals continued to believe the surrogates decision took precedence over the directive. This growing tension left me feeling angry and ineffective, questioning my role in the organization, while watching A. J. linger in a state not chosen. I believed I had failed... (shrink)

The word “epidemic” seems inadequate to describe the spread of the HIV virus in sub-Saharan Africa. The latest estimates suggest that 28.5 million people in this region are infected, including 5 million in South Africa alone. The HIV and AIDS pandemic, with infection rates of over 20 percent in seven African countries, rivals the worst of history's disease outbreaks, including the bubonic plague of medieval times. The devastating effects of the disease on the continent are compounded by extreme (...) poverty in the region and the lack of medical infrastructure essential for delivering the full range of available treatments for HIV infection, AIDS, and the opportunistic infections associated with the disease. Of the 40 million people infected with HIV worldwide, only 730,000 receive combination antiretroviral therapies. In the entire African continent, only 30,000 infected people currently receive such forms of treatment. (shrink)

The word “epidemic” seems inadequate to describe the spread of the HIV virus in sub-Saharan Africa. The latest estimates suggest that 28.5 million people in this region are infected, including 5 million in South Africa alone. The HIV and AIDS pandemic, with infection rates of over 20 percent in seven African countries, rivals the worst of history's disease outbreaks, including the bubonic plague of medieval times. The devastating effects of the disease on the continent are compounded by extreme (...) poverty in the region and the lack of medical infrastructure essential for delivering the full range of available treatments for HIV infection, AIDS, and the opportunistic infections associated with the disease. Of the 40 million people infected with HIV worldwide, only 730,000 receive combination antiretroviral therapies. In the entire African continent, only 30,000 infected people currently receive such forms of treatment. (shrink)

Targeting high-risk populations for public health interventions is a classic tool of public health promotion programs. This practice becomes thornier when racial groups are identified as the at-risk populations. I present the particular ethical and epistemic challenges that arise when there are low-risk subpopulations within racial groups that have been identified as high-risk for a particular health concern. I focus on two examples. The black immigrant population does not have the same hypertension risk as US-born African Americans. Similarly, Finnish descendants (...) have a far lower rate of cystic fibrosis than other Caucasians. In both cases the exceptional nature of these subpopulations has been largely ignored by the designers of important public health efforts, including the recent US government dietary recommendations. I argue that amending the publicly-disseminated risk information to acknowledge these exceptions would be desirable for several reasons. First, recognizing low-risk subpopulations would allow more efficient use of limited resources. Communicating this valuable information to the subpopulations would also promote truth-telling. Finally, presenting a more nuanced empirically-supported representation of which groups are at known risk of diseases (not focusing on mere racial categories) would combat harmful biological race essentialist views held by the public. (shrink)

BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)

The novel coronavirus disease is regarded as one of the most imminent disease outbreaks which threaten public health on various levels worldwide. Because of the unpredictable outbreak nature and the virus’s pandemic intensity, people are experiencing depression, anxiety, and other strain reactions. The response to prevent and control the new coronavirus pneumonia has reached a crucial point. Therefore, it is essential—for safety and prevention purposes—to promptly predict and forecast the virus outbreak in the course of this troublesome time (...) to have control over its mortality. Recently, deep learning models are playing essential roles in handling time-series data in different applications. This paper presents a comparative study of two deep learning methods to forecast the confirmed cases and death cases of COVID-19. Long short-term memory and gated recurrent unit have been applied on time-series data in three countries: Egypt, Saudi Arabia, and Kuwait, from 1/5/2020 to 6/12/2020. The results show that LSTM has achieved the best performance in confirmed cases in the three countries, and GRU has achieved the best performance in death cases in Egypt and Kuwait. (shrink)

Advances in understanding genetic disorders have been rapid in the last few years and with them the need and desire for genetic counselling have grown. Almost simultaneously, particularly in the USA, several large screening programmes have been initiated to screen large numbers of people who may be carriers of such deleterious genes as those of Tay-Sachs disease and sickle cell anaemia. The authors of this paper, clinical medical students at University College Hospital, London, spent some time studying the ethical issues (...) raised. The first part of their study, which is not published here, relates to the biochemistry of certain genetic disorders, so leading up to the aspect of the subject which must concern readers of this journal, genetic counselling. At present genetic counselling is generally the province of the medical practitioner working with clinical biochemists, and in this paper their function is described and how programmes of screening for carriers are designed. Whether the subjects of the screening tests are found to be 'innocent' or 'guilty' psychological problems confront them, and of these the genetic counsellor must be aware. In fact the range of ethical problems raised by such counselling is wide and can only be sketched in this article. (shrink)

Before September 11, 2001, a mass-casualty terrorist attack on American soil was generally considered a remote possibility. Similarly, before October 4, 2001—the first confirmed case of anthrax caused by intentional release — widespread bioterrorism seemed implausible. Among the arguments that such a biological artack was unlikely included: the lack of a historical precedent; the technological and organizational challenges to acquiring and weaponizing a biological agent; and the almost universal moral opprobrium that would certainly accompany the use by terrorists of such (...) a weapon. In the wake of September 11th and October 4th, however, many are reconsidering the likelihood of a large-scale bioterrorist attack against civilians.The Centers for Disease Control and Prevention defines bioterrorism as the intentional release of viruses, bacteria, or toxins for the purpose of harming or killing civilian. One measurement of the public health system's level of bioterrorism preparedness is the quality and distribution of laws mandating the reporting of diseases caused by certain biological agents. (shrink)

Before September 11, 2001, a mass-casualty terrorist attack on American soil was generally considered a remote possibility. Similarly, before October 4, 2001—the first confirmed case of anthrax caused by intentional release — widespread bioterrorism seemed implausible. Among the arguments that such a biological artack was unlikely included: the lack of a historical precedent; the technological and organizational challenges to acquiring and weaponizing a biological agent; and the almost universal moral opprobrium that would certainly accompany the use by terrorists of such (...) a weapon. In the wake of September 11th and October 4th, however, many are reconsidering the likelihood of a large-scale bioterrorist attack against civilians.The Centers for Disease Control and Prevention defines bioterrorism as the intentional release of viruses, bacteria, or toxins for the purpose of harming or killing civilian. One measurement of the public health system's level of bioterrorism preparedness is the quality and distribution of laws mandating the reporting of diseases caused by certain biological agents. (shrink)