SummaryThis article documents understandings and responses to mass drug administration for the treatment and prevention of lymphatic filariasis among adults and children in northern coastal Tanzania from 2004 to 2011. Assessment of village-level distribution registers, combined with self-reported drug uptake surveys of adults, participant observation and interviews, revealed that at study sites in Pangani and Muheza districts the uptake of drugs was persistently low. The majority of people living at these highly endemic locations either did not receive or actively rejected (...) free treatment. A combination of social, economic and political reasons explain the low uptake of drugs. These include a fear of treatment ; divergence between biomedical and local understandings of lymphatic filariasis; and limited and ineffective communication about the rationale for mass treatment. Other contributory factors are the reliance upon volunteers for distribution within villages and, in some locations, strained relationships between different groups of people within villages as well as between local leaders and government officials. The article also highlights a disjuncture between self-reported uptake of drugs by adults at a village level and the higher uptake of drugs recorded in official reports. The latter informs claims that elimination will be a possibility by 2020. This gives voice to a broader problem: there is considerable pressure for those implementing MDA to report positive results. The very real challenges of making MDA work are pushed to one side – adding to a rhetoric of success at the expense of engaging with local realities. It is vital to address the kind of issues raised in this article if current attempts to eliminate lymphatic filariasis in mainland coastal Tanzania are to achieve their goal. (shrink)

Carruthers argues that knowledge of our own propositional attitudes is achieved by the same mechanism used to attain knowledge of other people's minds. This seems incompatible with "privileged access"---the idea that we have more reliable beliefs about our own mental states, regardless of the mechanism. At one point Carruthers seems to suggest he may be able to maintain privileged access, because we have additional sensory information in our own case. We raise a number of worries for this suggestion, concluding that (...) Carruthers's new theory cannot clearly preserve the superior reliability of our beliefs about our own attitudes. (shrink)

The influential public health ethics framework proposed by Childress et al. includes five “justificatory conditions,” two of which are “necessity” and “least infringement.” While the framework points to important moral values, we argue it is redundant for it to list both necessity and least infringement because they are logically equivalent. However, it is ambiguous whether Childress et al. would endorse this view, or hold the two conditions distinct. This ambiguity has resulted in confusion in public health ethics discussions citing the (...) Childress et al. framework, as demonstrated by debate between Resnik and Wilson and Dawson. We analyse this debate to resolve these ambiguities. Finally, we argue that the necessity/least infringement principle of the Childress et al. framework applies only in cases in which only one intervention is to be implemented to achieve one specific goal. In other cases, it is not essential to require that only the least infringing intervention be implemented. (shrink)

Uganda is invoked as a metaphor for a host of arguments and insights about HIV/AIDS. However, much of what has been asserted about the country is not based on the available evidence. This paper reviews findings by epidemiologists and anthropologists, and draws on the author’s experiences of researching in the country since the early 1980s. It comments on various myths about HIV/AIDS in Uganda, including myths about the origin and dissemination of the disease, about the links between HIV/AIDS and war, (...) and about declining rates of infection. It shows that much less is known about Uganda than is commonly supposed, and it offers some alternative hypotheses for interpreting HIV prevalence and incidence data. In particular it draws attention to the importance of mechanisms for social compliance. It concludes by raising concerns about the current enthusiasm for provision of anti-retroviral drugs. (shrink)

Most of us came into ecology with memories of special personal places. A cliff top that Claude Monet might have painted. Allen as a youth spent his holidays on the Dorset Coast near Swanage; he can still smell the sea breeze of his childhood. Curtin grow up on a farm in southwestern Wisconsin, the dew of the grass and the bright green on a June morning remains vivid. The catching of reptiles and insects for him awakened a curiosity about the (...) natural world that has remained to this day. But once into the field there came the scholarship. With ever tighter grant monies, the pressure to publish takes so much of the fun out of it. A climate of unbridled careerism prevails and shows itself in the incremental state of the literature: little things to list on this year's activities report. There are now even predatory journals that cynically do not seriously review submissions, and only collect page charges. As journal editors have a desperate time getting reviews done by mature scholars, instead of a hand off to their overworked graduate students. So what is to be done - how can we bring the joy and importance of discovery back into it all? After all ecology is done by human beings. Mostly it is a personal mission, for what great ecologists write is frequently personal and life changing. So an undercurrent of this book is to remind and reveal the original purpose of science. Not professional advancement, but the genuine search for novel ideas and the imperative to share hard won insights and personal passions. (shrink)