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Fresh fights roil evidence-based medicine group
Expelled Cochrane co-founder Peter Gøtzsche is suspended as head of the Nordic Cochrane Centre. A messy clash within Cochrane, an international network that promotes evidence-based medicine, is spiraling into what some see as a battle over the organization's character and purpose. Last week, prominent pharma critic Peter Gøtzsche failed in a bid to sever the Nordic Cochrane Centre in Copenhagen, which he led, from the wider international organization. Instead Gøtzsche himself was suspended by the Rigshospitalet in Copenhagen, which hosts the center. The move triggered protests from within the organization, which expelled Gøtzsche 2 months ago. At stake is not just Gøtzsche or his center, but the extent to which Cochrane can tolerate debate and dissent, observers say.
Journal Article
Strengthening Health Systems in Poor Countries: A Code of Conduct for Nongovernmental Organizations
The challenges facing efforts in Africa to increase access to antiretroviral HIV treatment underscore the urgent need to strengthen national health systems across the continent. However, donor aid to developing countries continues to be disproportionately channeled to international nongovernmental organizations (NGOs) rather than to ministries of health. The rapid proliferation of NGOs has provoked “brain drain” from the public sector by luring workers away with higher salaries, fragmentation of services, and increased management burdens for local authorities in many countries. Projects by NGOs sometimes can undermine the strengthening of public primary health care systems. We argue for a return to a public focus for donor aid, and for NGOs to adopt a code of conduct that establishes standards and best practices for NGO relationships with public sector health systems.
Journal Article
A Médecins Sans Frontières Ethics Framework for Humanitarian Innovation
Abbreviations: EMC, Ebola management centre; ERB, ethics review board; MSF, Médecins sans Frontières; PNG, Papua New Guinea; UAV, unmanned aerial vehicle Provenance: Not commissioned; externally peer-reviewed Summary Points * Humanitarian organisations often have to innovate to deliver health care and aid to populations in complex and volatile contexts. * Innovation projects can involve ethical risks and have consequences for populations even if human participants are not directly involved. Relation between humanitarian innovation and medical research and their oversight in MSF. http://dx.doi.org/10.1371/journal.pmed.1002111.g001 The framework is intended for self-guided use by nonmedical innovators (or innovation project owners) with little or no knowledge of medical ethics.\\n Applying the Framework The case studies presented in Tables 1-3 are based on analysis of abstracts and slides of conference presentations of MSF innovation projects [17-19].
Journal Article
Transnational Medicine in Public Arenas: Aids Treatments in the South
This article looks at the AIDS-related controversy surrounding the experiments on and the availability of medicines in southern countries. It situates these debates in a longer-term history of transnational medicine. It highlights the rise of international therapeutic modernity at the beginning of the 1990s, based on the strict regulation of clinical trials and on the formalization of the international ethical rules governing experiments. This rise helped to change radically the reception of experiments conducted in southern countries around AIDS. With regard to this new ethics applied to clinical trials in southern countries, this article goes on to demonstrate the confrontation at the end of the 1990s between two different approaches to the universalization of healthcare. Finally, it shows how new laws on international trade have reinitiated this confrontation. Through this story, the article suggests in what sense the study of the political transformations of transnational medicine could offer a new field of investigation for the social sciences.
Journal Article
Time for an overhaul at the World Medical Association
Serious questions must be asked about its standards of governance
Journal Article
‘He who helps the guilty, shares the crime’? INGOs, moral narcissism and complicity in wrongdoing
Humanitarian organisations often work alongside those responsible for serious wrongdoing. In these circumstances, accusations of moral complicity are sometimes levelled at decision makers. These accusations can carry a strong if unfocused moral charge and are frequently the source of significant moral unease. In this paper, we explore the meaning and usefulness of complicity and its relation to moral accountability. We also examine the impact of concerns about complicity on the motivation of humanitarian staff and the risk that complicity may lead to a retreat into moral narcissism. Moral narcissism is the possibility that where humanitarian actors inadvertently become implicated in wrongdoing, they may focus more on their image as self-consciously good actors than on the interests of potential beneficiaries. Moral narcissism can be triggered where accusations of complicity are made and can slew decision making. We look at three interventions by Médecins Sans Frontières that gave rise to questions of complicity. We question its decision-guiding usefulness. Drawing on recent thought, we suggest that complicity can helpfully draw attention to the presence of moral conflict and to the way International Non-Governmental Organisations (INGOs) can be drawn into unintentional wrongdoing. We acknowledge the moral challenge that complicity presents to humanitarian staff but argue that complicity does not help INGOs make tough decisions in morally compromising situations as to whether they should continue with an intervention or pull out.
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Biodiversity Governance: A Tower of Babel of Scales and Cultures
The recently created Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES), originally focused on multilateral and global issues, is shifting its focus to address local issues and to include in its assessments local stakeholders and indigenous and traditional systems of knowledge. Acknowledging that full biodiversity governance is unavoidably rooted in participation of local actors and their problems and knowledge, we suggest that to deal successfully with the complexity and diversity of local issues, including indigenous knowledge systems, IPBES must recognize a key role of local institutions.
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Three weeks among the Korowai people
Reported to be the world's only tree dwelling people, their first contact with the Western world was in the 1970s. Because of the inaccessibility of the rain forests where they live, they have retained their traditional semi-nomadic way of life. The births and deaths of the Korowai people are never registered; they therefore do not officially exist. Since the trip we have been able to bring the Korowai's unmet needs to the attention of the government and the World Health Organization's public health programmes in Papua, which have been receptive.
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