Access to Essential Drugs

By way of promoting a book I co-edited, here's a review of said product in this week's medical journal THE LANCET.

The Lancet 2007 24 March

Book Review

Access to essential drugs and the pendulum of power

The Power of Pills: Social, Ethical and Legal Issues in Drug Development, Marketing and Pricing
Jillian Clare Cohen, Patricia Illingworth and Udo Schuklenk, eds.
Pluto Press, 2006, ISBN 0-745-32402-9.
Pp 320. £19·99, US$35·00

Many factors have influenced my commitment to campaign for access to essential medicines, but two immediately leap out. When I was working in Bangladesh I witnessed a certain drug company promote the virtues of a sugar-coated vitamin pill as the most important factor in helping children grow and stay healthy. Families spent a day's wages on these useless tablets when they could have been buying bananas, spinach, and dahl instead. As I watched parents make sacrifices to pay for these pills, I realised that I was obliged to do something about this profoundly unjust situation:

I knew what was going on, doing nothing would make me complicit in the drug company's actions.

Years later, in my role as a medical editor, I accepted an invitation to lunch with the Association of the British Pharmaceutical Industry. It was just after the South African Government had won their landmark court case against the pharmaceutical industry, in April, 2001, and I wanted
to hear the association's view of the outcome. It was in London's Grosvenor Hotel and everyone apart from me was tucking into a three-course meal under the chandeliers. I felt alone in my disapproval of drug companies' evangelical zeal to uphold patents, and uncomfortable about the way those present were talking about African people. After I said my piece, I left the dining room and a Brazilian waiter came running after me to thank me for what I had said.

And here lies the problem. The activities of drug companies that put patents before public health—encouraged by the World Trade Organisation's rule on Trade-Related Intellectual Property Rights (TRIPS)—places the pharmaceutical industry and campaigners on different sides of an impasse that is so wide there seems to be no possibility of meeting in the middle. In the real world, the outcome of this polarised debate depends on who has the most power, which unfortunately for now is the drug companies. But if there is any hope of making progress, there has to be some mutual recognition and acknowledgement of each other's point of view. Will I find any thought-provoking reasoning in The Power of Pills to help me appreciate the
position of drug companies?

The Power of Pills explains the social, ethical, and legal issues involved in drug development, marketing, and pricing and has contributions from an eclectic mix of academics, activists, economists, ethicists, health-care professionals, lawyers, and philosophers. There is one contributor from the pharmaceutical industry. Most of the essays are beautiful examples
of moral, philosophical, and economic reasoning at its best. For example, Michael Selgelid and Eline Sepers argue that drug companies should be "incentivised" to research diseases in developing countries. The need for governments in the south to implement a comprehensive public-private policy that sets the agenda is the focus of Joao Carapinha's essay. Steve Miles suggests that the socioeconomic gap between rich and poor countries is likely to grow unless
developing countries establish their own research capacity that prioritises the health needs of their populations. The case for abolishing the patent system is made convincingly by Adam Mannan and Alan Story. And Brook Baker argues that access to essential medicines is a human right and proposes that the international community should put it firmly on the human rights agenda.
The drug industry is represented by Robert Freeman, a pharma veteran. He offers a predictable defence arguing for "strong intellectual property rights, a stable regulatory, pricing and reimbursement environment, and the recognition that pharmaceutical innovation is a major contribution to the health of nations." We are back at the impasse. I am not convinced.

Another prime example of pharma dogma is in the 2005 report from the Millennium Project Working Group on Access to Essential Medicines, one of the Millennium Development Goal targets, which discusses the way forward.
The report's authors come up with similar solutions to those outlined in The Power of Pills, such as fair pricing of essential medicines and innovative methods of research and development that are not led by the pharmaceutical industry. However, at the back of the report is a statement of dissent by representatives of the research-based pharmaceutical industry and signed by
Eli Lilly, Merck, and Pfizer. Although representatives for the industry were part of the working group they refused to sign the report, "because of the enormous visionary gap between ourselves and the working group in identifying root causes of the access challenge". Their reasons are so important in understanding why there is a stand-off position when it comes
to access to essential medicines that I think their response is worth quoting. They state, "We do not believe that the main problem in barring medicines to the poor is patent protection, nor do we accept that individual pricing practises are fundamental to explaining why one-third of
the world's poor lack access to basic, low cost essential medicines." They conclude, "In short, the report fails to provide the balanced and accurate perspective necessary to stimulate fresh policy approaches that could make a real difference to the lives of the poor. To allow these inaccuracies and misinterpretations to become accepted truth and as the basis of moving policies forward does no one any service, least of all patients who rely most on the commitments we have made. It would significantly diminish our ability to fulfil commitments to current and future partnerships—most importantly—our capacity to produce new drugs, diagnostics, and vaccines."

I am left wondering how much more evidence and reasoning it will take for the drug industry to meet somewhere along the impasse. Is there any way forward? A WHO Intergovernmental Working Group on Public Health, Innovation and Intellectual Property may offer some hope. The group's aim is to help devise a global strategy to boost research and development for neglected diseases, including looking at new ideas such as patent pooling, to address the barriers posed by patents for individual drugs. But experience to date shows that drug companies will do everything they can to cling on the status quo where they hold all of the power. The pendulum of power will need to swing to the other side before there is any reasonable progress.

So imagine this: after deciding to diversify and invest in its own research and development, a former Indian generic drug company has come up with a new compound that could be of major benefit to people with lung cancer—the leading cause of death from cancer in rich countries. The company has tested its drug in clinical trials, it has been approved for use, and as is within the company's rights, according to TRIPS, the company patents it and charges a premium so that the cost for treating one patient for 1 year with the new drug is £50?000. Can you imagine the response to this situation, including the tabloid headlines? Now why should the response to access to life-saving treatment, such as antiretroviral therapy, for people in developing
countries be any different? Is it because they are poor? Is it because they are powerless? Or is it because, on the whole, the international community just does not care? The power is not with the pills. It is with the pill makers.

nathan ford < nathan.ford@london.msf.org >

Royal Bank of Scandalous (aka Scotland)

Regular readers of this blog will know that I made atrocious experiences with the Royal Bank of Scotland. For the record, the stuff-up the bank caused months ago during a stay in San Francisco has still not been rectified. Even my branch manageress thinks that the organisation's conduct has been shameful at best.

Having declared my personal conflict of interest, I should probably also mention that I continue to monitor this record profit making organisation for further evidence of truly scandalous conduct. And indeed, given half a chance, the Royal Bank of Scandalous (as a reader of this blog renamed the organisation) will almost certainly jump at it.

Well, here's what's happening. Just like other organisations, the company requires that its staff also buy its products. Any of its staff members caught not having a bank account with the Royal Bank of Scotland will be subject to disciplinary procedures. I don't understand why the company's staff would be so recalcitrant. Is it because they know better than most of us how crappy the bank's customer (dis-service) really is? May be they don't want to wait months to see an apology for bad service and some kind of compensation? After all, the bank pretty much instantly charges the living hell out of you if you overdraw your bank account. If they (by their own admission) mistakenly drain your account of money, they quite happily charge you (yes, you!) instantly. They then fail, months after having punished you for overdrawing an account that they accidentally drained, to compensate you or fix the mistake.

Of course, I shouldn't be unfair. There are plenty of other companies requiring their staff to buy their products. Rolls Royce for instance demands that its staff drive only Rolls Royce, and so do Bentley, Jaguar and Mercedes Benz. Come to think of it, thousands of Lufthansa staff were recently disciplined for flying other airlines. Worse, McDonald's staff seen with a Burger King burger in their hand will be shot on the spot by McDonald's Staff Monitoring Services. - OK, I guess you realise that I made these stories up. I also hope you get the point that I am trying to make. Take the opportunity to cancel your account with the RBS when you have a minute. As a bank it fails to provide decent customer services, and as an employer it undoubtedly sucks big time. Move on while you can.

Some good news from South Africa - at long last

Here's good news from today's BRITISH MEDICAL JOURNAL. It's a copy-paste job really. I am tempted to go on raving again about human lives lost due to the unimaginable incompetence of the current South African minister for health prevention, Dr (Beetroot) Manto Tshabalala-Msimang, and, of course, the country's slightly paranoid President Thabo Mbeki, but what's the point... readers of this blog will know. So, here's the BMJ item:

South Africans to get AIDS plan

Pat Sidley

Johannesburg

The South African government has finally introduced a full and far reaching plan to deal with its HIV/AIDS epidemic. But it will cost the country some 14bn rand (£970m; 1.4bn; $1.9bn) over the next five years. This amount was not planned for in the present budget for the year ahead.

The plan aims to give antiretroviral treatment to up to 80% of people with AIDS who need the treatment; to halve the new infection rate by 2011; and to ensure that all pregnant women who are HIV positive have access to treatment to prevent transmission to their babies. The plan envisages better spending of the large donations that pour into the country, with the intention of strengthening the health system and using health staff more efficiently. The whole process will be properly evaluated and monitored.

Less than a year ago, Mr Mbeki's government followed the president's view that AIDS was a syndrome and that "a virus could not cause a syndrome." Mr Mbeki thought that the extent of disease in the country could be attributed to poverty. He voiced misgivings about white Western experts who claimed that AIDS originated in Africa as though Africans were dirty and immoral. And he presided over a cabinet which approved a product as a cure for AIDS that was later found to contain an industrial solvent (BMJ 1997; 314:450).

The health minister Manto Tshabalala-Msimang, who had a liver transplant earlier this month (15 March), has previously advocated the virtues of beetroot and garlic over antiretrovirals and appealed against court decisions fought for and won by the Treatment Action Campaign to compel the government to provide treatment (BMJ 2006,333:167)

Complementary medicine - a contradiction in terms

Can't believe that more and more cash-strapped UK universities resort to teaching degree courses in complementary medicine. It's a contradiction in terms. The only reason why this kind of stuff is called 'complementary' is precisely because it isn't tested medicine to begin with. If it had been tested and was known to work we would stop calling it complementary. So really this pseudo-medicine attaches itself to medicine (hence 'complementary medicine') to gain credibility.

Here is a nice exchange between a scientist and a teacher of gobbledigock, check it out: http://www.bbc.co.uk/mediaselector/check/player/nol/newsid_6480000/newsid_6481700?redirect=6481767.stm&news=1&nbwm=1&nbram=1&bbram=1&bbwm=1

German Justice - Postmodern relativism at its best

Here's a story to think about. A female German national, born in Morocco, suffered serious physical abuse at the hands of her husband, a male German national, also born in Morocco. She files for urgent divorce, seeing that her husband is also threatening to kill her. Well, a female German judge ruled against her request, arguing that both parties to the dispute were Muslims, and that allegedly the Quran doesn't rule out this sort of violence. Therefore, when considering the cultural background of the two parties in the dispute, so argued the judge, there was no unreasonable harm done by the husband (after all, we know from watching TV on the odd occasion, that women get killed by irate Muslim husbands and/or their families occasionally in places like Pakistan, Afghanistan, Iraq, and Iran). The argument essentially was that we should be respectful of the cultural difference that expresses itself in such actions.

Well, this kind of postmodern hogwash was quickly and sensibly dealt with in Germany. The judge in question was removed from the bench and someone else is hearing the woman's request for an urgent divorce.

Virgin vs Sky vs ... us the paying subscribers

I feel stupid. The UK's 'free market' system which is supposed to guarantee low prices due to 'real' competition is more often than not a pseudo-free-market. One duopoly is probably the British Airways / Virgin Atlantic control over London's Heathrow Airport. No big surprise that Richards Branson (image to the left), the greedy ex-hippie trying to line his pockets with our hard earned cash, didn't much like the idea of an open skies agreement with the US as it would have brought competition into the market and the prices down.

No big surprise when this self-appointed hero of the small man (read people like you and me), was recently at it again. After taking over NTL (a pretty terrible US cable company selling cable packages to UK TV audiences) his Virgin group refused to pay anylonger for a number of Sky channels. This is partly because a bun-fight has broken out between two billionaires, Rupert Murdoch (aka Darth Vader of the media world) vs Richard Branson (aka ... well, I don't know, nothing complimentary, that much is certain). Sky lost a million or two viewers from the Virgin cable customers who can't tune into its channels anylonger. Advertisers want some of their cash back, of course. And here's an interesting twist in the story. Sky has already budgeted for this loss of advertising earnings and will return money to its advertisers due to its loss in audience share. Compare this to the consumer hero Richard Greed Branson. I wrote to Virgin demanding a reduction in subscription fees seeing that some of my favourite programmes have disappeared without much of a warning. There's been no reply. Richard Greed Branson declared that subscribers would receive no reduction in their subscription fee and people who didn't like that could go to Sky.

I am pleased to see that these operators' activities are currently being investigated by the UK's media regulator. After all, this has been scandalous... and it has been a direct result of a serious lack of competition. These two organisations essentially hold the viewing audience for ransom.

Scottish Nationalist (aka Bigotry) Party ...

You may or may not recall this item on this blog. I posted it awhile ago, arguing that the Scottish Nationalist Party is essentially lowering itself to a gutter driven political party. One of its MSP's proposed at the time that religious adoption agencies ought to be allowed to discriminate against same-sex potential adoptive parents. This was a clear attempt by the Catholic Church and its minions in parliament to undermine legislation designed to prevent unjust discrimination based (among other things) on sexual orientation. Despite public demands that the party take a stance on this issue, there was silence from the organisation's leadership.

I am 'pleased' to say that the party's efforts have finally paid off. It received a 500,000 GBP cheque in support of its election campaign from Brian Souter, a fundamentalist Christian and owner of transport company Stagecoach. Not a big surprise then that the party refuses to reply to queries from civil rights organisations demanding to find out what its stance is on equality related matters. This (very local, I know - apologies to readers slightly further afield...) is not completely insignificant as the SNP is set (according to virtually all opinion polls) to become the biggest party in the next Scottish parliament. So, a win for bigotry is quite possibly on the books. As the Romans said: Let the Buyer Beware.

Boycott Reed Elsevier

The British Medical Journal enjoins academics and others, to boycott the publisher Reed Elsevier. Its main reason is that Elsevier (publisher, among other things, of the medical journal THE LANCET and the Encyclopedia of Applied Ethics) organises international arms trade fairs, and is therefore partially responsible for sustaining an industry that thrives on the suffering of others. The BMJ argues that academics should withdraw their support for Elsevier to express their disagreement with its involvement in the arms trade, and its profiteering from the suffering of others.

So, for better or worse, as of today and until the matter is resolved, I will not be submitting manuscripts to Elsevier published journals or books. Least one can do, I guess, and good on Richard Smith, the former Editor in Chief of the BMJ, for blowing the whistle on this one. Find the current BMJ Editorial on the issue here.

Those slippery slopes - cloning babies

The reproductive cloning debate was undoubtedly 'won' by Luddites. You can tell already that I do believe that the other side of the argument deserves our support. What interests me in this context is how a slippery slope argument has been deployed by my learned Luddite friends against therapeutic cloning research. Of course, the Luddites have long been railing against therapeutic cloning research because it relied on the destruction of human embryos. Virtually all of these embryos are surplus IVF embryos (ie they would have been flushed down the sink anyway). I never understood the logic of this argument, because the embryos in question were at a developmental stage of about 10-14 days after conception. There is no central nervous system, brain, suffering, nothing in other words that should make us pause and ask whether the destruction of such an embryo is something to be concerned about.

I digress. What I really meant to focus on in today's commentary is a slippery slope argument. Those against therapeutic cloning research argued that if we permitted therapeutic cloning research we would slide down the slippery slope to the reproductive cloning of human beings.

There are two problems with this argument:

1. There is no straightforward slippery slope from therapeutic cloning research to reproductive cloning research. Those using this kind of argument consistently fail to provide evidence for their claim. - So, really the word 'cloning' has been deployed here as a bogey woman in the Luddite fight against progress in biomedical research.
2. Secondly, the Luddite rhetoric also begs the other question, namely what would be wrong with reproductive human cloning if we were capable of doing it? Surely the argument against reproductive cloning needs to succeed first in order to deploy the slippery slope related concerns against therapeutic cloning. To my mind, there are no serious reasons against reproductive cloning. It would simply give a few hundred or a few thousand people worldwide another means of non-sexual reproduction (eg infertile couples for whom IVF failed could access cloning to have a genetically linked child). In fact, there could be a good medical reason for this. What if a loving couple with a desire to have their own genetically linked child runs a serious risk of passing a genetic illnes on to their off-spring. Reproductive cloning would permit to eliminate that risk by using only the healthy parents genetic material. Good news all round, I would think, but then, hey, my initial isn't 'L' for Luddite.

Of course, none of this suggests that reproductive cloning should be a research priority (there is bigger fish to fry on the health front, just think TB, Malaria, HIV). In fact, considering the millions of orphans in need of loving homes, this pre-occupation with having our 'own' genetically linked kids has always struck me as obscene. However, from this observation it doesn't follow that therefore we should outlaw reproductive cloning.

Business is business - ethics is ethics is something else altogether

UK arms manufacturers, pretty much beyond reasonable doubt, bribed their way into getting multi-billion pound contracts from Saudi Arabia. The current UK government, which is pretty close to or has beaten the governmental sleaze factor introduced during the disastrous Major years, has ended an official investigation into the issue on the grounds that it would not be in the 'national interest' to investigate the matter. The reason (ie the 'national interest') is that the Saudi government threatened to stop buying any further arms from the UK if the investigation continued. They were upset that their cosy little corrupt world was just about to be opened up to the glare of the public eye (mass media, the lot). No wonder that high-flying ethical governance principles were discarded in an instant by Tony Blair and his governmental cronies.

In Germany Siemens managers admitted to having paid kick-backs to secure contracts from Italy's state owned energy company Enel. Goes without saying that they insist that they didn't 'offer' the dosh, but that those Italians demanded it out of the blue - what choice did they have other than to pay up. It goes also without saying that Siemens has an ethics structure (mission statement, compliance staff etc etc) that's second only to Enron.

Which brings me back to 'business ethics'. I am almost certain that all the business ethics activities in the universe won't make a difference to companies' real-world behaviours, unless there's a severe threat to a company's reputation and business, in case its ethical failing is discovered. So, at the end of the day it's about CONTROL, CONTROL, CONTROL, and almost certainly not about voluntary codes of conduct.

In the case of democratically elected governments that back corruption, at the end of the day it's about ELECTING A NEW GOVERNMENT. We, the electorate must hold them accountable and remove them as soon as is feasible.

TB is coming our way again... -

An interesting article was published recently in a free online medical journal. Academics from Southern Africa and Canada discuss the question of whether or not it is necessary to quarantine tuberculosis sufferers in South Africa in order to stop the development and spread of a drug resistant variety of the bug. Part of the man-made problem of XDR-TB is that instead of staying in hospital voluntarily in order to receive proper care patients leave as quickly as they can, because otherwise their welfare benefits would be cut by government. This is a serious problem obviously. While proper care cures about 98% of TB sufferers in developed countries, this figure comes down to 50% in South Africa. One consequence is that ever more dangerous variations of TB develop. The reason is that people out of hospital are less compliant when it comes to taking their medication as they should. A paper worth reading.

Torture and political assassination in Zimbabwe - the ANC is silent...

Morgan Tsvangirai, the leader of the Zimbabwean movement for democratic change, has reportedly been nearly beaten to death by Zim security forces during recent demonstrations his organisation staged against the kleptocratic rule of one Bob Mugabe. There is nothing really newsworthy with regard to that collapsing country and its corrupt ruling class. What remains very worrisome is that there isn't a word of criticism from neighbouring South Africa's ANC. The organisation's tacit approval of what is happening in Zim makes one wonder what the future might hold for democracy in South Africa itself.

Israeli diplomacy in action - sort of

I am sure you will have seen ambassadors in action. Suit, style, eternal boredom - most of the time. In recent years a bunch of Israeli diplomats have made it worthwhile looking out for nocturnal activities undertaken by senior Israeli diplomatic missions' staff. Tsuriel Raphael, for instance, was until very recently the Israeli ambassador to El Salvador. 'Until very recently' because he had to be recalled a day or two ago because he was found bound, gagged, and naked outside the diplomatic mission, wearing sado-masochistic paraphernalia. Guess, as long as he didn't hurt anyone against their wishes and he was only hurt because he wanted to, one should probably not bother too much about this case. One can understand, though, why he was recalled. Imagine him going to a reception with other ambassadors... no doubt he would not be able to handle the bickering behind his back - well, I couldn't.

Then there was that Israeli diplomat who was found dead in a Parisian hotel room with a woman who probably wasn't his wife. He suffered a cardiac arrest during a sex romp. Exciting times, no doubt.

And yes, there was also that comedian version of a diplomat who explained during a reception that Israel and Australia have much in common, as both are located in Asia, yet their peoples don't have the Asian characteristics of “yellow skin and slanted eyes.

Looking at this track record, it doesn't seem overly demanding to succeed as a diplomat. The challenges in terms of tactfulness and such things seem actually remarkably low.

More on Abdelkareem Soliman

Here's the latest on Kareem Soliman's case. I reported earlier about this 22 year old secular Egyptian blogger who has been sentenced to jail for criticising al-Azhar university and allegedly denigrating the Egyptian President.

The Empire of the Flat Earth Strikes Again

The Observer newspaper in the UK reports today that flat earthers are highly incensed about a pilot scheme tested in some of the country's schools. Kids ages 4-11 receive booklets featuring a prince who's turning down a couple of princesses before finally falling in love with his prince. Goes without saying that this isn't about sex but about love. Educationalists have pointed out that the power of children's books in terms of shaping future social values is very substantial. Omitting gay people from such literature likely contributes to homophobic societal values. I have no idea whether these factual claims are correct, but they do not sound utterly implausible.
Of course, the empire of the flat earth is pretty horrified. Says the education spokesman (of course a spokesman) of the Muslim Council of Britain, 'This is not consistent with Islamic teachings and from our point of view many parents would be concerned.' Other flat earthers have suggested that these books 'promote' homosexuality. Leaving aside the question of whether or not that would be a bad thing (if it was possible to promote some sexual orientation to such an extent that people change their's), the same could probably be said for the prince-meets-princess type children's literature. So, unless one thinks there's something inherently wrong about homosexuality one would probably have to worry about any kind of sexual orientation bias in children's books. Quite arguably children's booklets showing the diversity of relationships we have in modern societies (of course, the Vatican, Iran and similar oddities are not, strictly speaking modern, civilised societies :) are desireable.

Some Good Ideas from the Conservatives in the UK

It's been reported that the Conservatives are issuing a policy document on green taxes today. Among the policies proposed is a tax on all too frequent airtravel. From what I understand they're punishing airlines that fly inefficient old planes that are heavier polluters than more recently build ones. They also propose that each of us gets a kinda green frequent flier account whereby we - sort of - fly one long-distance flight per year and one short-distance flight per year on a reasonably low tax rate. However, someone flying from Glasgow to London several times per week will find herself paying a very substantial and increasing tax rate per flight. The logic behind this is pretty obvious: the Tories aim to discourage us from taking too many short-distance flights. That probably is a good idea. The airlines usually counter this by saying that their pollution is small fry compared with other polluters. However, it is also true that their contribution to overall emissions is rapidly increasing due to the fact that more and more of us fly for short-distance travel. The airlines have also argued that such tax policies would hit mostly the low-income traveller who would then be precluded from travelling (thereby losing valuable freedoms). The fact is though, that most of those travelling on low-cost carriers in the UK are actually business people and middle- to upper-income folks.
Of course, while this initiative aim to get us to take trains, is commendable, there is also the fact that trains remain - at best - an unreliable luxury activity in this country. The amount of delayed, cancelled etc trains in this country is probably only matched by South Africa's useless rail network. Just last week I needed to attend a meeting in Oxford. I planned the trip quite carefully in such a way that I would be able to go by train... only to discover that someone or other has decided to go on strike and that very severe disruptions were forecast. So I flew down to London on BA. No hassles, an obscene price (like 200 GBP one way...) - but I got where I needed to get in time for my meeting.

The table to the left shows a ranking of what the German news magazine SPIEGEL calls climate sinners (ie polluters). O course, this is in absolute terms as opposed to relative to population size.

German Logic

My German passport is running out some time in May this year. So, realising that in our globalised world we still have to keep local membership cards (passports), I went to one of the country's Consulates. I brought dutifully two passport photos along, cash, as well as my old passport. Not entirely unexpectedly, in this age of bitterly fighting terrorist's images, they were unhappy with my mugshots as they didn't fit exactly into the predetermined slot (I think there's too much space on both the left- and the right-hand side). So I had to go to a photographer who produces mugshots according to the book. Then I learn that I need my birth certificate, too. It's here where I kinda lost it. In order for me to have currently a valid German passport I must have a birth certificate to begin with. It's a conditio sine qua non. So, why ask me again? Beats me. Of course, it goes without saying that I didn't have it with me and needed to fax a copy the next day. Goes also without saying that the Consulate's fax line didn't work the next day etc etc.

The amount of time wasted by people making up such rules just defies belief (just scroll down to the KLM related item as their airport security operations are another case in point).

Incest just isn't a good idea - unless you stop breeding

This German couple (brother and sister) has been living together for six years. They managed to produce a number of children, some of which are seriously disabled. There's a harrowing nasty family background to the story, but that's the gist of it. No doubt many Germans will bicker when they hear that the couple lives in the former East, but truth be told, that's neither here nor there. Incest is illegal in Germany and there's up to three years in jail on the books for the couple. The main reason for such draconian measures is, of course, that reproduction between brother and sister has a 50% chance of serious disability caused by genetic abnormality.
So, no doubt, legally and ethically, what they did was bad. Well, I should be a bit more precise, their decision to reproduce was clearly wrong. There's several things worth thinking about, though.
For starters, why should a sister-brother couple be prosecuted and possibly jailed if they decided to live together, engage in sexual intercourse but do not reproduce (in the case under consideration the 'husband' has undergone a vasectomy and won't therefore be able to impregnate his 'wife' and sister again). They, quite possibly so, should be punished for producing disabled children, but I am less certain that they should be prevented from living together if that is what makes them happy - as long as they do not reproduce any longer.
The other issues is that we do not punish parents whose off-spring suffers similarly high risks of genetic illness (ie a genetically not linked couple whose kids suffer a 50% or higher risk to develop cystic fibrosis will not be threatened with jail if they go ahead and reproduce anyway).
It seems to me that we are not consistent, as a society, in our response to the issue under consideration. If the primary reason against incest is that we're concerned (rightly so) about genetic abnormality and disease among the off-spring of a sister-brother couple, we should deploy the same yard stick in other cases where the risk of genetic illness is similarly high. We are not doing this at this point in time. This strikes me as inconsistent.

Support academic freedom in Iraq

Here is a link to a Petition asking that the UK government support Iraqi academics. Colleagues in that country are currently under threat from more or less medieval forces. They're being kidnapped, tortured and murdered by sectarian barbarians in the country. The consequences for development are dire if teachers of medicine, nursing, architecture etc are leaving the country in order to save their lives and the lives of their loved ones.

Stem cell research - cultural wars continued

You will probably know of the never-ending ideological battles between pro-lifers and the rest of us. Main bone of contention is the moral status of embryos. Particularly viciously fought over was (well, is) the issue of embryonic stem cell research. For better or worse, embryonic stem cell research requires the extraction of embryonic stem cells around 10-14 days after conception. The embryos are destroyed in this process, much to the chagrin of pro-lifers. The cell accumulation they're concerned about has, of course, no central nervous system, no brain, no capacity to suffer, nothing in other words that would justify ascribing moral status to such embryos.
Comes scientific research 'demonstrating' that the same kind of therapeutic stem cell research can be undertaken without the destruction of embryos. In fact, so claims the research by Dr Catherine Verfaillie, we should also be able to use adult stem cells. Of course, if you can avoid fighting over nothing (with pro-lifers and others), that's what you should aim for. So, even if one subscribes to the view that the embryos in question do not deserve moral status of any kind, one should be relieved to see that valuable research can continue while cultural wars over moral standing can be avoided altogether by using adult stem cells.
Dr Verfaillie (that time of University of Minnesota affiliation) published her work in the prestigious peer reviewed journal NATURE. It has since turned out to be the case that some of the data she published was significantly flawed. Quite possibly her conclousions might not be sustainable in light of the serious mistakes she made. Perhaps, in light of the cultural wars just mentioned, it is not that insignificant that Dr Verfaillie since moved on to a Catholic university in Europe.
In case you're interested in good background information on stem cell research, check out this site at the US National Institutes of Health.

Drug, drugs, and drugs

Interesting article in today's OBSERVER newspaper. The word is that a research group established by Colin Blakemore, CEO of the UK Medical Research Council, proposes to re-classify drugs according the to harm they are likely to inflict on those taking them. They propose to de-link drug classification from the legal system's response to them and rely entirely on their direct harmful consequences. This means, for instance, that alcohol would receive a higher (ie more dangerous) ranking than for instance the party drug ecstasy. All perhaps unremarkable, except that it makes one wonder how any other system could possibly have ever been used. Surely, if one goes for drugs prohibition at all, one would want to deal with drugs in order of dangerousness to health as opposed to other criteria. But then, fighting drug abuse has long been code for fighting drug users (and occasionally those benefiting from the drugs trade). Of course, if ecstasy turns out to be a lower risk to our health than is alcohol, this begs the question why alcohol is not an illegal substance but ecstasy is. Here's the top 20 list:

1. Heroin
2. Cocaine
3. Barbiturates
4. Street methadone
5. Alcohol
6. Ketamine
7. Benzodiazepine
8. Amphetamines
9. Tobacco
10. Buprenorphine
11. Cannabis
12. Solvents
13. 4-MTA
14. LSD
15. Methylphenidate
16. Anabolic steroids
17. GHB
18. Ecstasy
19. Alkylnitrates
20. Khat

Sleeping thief

Nice story in today's online MAIL & GUARDIAN. A burglar in a Zimbabwean town went on gathering his loot in a small store that he broke into... and then fell asleep. He then went on to charge the store's owners with using 'magic' to protect their store from his activities...

Lottery ethics in British education

In the UK children are usually admitted to schools subject to their families living in close proximity to a given school. On the face of it this makes sense. After all, you avoid travelling long distances to get to school, etc. The problem begins when you realise that there are huge disparities in terms of school quality. Ever since it has become common practice that rich (well, even middle-class) people buy themselves houses close to desireable schools in order to give their children eventually a competitive advantage over other kids whose parents have to make-do with a not-so-good school.
Enter Tony Blair and his education secretary. The government has decided to do away with these so-called catchment areas and instead has opted that whenever there are more applicants for admission to a particular school there will be a lottery determining which children would be admitted. The result is that all children have an equal shot at getting into a better school, regardless of their parents' wealth. Likely that house prices in former school catchment areas will fall as living in such a catchment area will not increase the likelihood that a kid will get into a better school.
To me all of this makes perfect sense (equality of opportunity is one of the fundamental tenets of justice), but not, of course, to the TELEGRAPH newspaper, a conservative UK broadsheet.
Of course, a different issue altogether is, why there are better and worse schools, and why there are significant disparities to begin with. This, of course, is due to the fact that this country affords itself both private and public schools. Under Blair's reign the number of privately run schools has actually increased.

Why not sell your wife's kidney?

DIE WELT, a conservative German broadsheet, reports that a Pakistani national sold his wife's kidney so that he could pay for the purchase of a new tractor. His cunning plan (successfully executed, mind you) involved beating her to pulp in order to have a pretext for having her admitted into hospital. Once there she was quickly put to sleep by medical staff and the relevant organ extracted. Of course, she was the only one not knowing about this until a medical check-up some 18 months later revealed what had happened. Remarkably, relatives of the couple were in it as well as the medical staff.

So, while we go on about informed consent in biomedical research and health care practice... there's also the Pakistan version of the same.

Here's a pretty good documentary about organ sale in Pakistan.

Outsourcing is cost-effective, but does it always deliver?

The SPIEGEL news magazine in Germany reports a case where large companies outdsourced their occupational health provision to a a private health centre. Thousands and thousands of patients with occupational health related needs were treated by staff in that clinic, their blood was drawn etc. Thing is tho, nobody in that health clinic had any medical or even health care qualifications. There were builders, welders and others who took a liking to providing health care instead of building and welding etc. The owner of the clinic had a whole fleet of luxury cars confiscated. No doubt the clinic at the time made a very cost effective offer to the companies that subsequently outsourced their occupational health delivery to them ... and that is all that seems to matter in this day and age.

Wonna know how it feels to be an illegal immigrant?

Really interesting story on the BBC News website. Someone clever has set up a fairly realistic theme park in Mexico, of all places, aiming to give tourists a feel for what it is like to be an illegal Mexican immigrant into the US of A (land of the free etc etc). Fascinating stuff. Read the first person account of the corporation's Mexican correspondent about being an 'iilegal immigrant' at Eco Alberto Park in the central Mexican state of Hidalgo. The park itself is owned and operated by a local indigenous community, the Hnahnu. It is suggested that part of the rationale for setting it up was to generate empathy for 'illegals'.

Free Kareem Soliman

Interfaith Coalition Condemns Jailing of Egyptian Student over Blogposts, Calls on Egyptian President Mubarak to Pardon Abdelkareem Soliman

February 22nd, 2007

FOR IMMEDIATE RELEASE
Free Kareem Coalition
+1-617-661-0053
free.kareem@gmail.com

Interfaith Coalition Condemns Jailing of Egyptian Student over Blogposts, Calls on Egyptian President Mubarak to Pardon Abdelkareem Soliman

CAIRO – The “Free Kareem Coalition,” an interfaith group of human rights activists from around the world, condemned the sentencing of Egyptian student Abdelkareem Soliman for expressing his opinion on his personal blog.

A judge in Egypt today sentenced Kareem to four years in prison for the alleged crimes of “defaming the President of Egypt” and “insulting Islam.”

Dalia Ziada, a blogger and activist involved with the Cairo-based Arabic Network for Human Rights Information, explained that Kareem’s conviction remains the first time an Egyptian blogger has been arrested for writing on his blog. “It sends a chilling message to bloggers of all persuasions in Egypt and across the Middle East. We are not free to express ourselves openly on our websites.”

Kareem criticized Egyptian authorities for failing to protect the rights of religious minorities and women, and expressed views about religious extremism in strong terms.

Bahraini blogger Esra’a Al-Shafei, who launched the website FreeKareem.org to coordinate the international solidarity campaign, noted the basic human rights violation. “I was offended by some of Kareem’s blog writings. But I cannot support his imprisonment merely because he said a few things that insult my identity. Freedom of expression and open exchange of ideas must be respected.”

In November, Kareem was detained after being interrogated by prosecutors. He was held for over two months without trial and has remained in solitary confinement without access to his lawyers.

Kareem’s conviction comes despite global rallies on Kareem’s behalf, including demonstrations outside Egyptian embassies in Washington, Rome, London, Paris, Stockholm, and New York. Over 2,000 people have sent letters to Egyptian authorities demanding Kareem’s release.

Opinion editorials in the Washington Post, International Herald Tribune, and Beirut Daily Star have all also called for Kareem’s release, along with a bi-partisan coalition of US Congressional leaders, European parliamentarians, and Costa Rican representatives.

“We call on the appeals courts in Egypt to listen to international condemnation and do the right thing,” stated organizer Mohammed Shouman. “Kareem’s right to free expression has been violated and his conviction should be overturned.”

In the meantime, activists fear Kareem’s life is in danger and hope for high-level intervention. “We hope President Hosni Mubarak will pardon Kareem and allow him to start a new life outside of Egypt,” noted Al-Shafei. “We won’t be silent until Kareem is safe.”

See www.FreeKareem.org for the latest updates.

Here is a petition demanding his immediate release.

End to doctors' self-policing in the UK

There's some good news to report today. Doctors will lose the right to police themselves, at least if the UK government has its way. That probably is a good idea. For justice to be done it needs also to be seen to be done. A profession that essentially polices itself is about as credible an arbiter in conflicts between patients and doctors as an insurance industry having a policing body made up of insurance sales persons. Being a professional means to serve the public good. In return for us as society conceding a great deal of professional autonomy to doctors we expect a substantial degree of accountability in return. This objective was never met under the current regime. Change has long been overdue.

Budget airlines and 'harsh' landings

I don't know about you, but I am almost certain you've flown at one point or other with Ryanair, Easyjet or any number of other budget airlines if you live in Europe. We don't expect any service from them really, and they usually manage to meet this sort of expectation. What we do expect, of course, is that they bring us from A to B reasonably safely - at least we expect them to be as safe as any full-service legacy carrier. After all, our savings are meant to indicate that we're happy to be treated pretty terribly as opposed to getting killed in an accident driven by these airlines' cost cutting exercises.

Now, I wonder, whether there's a pattern here. Ryanair (and I got to be honest, after flying with them for a few times, I just can't get myself to use them ever again) is currently being investigated in the Republic of Ireland for its allegedly dangerous landing approaches. The claim has been made that rather than doing a second round if they come in badly, the airline's pilots will set the planes down anyway to avoid punishment from the airline's management. It goes without saying that the airline thinks the pilots are wrong. In my experience with Ryanair at least, truly nasty landings are standard operating procedure. I was on planes that literally fell out of the sky onto the tarmac and swerved all over the runway just to come to a stop before running out of space. The pilots seemed to go deliberately left to right to left just to increase the length of the runway. Pretty scary stuff. I decided that probably the life-time savings made by using Ryanair are not worth the nerve wrecking experience of its landing related gambles. - Mind you, I made a similar experience on a BA flight just this Monday, but at least it happens rarely on legacy carriers. That's a start.

In Indonesia (see picture above left) meanwhile, a plane was set down sufficiently harshly by a local by a local budget carrier's pilot to break apart on impact. Mind boggling.

So, other than the obvious question of whether or not we should be flying as much as too many of us do (myself definitely included here, so I am not pointing my finger at you!), I also wonder whether budget carriers in their ever-more desperate attempts at efficiency savings gamble with our and their staff lives. After all, as the old saying goes, if it looks too good to be true, it probably isn't true. Quite possibly budget carriers' prices are a case in point.

KLM's airline 'food', and Dutch anti-terrorism airport security

Yeah, I know, you will say 'big deal', 'not particularly interesting posting', but check out this photo of KLM's vegetarian breakfast in its economy class (commonly known also as torture class). The airline brags to its customers about great improvements it made to its inflight meals. Well, check out this dry role wrapped around two soggy slices of veggies. Even the poor stewardess on my flight from San Francisco to Glasgow thought of this offering as 'gross'... I couldn't agree more.

While I am at it, I'm sure you will know that most airports are busily fighting terrorists. Their primary focus in this regard is, as you'd expect, the duty free perfumes that we might wish to take on planes. Schiphol airport in Amsterdam has brought this by and large idiotic activity to even greater lows. So, here goes my true story: I bought in San Francisco's international airport perfume (you know, the stuff you better bring home if you want to live). It was carefully sealed in an airtight bag by airport security to ensure I couldn't secretly replace it with a nuclear bomb. Being safely (sic!) inside airport security I thought changing planes in Amsterdam would not be a major big deal. After all, so I thought, I had passed security already. Well, far from that, having arrived from the US of A in Amsterdam people busily scanned my back-pack again and found (no, not the nuclear device, but) the perfume bottle. 100 ml of deeply suspicious looking perfume-like material sealed in an undoubtedly fake sealed airport security bag from San Francisco. They quickly opened the dangerous package and discovered ... guess what..., there's perfume in there. Well, rules being rules, they happily confiscated the perfume and asked me to move on with my life. When I pointed out to them that the same bottle bought from a duty free agent in Amsterdam's airport and sealed by them could be taken on-board, they agreed. Of course, it would then probably be confiscated again by some other poor sucker in another airport on the look-out for terrorist perfume. While I appreciate the need to generate local sales... c'mon folks, surely duty free shops at Amsterdam's Schiphol airport can't be that desperate.

So then, here is my take-home message: if you live in the UK and you happen to think that Schiphol compared to London Heathrow is the lesser of two evils... think again!

On a more cheerful note, the Royal Bank of Scotland (see various postings below) wasn't heard of ever since and I have complained to my local branch manageress. The issue is now being investigated. I will keep you posted.

Dumping Homeless Patients in the Streets - LA Presbyterian Hospital Care in Action

First an update on the incompetence of Royal Bank of Scotland staff (see postings below for background). Bottom line: The bank was never heard of again. Scandalous is too polite a word to describe what I think about this outfit.

Anyway, on to Los Angeles. The Hollywood Presbyterian Medical Center dumped a homeless paraplegic patient it had cared for on the streets of a particularly crime ridden neighbourhood. The patient was reportedly found crawling on the streets, with a soiled gown, a broken colostomy bag, and a plastic bag with his belongings clenched between his teeth. This story reminds me a bit of similar reports I heard with regard to private hospitals while I lived in South Africa. - No comment required, no doubt...

And more from the US of A

While I write this I am watching a TV programme, appropriately on Rupert Murdoch's Fox TV. There's a middle-aged woman with finger nails about 10 cm long or so. She's video taped aliens and tells us that they're watching us and that they're unhappy about how we treat mother earth. There's viewers calling in asking for advice from her. Fascinating... -

Anyway, talking about aliens and messages from beyond, today on my way to the corner of Powell and Market (still no word from the Royal Bank of Scotland - see last two postings for background), I saw a car with stickers I kinda liked. You know, stuff like 'Impeach Bush', 'no more lies', that sort of thing. While I briefy rejoiced in having found a like-minded soul, I noticed another sticker on the car, with an image like the one to the top-left. So, probably not a like-minded soul after all.

More from the US of A

For what it's worth, the Royal Bank of S (see posting below) was never heard of again, and I am quietly preparing for another day at the corner of Market and Powell. At least I know which credit card to cancel the day I get back to Scotland. - Bunch of jokers.

So, while I have plenty of time to watch TV in-between begging stints necessitated by incompetent Royal Bank of Scotland staff, I thought I might as well keep you posted on the oddities of US political life. And yes, you guessed it, other than the Obama vs Clinton question (ie Blackish vs Womanish - two possible firsts for the US presidency), sex is high on the agenda. The US being the conservative country that it is, has long been preoccupied by sex (a fixation only matched by older guys working for the Catholic Church - you can spot them wearing funnily colourful robes, and usually talking non-stop about sex [mind you, something they claim they don't have]) . US gay campaigners' primary policy issue is access to 'gay marriage'. Typical, if there's a law saying only straight folks may burn their hands on glowing/hot oven plates, only gay folks would start a campaign to achieve the same right. I am AGAINST gay marriage. What exactly is progressive about extending access to a failed institution to gay people? It is - at best - intellectually dishonest for anyone (usually at very young age) to promise to someone they know only a little to stick together with him or her until 'death parts' them. Close to half of all marriages fail, and there is an even larger number of unhappy marriages, yet gay folks busily campaign for a 'right' to more of just that. I think the civil partnership idea put into action in the UK and many other countries is the most sensible way of going about this. If two (why not more?) people want to give each other particular rights of access to each other's assets, visitation privileges in case of illness and such things, the state should support those decisions in some form or other. Marriage is fundamentally a religious exercise and should be eliminated from the state's statute books altogether. If you want to get married, grab your local priest and take it from there. The state has no proper business in this thing called marriage.

What's interesting about the US debate that's currently on the TV is the take some gay activists have on a recent Washington Supreme Court ruling. The court argued in its majority opinion that the state has an interest in upholding the institution of marriage (and limiting access to it to straight folks) because of its procreative character. Well, leaving aside for a moment that it wasn't love that was foremost on the judges minds but baby production, a gay activist is now campaigning to limit marriage to only those couples that actually have produced children. The thing is that it's not only many gay folks who are reproductively challenged but also 1 out of 4 married couples. So, the gay guy, attempting to show the idiocy of the majority opinion, argues that these marriages should be disssolved. Well, good on him and good luck to his cause (not that it's one I would support, but surely his argument is ingenious).

Well, there's a few other funny stories in the national headlines, but this should do it for now. Gotta get back to my begging corner at Market/Powell.

Some bad news from the Royal Bank of Scotland

I am currently in California. Haven't been to San Francisco for a very long time. I love this town.

Well, on to the Royal Bank of Scotland. Guess what, my credit card was declined just yesterday. This happened after I went out of my way to call the bank prior to going here so they'd not use unusual transactions overseas as a reason to shut down the card. Its call centre staff thanked me for being so considerate. I also transferred extra cash from my cheque into my credit card account to ensure I don't run out of money while in the USA. Well, yesterday my card didn't buy me a five quid brunch in the hotel bar. I sort of have to concede that I cursed (quietly) what I thought were incompetent hotel staffers. I tried then to ring my bank to find out why my card was declined. Goes without saying that I had to call at 4:30 am local time so as to catch someone working in the UK based call centre. Of course, the hotel had since cut my outside phone line, seeing that my card wasn't valid. So, the toll free call to my bank had to be made from my mobile and cost me probably a small fortune. After spending probably 5 minutes in a (likely) expensive (for me) queue I got thru to a call centre operator. It quickly became clear what happened. I am a victim of a suitably incompetent call centre agent. When I called to top up my credit card balance (with a transfer from my cheque account) the call centre staffer decided instead to move a large chunk of money from my credit card into my cheque account. The result is that I travelled to the USA with a carefuly drained (and, in fact, overdrawn) credit card account. I'm sure the bank has since busily levied charges for my overdrawn credit card... guess it's a typical case of let the buyer beware.

The bank is currently trying to fix the problem (at least on the phone its staffer acknowledged straightaway that it's their fault), but it could be a couple of days till my card would be back in credit.

Begging is fairly common in this country, so if you see me today on the corner of Powell and Market street, spare me a dime while I wait for the Royal Bank of Scotland to fix its mistake. One has to eat after all ...

Udo Schuklenk is testing

... there's something about African Heads of State

... well, some of em anyway. I'm sure you will remember the South African President's ruminations about HIV being not the cause of AIDS, and it all being a nasty conspiracy of white supremacists aimed at denigrating black men. Anyway, Thabo Mbeki has since been engaged in a bitter race towards the ultimate goal, namely the title of 'Nuttiest President on the African Continent'. His most recent efforts in that regard are not focused anylonger on AIDS, he has moved on to suggesting crime isn't that serious a problem in South Africa (population: about 40 million, annual number of murders: 18,000). Another serious contender for the covetted title was for awhile his that-time Deputy President Jacob Zuma. Zuma thought nothing of having unsafe sex with a woman he knew to be HIV infected. Incidentally that woman was not one of his wives (plural, odd, I know) and claimed to have been raped by Zuma. Zuma decided to take serious efforts at post exposure prophylaxis in form of ... guess what ... a shower. Yep, Zuma thought if he washed himself properly his chances of contracting HIV would be reduced. Truly challenging to determine whether Mbeki is ahead or whether Zuma is currently the frontrunner.

My apologies, I have to concede that I kind of digress. I really wanted to tell you about another serious African presidential contender for the title of 'Nuttiest President on the African Continent'. I'm talking about the Gambian President Yahya Jammeh. He claims (yep, proudly on the record) that he is capable of curing AIDS within three days. I understand he was offered a place in various local psychiatric hospitals but he declined, obviously worried that he might have to share a room some time down the road with Thabo Mbeki, or (scary thought) Manto Tshabalala-Msimang, Mbeki's Minister for Health Prevention.

Moral Minds - On Yawning and Empathy

I read this most fascinating book by Mark Hauser. He argues that we as a species have developed a universal moral instinct guiding our ethical decision making. Here's a snippet from the book - sort of my end of the week type quote:
'In my discussion of empathy in humans, I mentioned the interesting observation that people who are more empathetic are more susceptible to yawning. Yawning is generally contagious. But it is really contagious if you have a big heart, unable to turn off your compassion for others. Based on this correlation between yawning and empathy, the psychologist James Anderson wondered whether other animals might also be susceptible to contagious yawning. 39 Captive chimpanzees watched videos of other chimpanzees yawning and doing other things. Though inconsistent across individuals, some individuals consistently yawned back. We can't say that the yawners are empathetic while the non-yawners are not. What we can say is that given the observation that contagious yawning is a signature of empathy in humans, it is possible that the same holds true for chimpanzees and other species. This possibility, as well as other observations of caring in animals, sets up a more specific look for empathy.'

Lucky day for bioethicists: Another Jehova's Witnesses story for our clinical ethics teaching

Reports today's issue of the Canadian broadsheet GLOBE AND MAIL that the authorities in one of the country's provinces have taken control over the medical care of a couple's newborns. In this case, of their sextuplets two newborns died in the meantime, the other four need regular blood transfusions to stay alive. The kids are unfortunate enough to have parents who happen to be Jehova's Witnesses. Not unexpectedly Jehova has told his witnesses that their kids may not receive blood transfusions etc etc - really the usual ridiculousness that religions dump without warning on the uninitiated and unprepared observer. So, these parents are quite happy to see them die rather than receive life saving blood transfusions. Dad reportedly left the hospital when the life preserving transfusions took place as he didn't feel good about sticking around while his newborns were being 'violated'. Of course, if he wasn't be a member of an organised religion (meaning there's plenty more where he came from), the courts would have him on neglect and probably child abuse charges. Given that he believes so very strongly, it seems somehow his 'conscience' based decision deserves some respect instead of derision.

The main point (ie the take-home message) is this: As an adult, competent person you're entitled to decline life preserving means such as blood transfusions. There is no way, however, that you're entitled to make such a decision on behalf of your kids. You are entitled to harm yourself, you are not entitled to harm others (including your kids). That you belief otherwise is besides the point, clinical judgment must win the day, and thankfully it does in most countries.

Funny though that news media continue reporting such cases. I assume this is done so us bioethicists get our hands on more teaching materials ... and for that we ought to be grateful to them!

Beware: AIDS microbicide makes you more vulnerable to HIV infection

An HIV prevention trial was halted in various Southern African countries and in India. The BBC reports that the investigators discovered that instead of reducing the risk of HIV infection the microbicide in question actually increased the risk. In other words, more participants (it being a microbicide, all women, of course) became infected in the active agent arm then in the placebo controlled arm of the trial.

There are several interesting questions with regard to this trial, none of which was flagged in the BBC news report:

1. The women who participated in the trial, by definition were HIV negative when they enrolled. They became infected (almost certainly due to unsafe sex) during the trial. The question is whether these infections constitute a trial related injury that ought to be subject to compensation. Many of them might well have had a therapeutic misconception, that is they might have thought that the stuff they got in the clinic gave them some (a lot - complete?) protection against HIV.
   
2. Indeed, one wonders whether these women will be provided with access to HAART when this could be clinically beneficial to them.
3. Sexy as the idea of an HIV microbicide is, none of the trials undertaken so far have led anywhere. As a non-expert I wonder whether this is a dead-end type concept that is never going to work. You might say, reasonably so, that only further research will tell. The trouble is that we will only find out when women become infected during a trial. That's arguably a pretty high price to pay, even if the women were volunteers and even if they gave truly informed first person consent.