Sunday, July 18, 2010

Ethics of dealing with irresponsible HIV/AIDS denialist parents

A fellow Facebook addict from Toronto sent me a message asking me what I thought about the case involving Barbara Seebald and a commentary written by Matthew Weait, a law scholar with particular expertise on HIV/AIDS and human rights issues who is based in London. Weait wrote a monograph arguing that the criminalization of HIV transmission, and indeed the criminalization of infected people who knowingly subject others to the risk of infection, are bad news. He basically thinks that the criminal law ain't a good tool to achieve desirable public health objectives, at least not with regard to HIV/AIDS. This may or may not be true, but - as I have argued in a lengthy review of this book - there can be another good reason for keeping some HIV transmissions a criminal offense, namely the fact that they demonstrably harm other parties. The same case can probably be made for subjecting some third parties to the risk of HIV infection, too. Read my review of his book. I do, in fact, agree with Weait on many HIV policy and legal issues, but I do think there are circumstances were an HIV transmission could constitute reasonably a criminal offense.

Here's Weait's take on the Seebald case.

Seebald is the second case known to me involving an HIV denialist whose belief that HIV is not the cause of AIDS has translated into serious bodily harm for her offspring. Seebald has chosen not to take antiretrovirals during pregnancy, thereby increasing significantly the risk of her off-spring being HIV positive. One of her children has been hospitalised as a result of HIV-related pneumonia. She breastfed her newborn at the time, thereby further increasing the child's risk of HIV infection. She also misled the midwife assisting in her natural birth to avoid the cesarean section required to reduce the HIV risk. Seebald's children have since been removed from her (yes, they do live with foster parents to protect them against their mother's irresponsible conduct) in order to permit medical doctors to treat them to the best of their professional abilities, an option unavailable to them while the children were with their biological parents. Seebald's - also HIV infected denialist - husband died in May 2010.

As I mentioned, this is the second case that I am aware of that deals with the harmful conduct of HIV denialist parents toward their children. Christine Maggiore, she since died on AIDS, arguably indirectly killed one of her children by ensuring the child did not receive proper medical care.

Matthew Weait, in keeping with what seems his primary legal concern: namely to ensure that the transmission of HIV remains decriminalized (or becomes decriminalized), runs the following line of reasoning to make his case with regard to an Austrian court finding against Barbara Seebald. The court issued a 10-month suspended sentence against Seebald because of her refusal to protect her newborn reasonably against HIV infection. Weait doesn't like the verdict at all. Here are what I take to be the crucial bits from his analysis (please do read his complete analysis here):

He begins by pointing out that for retributive justice to work we need a moral blameworthiness (ie a bad intention - undoubtedly not the case in either Seebald's or Maggiore's case), or the people whose actions we are concerned about need to have been grossly negligent (it's a no-brainer that this applies to both the Seebald as well as the Maggiore cases). I do think Weait's analysis is as seriously flawed as quite some of that presented in his monograph. In this particular instance he rehearses reasons from his monograph that clearly do not apply to these cases. The argument that Seebald and Maggiore were arguably criminally negligent has nothing at all to do with public health concerns (the numbers are too small for this). They have to do with something I elaborated on at great length in my review of his book: gross negligence leading to serious bodily harm to third parties. In this case the third parties were not even volunteering sexual partners, in this case the third parties were these women's own children! As an HIV clinician pointed out in this context: '...infants whose HIV infected mothers listen to AIDS denialists never got the chance to make their own decisions. The Maggiore case received wide publicity. Christine Maggiore is a person who’s proselytized against the use of antiretrovirals to prevent HIV/AIDS. She’s a classic AIDS denialist, and she gave birth to a child who died at age three late last year of an AIDS-related infection. The coroner’s report clearly reports that the child died of AIDS. That was another unnecessary death.'

Weait's analysis, on the other hand is concerned not really about the kids that have been grossly negligently infected by their nuttish mothers, but about the genuinely held dissident views of their parents. How dare we to ignore 'It follows that someone who honestly (even if misguidedly) denies the relationship between HIV and AIDS cannot legitimately be punished for onward transmission of HIV, unless one takes the view that such honest belief is to be ignored' he writes. And further, to drive this important insight home, 'And if we ignore it, then we fail to take seriously the reasons - whatever those might be – for denialism. These might be grounded in a person’s particular life story; or they might result from misinformation or misunderstanding. Whatever its cause, and however difficult it might be to understand that denialism or to sympathise with it, our incomprehension cannot be a sufficient justification for criminalisation and punishment.'

This shows, to my mind, the trap the decriminalization crowd is finding themselves in, with their blanket refusal to acknowledge that there can be circumstances where HIV transmission deserves to be dealt with thru our criminal justice system. Why should it make any difference to our evaluation of the Seebald and Maggiore cases (where idiotic views demonstrably led to serious bodily harm inflicted by these pregnant women on their off-spring), that these people held such idiotic views genuinely, that they ignored overwhelming clinical evidence to the contrary and so on and so forth. Is the argument that their circumstances were such that they were unable to compute the evidence that would have been available to them, had they cared to clear their minds? If this is the argument, perhaps removing their kids from them would have been a sensible choice. It doesn't appear to be the case then that they were strictly speaking competent to bring up these kids to begin with. Surely it is unreasonable to risk one's child's life in order to test the hypothesis of a negligible number of dissident scientists. It's here where Weait moves too quickly to discard the grossly negligible rationale as the basis for a criminal prosecution. This all, of course, is in the service of the blanket decriminalization policy he propagates.

And, just to be on the safe side, Weait quickly throws some mud at those disagreeing with this take, 'doing otherwise effectively makes a failure to accept what most other people believe a sufficient justification for punishment, and that has a frighteningly totalitarian ring to it.' This is bollocks, of course. Failure to believe what other people believe would never lead to punishing anyone, unless that failure leads to the deaths of other parties, or serious bodily harm inflicted upon third parties. Harm to self is fair game, harm to others ain't. That's why even Jehova's Witnesses today in most jurisdictions won't get away with preventing their off-spring from receiving life-preserving blood transfusions when that is clinical indicated. They can harm themselves, but they must not harm others. Nothing totalitarian about this.

Of course, there's never a chance lost to lament 'the effects of HIV-related stigma and prejudice', and so Weait concludes his analysis with general stuff about stigma and prejudice. I pretty much lost it at that point: Here's pregnant women that deliberately decided to disregard mainstream medical advice, and who so chose to risk their children's well-being (with the terrible consequences of death in the Maggiore's child's case, and of life-long serious chronic illness in the Seebald's case). The thing is, virtually all pregnant HIV infected women do NOT act like Seebald and Maggiore, hence Weait's other claim, namely that of 'systemic failures in HIV/AIDS education' is obviously baseless. - None of this has anything at all to do with HIV-related stigma and prejudice.

It goes without saying that these cases are tragic, and thankfully they occur very infrequently. The broader policy point, however, is this: Parents do not own their children. Their kids' lives ain't a free for all. The state has an interest in protecting children against abusive behavior that parents engage in, regardless of whether parents feel strongly that their behavior is not abusive when it actually is. While it might be of interest to Matthew Weait and a lot of sociologists and psychologists to figure out what drives such parents (check out the Darwin Awards in case you've doubts that there's plenty of nutcases out there), at the end of the day society needs to step in and prevent such abuse in its tracks. That's the objective. If currently that can only be achieved thru the criminal justice system, then so be it.






Saturday, July 17, 2010

Citizens of the World Against Stoning: International Sakine Mohammadi Ashtiani Day

I am reproducing this on my blog in order to support protest events the world all over.

On a more cheerful note, I am truly thrilled to know many of the signatories of this statement personally. Thanks to all and everyone for supporting this initiative!

udo
24 July 2010 - International Sakine Mohammadi Ashtiani Day
Citizens of the World against Stoning

We, the undersigned, are extremely concerned about the fate of 43 year old Sakine Mohamadi Ashtiani and fear she may be executed in Iran at any time for ‘having an illicit relationship.’

We call on people everywhere to intensify their protests by marking Saturday 24 July as the International Sakine Mohamadi Ashtiani Day. On the Saturday, we ask you to come out on to the streets and in city centres across the globe at 2pm local time bringing photos of Sakine and messages in her defence and against stoning and execution. Other measures that can be taken include highlighting her case wherever possible, signing petitions (http://stopstonningnow.com/sakine/sakin284.php?nr=50326944&lang=en), http://www.avaaz.org/en/stop_stoning/?cl=651962225&v=6766 and (http://freesakineh.org/), joining rallies, and keeping pressure on the Islamic Republic of Iran.

The mother of two has already received 99 lashes and been sentenced to death by stoning. Sajjad, her 22-year-old son, who raised the alarm of her imminent stoning when there was no further legal recourse via an open letter to the people of the world (http://notonemoreexecution.org/campaigns/sakineh-mohammadi%c2%a0ashtiani/) and said ‘there is no justice’ in Iran (www.notonemoreexecution.org/2010/07/07/6july2010-sajjad/) has been summoned to the Ministry of Intelligence for his brave efforts to secure his mother’s freedom (http://notonemoreexecution.org/2010/07/14/press-release-no-16/).

As a result of the public outcry, the embassy of the Islamic Republic of Iran in London has issued a press release stating that the regime did not intend to stone her, that stoning in Iran was rare and that there was no truth to the reports (http://iransolidarity.blogspot.com/2010/07/keep-pressure-on-until-we-end-stoning.html). Her lawyer, however, has made it clear that ‘Iranian embassies are not a part of the judiciary system, and it is the judiciary which should cancel this sentence’ (http://notonemoreexecution.org/2010/07/09/pr-sakineh4/). Rather than being rare, a new report has found that over 100 known stonings have already taken place and another 25 known cases await death by stoning in Iran (http://countmein-iran.com/Sangsarha%20lst-farshad-july2010.pdf). Since the global protests, families of others held in Tabriz prison have come forward with news of 170 people sentenced to death, including children, youth, and 18 men and women for being gay. Two other women also await death by stoning in the same prison including Azar Bagheri who was 15 when she was arrested and 25 year old Maryam Ghorbanzadeh who is currently pregnant (http://notonemoreexecution.org/2010/07/14/press-release-no-13/).

On 24 July 2010 at 2pm join us and make the world stand still in its rage against medievalism and barbarity and in its support of humanity. Sakine, her children and the many others awaiting death by stoning and execution deserve nothing less.

Mina Ahadi, International Committee Against Stoning and International Committee Against Executions (Germany)
Maryam Namazie, Iran Solidarity, Equal Rights Now – Organisation against Women’s Discrimination in Iran and One Law for All (UK)
Maria Rohaly, Mission Free Iran (USA)
Shahla Abgari, Human Rights Activist (USA)
Nazanin Afshin-Jam, Stop Child Executions (Canada)
Russell Blackford, University of Newcastle (Australia)
Caroline Brancher, Union des Familles Laïques (France)
Helle Merete Brix, Journalist and Writer (Denmark)
Roy Brown, International Humanist and Ethical Union (Switzerland)
Ed Buckner, President, American Atheists (USA)
Peter Calluy, Belgian Humanist Society (Belgium)
Pierre Cassen, Riposte Laïque (France)
Megan Cornish, Seattle Radical Women (USA)
Parvin Darabi, Dr. Homa Darabi Foundation (USA)
Richard Dawkins, Scientist (UK)
Sanal Edamaruku, Rationalist International (India)
Bill Flanagan, Queen's University (Canada)
Tahir Aslam Gora, Writer and Journalist (Canada)
AC Grayling, Writer and Philosopher (UK)
Laura Guidetti, Marea Association (Italy)
Maria Hagberg, Network against Honour-Related Violence (Sweden)
Johann Hari, Journalist (UK)
Farzana Hassan, Author (Canada)
Tasneem Khalil, Independent World Report (Sweden)
Hope Knutsson, Sidmennt, the Icelandic Ethical Humanist Association (Iceland)
Leo Igwe, Nigerian Humanist Movement (Nigeria)
Sonia Jabbar, Journalist (India)
Trefor Jenkins, University of the Witwatersrand (South Africa)
Ghulam Mustafa Lakho, High Court Advocate (Pakistan)
Monica Lanfranco, Marea Feminist Review (Italy)
Anne-marie Lizin, Belgian Senate Honorary Speaker (Belgium)
Marieme Helie Lucas, Secularism Is A Women's Issue (France)
Kinga Lohmann, KARAT Coalition (Poland)
Mohamed Mahmoud, Centre for Critical Studies of Religion (UK)
Irshad Manji, European Foundation for Democracy and New York University (USA)
Caspar Melville, Rationalist Association (UK)
Behnaz Parman, Artist (Germany)
Angela Payne, Anti-Injustice Movement (UK)
Clancy Pegg, Bioethics Journal (UK)
Naomi Phillips, British Humanist Association (UK)
David Pollock, European Humanist Federation (UK)
Venita Popovic, Zenicke Sveske Journal (Bosnia and Herzegovina)
Gita Sahgal, Human Rights Campaigner (UK)
Terry Sanderson, National Secular Society (UK)
Nina Sankari, European Feminist Initiative (Poland)
Udo Schuklenk, Queen's University (Canada)
Aisha Lee Shaheed, Women Living Under Muslim Laws (UK)
Issam Shukri, Defense of Secularism and Civil Rights in Iraq (Canada)
Elizabeth Sidney, Women Worldwide Advancing Freedom and Equality (UK)
Joan Smith, Writer and Activist (UK)
Roy Speckhardt, American Humanist Association (USA)
Annie Sugier, Ligue du Droit International Des Femmes (France)
Richy Thompson, National Federation of Atheist, Humanist and Secular Student Societies (UK)
Christine Tasin, Résistance Républicaine (France)
Peter Tatchell, Human Rights Campaigner UK)
Giti Thadani, Writer and Filmmaker (India)
Shishir Thadani, South Asian Voice (India)
Gianni Verdoliva, Journalist (Italy)

Notes:

1. The new and comprehensive list of persons stoned to death or awaiting death by stoning in Iran compiled by Farshad Hosseini of the ICAE is available in Persian:http://countmein-iran.com/Sangsarha%20lst-farshad-july2010.pdf. It is being translated into English.

2. See a 17 July article in the Times calling for the eviction of the Islamic Republic of Iran from the UN Commission on the Status of Women: http://iransolidarity.blogspot.com/2010/07/evict-iran-from-commission-on-status-of.html

3. For more information, please contact:
Mina Ahadi, Germany, ICAE and ICAS Coordinator, minaahadi@aol.com, 0049 1775692413
Ahmad Fatemi, ICAE Public Relations, fatemimark@gmail.com, 0046 0735203817
Maryam Namazie, UK, Iran Solidarity Spokesperson, iransolidaritynow@gmail.com, 0044 7719166731

4. To donate to the important work of the International Committee Against Stoning and International Committee Against Executions, please make your cheque payable to ‘Count Me In – Iran’ and send to BM Box 6754, London WC1N 3XX, UK. You can also pay via Paypal (http://countmein-iran.com/donate.html). Please earmark your donation.

5. You can also find the latest news on the following websites:
International Committee Against Executions (http://notonemoreexecution.org/)
International Committee Against Stoning (http://stopstonningnow.com/wpress/)
Facebook Page of Save Sakine Mohamadi Ashtiani: http://www.facebook.com/group.php?gid=55479797684&ref=ts

Tuesday, July 13, 2010

Was the University of Illinois at Urbana-Champaign right to fire Catholic instructor?

Here's a tricky case involving academic freedom at the University of Illinois at Urbana Champaign. The University fired a Catholic instructor because he wrote this letter to students in a class he taught on (get this) 'Utilitarianism and Sexuality'.

The academic in question didn't actually have tenure, he was an adjunct instructor. In his letter he states - among other things - the following:

'To the best of my knowledge, in a sexual relationship between two men, one of them tends to act as the "woman" while the other acts as the "man." In this scenario, homosexual men have been known to engage in certain types of actions for which their bodies are not fitted. I don't want to be too graphic so I won't go into details but a physician has told me that these acts are deleterious to the health of one or possibly both of the men. Yet, if the morality of the act is judged only by mutual consent, then there are clearly homosexual acts which are injurious to their health but which are consented to. Why are they injurious? Because they violate the meaning, structure, and (sometimes) health of the human body.'

What wrong about this statement?
1) It is not the case that in same sex relationships one of the partners necessarily acts as the 'woman' and the other one acts as the 'man'. Even if this was the case, nothing at all followed normatively.
2) Empirically it makes no sense at all to speak of people engaging in sexual acts that their bodies are not fitted (by whom?) to undertake. Everything that we are physically able to undertake with our bodies are able ('fitted'?) to do.
3) It is question begging to claim that a sex act violates the meaning of our bodies? As in 'how', 'why', 'by means of what'? Are we violating our bodies each time we engage in sexual acts for the fun of it as opposed to in order to breed? What's he on about here?
4) What is meant by the 'structure of the human body' being violated by a same sex act?

And so he concludes,

'Catholics don't arrive at their moral conclusions based on their religion. They do so based on a thorough understanding of natural reality.'

This, of course, is patently untrue and unprofessional a statement. By necessity Catholics (qua Catholics) arrive at their moral conclusion about sexuality (amongst others) by means of a normative understanding of natural reality (ie their interpretation of what nature, especially human nature ought to be like, as opposed to what it really is like). For that reason the preacher (aka teacher) sneaks in Natural Moral Law and Reality. Really he's saying that natural law theory thinks that human reality ought to be such and such, when quite obviously it is different. The problem then ain't with the theory but with our behavior. All quite silly stuff to be honest.

Was it sensible to fire him? Well, given that the topic of the class was 'Utilitarianism and sexuality' (I can't see how anyone could teach that topic for a whole term, but hey), he clearly went on an agitprop exercise, even trying to hide is real reasons (Catholic doctrine) by claiming that his views have nothing to do with religion. He said, for instance, 'As a final note, a perceptive reader will have noticed that none of what I have said here or in class depends upon religion.' That's a plain lie. No wonder his University chose to take him down.

A nice analysis of some other nonsense in the good preacher's email to his students can be found at the - as ever - dependable Pharyngula.

Wednesday, July 07, 2010

Britain becomes safe heaven for gay refugees

The UK Supreme Court issued a finding today that gay refugees from countries that discriminate against homosexuality may not be send back to their home countries if there is a risk that they might be persecuted at home. The new conservative-liberal government promised to implement the ruling immediately, adding that they already have stopped sending such refugees back to their home countries. Initially, UK Home Office officials came up with the ingenious idea that gay people, after their deportation, should simply hide their sexual orientation at home, and so they would be fine. Lower courts agreed with the Home Office proposition, but the justices of the Supreme Court decided that that would constitute a violation of these gay people's human rights.

Here are bits from the finding that I did truly enjoy (taken from the UK Guardian website):

Deputy court president Lord Hope said in his ruling: "The ultra-conservative interpretation of Islamic law that prevails in Iran is one example. The rampant homophobic teaching that rightwing evangelical Christian churches indulge in throughout much of sub-Saharan Africa is another."

A "huge gulf" had opened up in attitudes towards gay people, he said. "It is one of the most demanding social issues of our time. Our own government has pledged to do what it can to resolve the problem, but it seems likely to grow and to remain with us for many years." More gay and lesbian people were likely to have to seek protection in this country if it was denied in their home countries, he said.

Another member of the court, Lord Rodger, said normal behaviour of gay people must be protected just as it was for heterosexual people. "What is protected is the applicant's right to live freely and openly as a gay man. To illustrate the point with trivial stereotypical examples from British society: just as male heterosexuals are free to enjoy themselves playing rugby, drinking beer and talking about girls with their mates, so male homosexuals are to be free to enjoy themselves going to Kylie concerts, drinking exotically coloured cocktails and talking about boys with their straight female mates."

Leaving aside for a moment the characterization of gay men as being typically this or being typically that, the point is well taken that if this is how you express your identity you have every right in the universe to do so without risking your life. You can see how important this judgment is when you look at how bad the situation for gay people in many countries is.

Tuesday, July 06, 2010

German Federal Court on PID

Imagine my surprise when I read in today's paper about a judgment from Germany's Federal Court in a case determining the legality or otherwise of pre-implantation diagnosis. Just so you get the significance of this, here's a blurb from Wikipedia about the relevance of the Federal Court in Germany's legal pecking order: 'The Federal Court of Justice of Germany (German: Bundesgerichtshof, BGH) is the highestcourt in the system of ordinary jurisdiction (ordentliche Gerichtsbarkeit) in Germany. It is the supreme court (court of last resort) in all matters of criminal and private law. A decision handed down by the BGH can only be reversed by the Federal Constitutional Court of Germany in rare cases when the Constitutional Court rules on constitutionality (compatibility with the Basic Law for the Federal Republic of Germany).'

The Court determined that it is OK to check for serious genetic defects of embryos prior to implantation in couple with known serious genetic illnesses. In one of the cases the woman considering conceiving another child had already given birth to a disabled daughter, another woman went thru three failed pregnancies. It goes without saying that embryos that are non implanted after PID took place (ie after serious genetic defects have been diagnosed) will be destroyed.

Critics have trotted out the usual stuff like that this discriminates against the disabled, and that this takes us on a slippery slope to designer babies (ie selection in favor of blue eyed kids was mentioned). It is true that the court judgment takes a clear stance on the former issue. If at the embryonic stage it is possible to make a choice between a future seriously disabled child and a healthy (healthier) child, the latter is preferable and it is up to pregnant women to decline the implantation of the embryo known to be defective. On the latter issue, currently such choices would not be covered by the judgment, but frankly, what if someone chose blue eyes over brown eyes, or brown eyes over blue eyes, what danger would this really entail? If someone - like me - subscribes to the ethical stance (as I do) that women are very much entitled to make reproductive choices entailing abortions, for any reason or none, why should it matter that they decline the implantation of an embryo with the wrong eye color?

I do think my progressive friends need to think carefully about whether or not they support unconditionally a woman's right to make reproductive choices. If they do, the above mentioned slippery slope arguments must not faze them.


Monday, July 05, 2010

Jamaican papers are at it again – homophobia in 'reporting' action

Having just redeemed themselves in the eyes of regular readers with pretty sharp reporting about the Dudus' affair, Jamaica's journalism is back to its usual quality-wise lows.

Two of Jamaica's papers, the Observer and the Gleaner have a long and distinguished history of anti-gay agitprop. The Gleaner frequently does it under the guise of pseudo-openness perpetuated by one of its columnists. He's a quite eloquent chap who likes to gives his musings an air of scientific soundness when really he picks and chooses biased academic content usually from low-ranking academic journals likely gleaned from the Family Research Council's (or some other Christian fundamentalist organisation like it) treasure chest of anti-gay 'research'. You know, the kind of research 'demonstrating' that gays are more likely to rape little kids, murder your grannie and have a hotline to the devil. A long running Jamaican agitprop feature on that front has been this: Antigay violence in Jamaica ain't the real problem (empirical research undertaken by international human rights organisations be damned) but violent gay men beating each other up are the real problem.

Here's an example taken from the Observer. In last Sunday's edition, under the byline of 'DONNA HUSSEY-WHYTE Sunday Observer staff reporter', the campaign continues. Hussey-Whyte notes in her introductory line that 'Many may argue that the gay community is falsely accused of excessive violence against its own members, but the horrible wounds on Keron Brown's body tell a different story.” Her story is about a gay man who she reports has been abused pretty badly by his partner and that partner's mates. Assuming that the case is true – I have no way to verify it, but it's perfectly possible, of course, that a gay man was abused by his partner – nothing follows with regard to how the average gay person treats his or her partner(s).

No doubt Donna Hussey-Whyte doesn't know what inductive reasoning is, and even less why we know that such modes of analysis don't work as a scientific method. So, to her benefit: You can't really use anecdotal cases to make a general point. Say, assume I see someone jumping out of a 10th floor window and ending up on the ground floor without injury. I shouldn't make that the story line of an article suggesting that generally speaking it's sensible to assume that jumping out of 10th floor windows isn't a risky activity. I'm sure you get the drift. So, before Donna Hussey-Whyte's agitprop piece even goes into full swing, anyone who took Scientific Method 101 knows already that not only is her first sentence wrong, but more importantly, that anyone can know with certainty that her story can't prove her point about the gay community being pretty violent against its own members. It's not even clear what she means with gay community to be honest. Is her proposition that the average gay person is more likely, or a membership club called 'gay community' or is something else tickling her incisive reporting mind?

Even if there was a whole bunch of such cases, nothing would follow regarding the question of how the majority of gay people in Jamaica treat each other. Short of a representative survey, this bunch of cases would be just that, a bunch of anecdotes. The question is: Could such research even be undertaken in a society where gay people are hunted out of their houses, beaten up randomly in the streets, and where homosexual conduct and relationships are still illegal. The truth is, if we bothered investigating what amounts to an odd-indeed hypothesis to begin with, we would really have no means to undertake such a study in current-day Jamaica.

Anyhow, back to Donna Hussey-Whyte's agitprop piece: Just think of a counter example of similar disingenuity, think of the number of crimes committed by heterosexual people in Jamaica. Most of those crimes are committed against other heterosexual people. Would this tell us anything at all about a purported link between heterosexuality and violent behaviour? Not at all – that is unless you're Donna Hussey-Whyte. Oddly, she never filed this particular investigative report. Makes you wonder why...

Having said that, from societies more peaceful than the Jamaican we do know that gay people are – if anything – less prone to be violent than their straight counter parts. Is it possible that anti-gay violence and general societal homophobia cause possibly surplus violence among gay people that otherwise would not exist? This truly is an interesting question, if we accept the local media's as yet unsubstantiated premise that gay people in Jamaica are really more prone to abuse each other than they are in other countries. Do we know whether they are more prone to this sorts of behaviour than they are in other countries, or do we know whether they're more prone to violence than are heterosexual people in Jamaica? We know none of this, unless we believe that Donna's inductive 'reasoning' is a good substitute for actual evidence.

As ever, beware of Jamaica's newsmedia when it comes to the issue of homosexuality. Their reporting is by and large in the service of anti-gay prejudice. It's mostly propaganda, no more, no less.

Friday, July 02, 2010

Circumcision time again

The time honored barbarism of killing young (South) African men in that traditional practice of circumcision has again yielded a decent crop of dead men in South Africa. Reportedly about 150 young men died in circumcision ceremonies (or as a result of their participation) between the beginning of 2008 and the end of 2009. So-called traditional healers (elevated to a profession under the able guidance of the late Dr Beetroot, the former South African health minister and arch AIDS denialist Manto Tshabalala-Msimang) are frequently involved in botched circumcisions, causing so substantial numbers of avoidable deaths. The opposition DA party suggests that the actual circumcision should take place in a hospital. Now that's a thought.

Of course, there will be those who say that circumcision is always wrong, and - my own preferences to the contrary notwithstanding - there's some truth in that. The thing is though, since we have fairly strong evidence that circumcision dramatically reduces the risk of catching HIV there's probably a public health argument to be had - in Southern Africa - for undertaking circumcisions. Wouldn't it be nice though, if authorities in that country managed to have them conducted in such a way that not so many young men needlessly lose their lives over them?

Monday, June 28, 2010

G8 and G20 cost

What's the point of hosting these G8 and G20 events in big cities? Toronto was transformed into a police state for the duration of the event, the losses in terms of tourism revenue and productivity were/are large, and the list goes on.

I can see that there is an argument to be had that democratically elected heads of state should be able to meet even if there's violent protesters threatening to disrupt their meeting. In Canada, what was odd were marketing exercises (like a - get this - fake lake) that might have been of interest to tourists (who saw mostly violent protests on TV) but that were certainly of no interest to the attending heads of state (they got their own lakes). The photo shows an artist rendering of the lake ...

So, my question is this: if these heads of state believe it's worth meeting - the official results along would suggest that perhaps they might be mistaken - why can't they meet in some out-of-nowhere place? You know, all things considered, it might be cheaper building them a hotel in some place in the sticks and have em take their helicopters or planes there. Should be cheaper than shutting down multi-million people cities. What a waste!

Friday, June 25, 2010

Assisted dying OK in Germany under certain circumstances

Imagine my surprise when I read in today's paper about a judgment from Germany's Federal Court in an assisted dying case. Just so you get the significance of this, here's a blurb from Wikipedia about the relevance of the Federal Court in Germany's legal pecking order: 'The Federal Court of Justice of Germany (German: Bundesgerichtshof, BGH) is the highest court in the system of ordinary jurisdiction (ordentliche Gerichtsbarkeit) in Germany. It is the supreme court (court of last resort) in all matters of criminal and private law. A decision handed down by the BGH can only be reversed by the Federal Constitutional Court of Germany in rare cases when the Constitutional Court rules on constitutionality (compatibility with the Basic Law for the Federal Republic of Germany).'

So, today said court ruled that if someone competent has decided they wish to die, even if the nature of their illness does not suggest that their dying process has begun, whoever removes pro-actively their means of life-support has not broken German law. Further, in the case of unconscious patients the patients' likely intention is considered sufficient to make the removal of life support systems legal. In the case under consideration a reportedly a woman who had been in persistent vegetative state for 5 years had her means of life support terminated by her daughter based on the patient's expressed wishes. Part of the problem was that her wishes were only expressed verbally to her daughter prior to her coma, hence no written advance directive existed. The patient had no chance of an improvement of her clinical situation. I wonder whether different circumstances might have changed the verdict or whether this really suggests that self-determination takes priority over the purported sanctity of life in German law.

This, of course, is terrible news for those God people who believe that we are not entitled to make respect demanding decisions about how we wish to die.

Tuesday, June 22, 2010

Publicationethics.org on Ghostwriting

Publicationethics.org has a feature about several papers from the current issue of Bioethics on ghostwriting of medical journal articles.

Ghostauthors, ghost management and the manipulation of medical research

There are three articles in the June issue of Bioethics on different aspects of ghostwriting.

The first article, by Tobenna D Anekwe, “Profits and plagiarism: the case of medical ghostwriting” argues that “medical ghostwriting often involves plagiarism and, in those cases, can be treated as an act of research misconduct” and suggests measures to counter ghostwriting.

The second article, by Sergio Sismondo and Mathieu Doucet, “Publication ethics and the ghost management of medical publication" discusses the wider issue of management of the whole publication process, showing how “pharmaceutical companies engage in the ghost management of the scientific literature, by controlling or shaping several crucial steps in the research, writing, and publication of scientific articles."

The final article, by Carl Elliott and Amy Snow Landa, "What’s wrong with ghostwriting?" concludes that ghost authorship and ghost management are part of a much larger problem, “the manipulation of medical research for marketing purposes.”

Sunday, June 20, 2010

Bioethics and Developing World Bioethics show improved impact factors

As you probably know, I am a co-editor of two peer reviewed international journals called Bioethics and Developing World Bioethics. Each year a commercial Canadian outfit called ISI (owned by Thomson Reuters) delivers its verdict on journals' impact (often confused with quality by journalists, academics and university administrators).

Publishers invariably get excited about their journals as good impact factors mean 'better' journals mean better marketing opportunities mean more money. There is plenty of evidence to go around that the impact factor is highly unreliable (in fact, ISI failed to reproduce, on request, its own impact factors in several test cases). Still, much like donors, students and government funders take notoriously nonsensical university rankings as their gospel, academics use high-ranked journals as preferred outlets and so this stuff becomes a self-fulfilling prophecy. In many universities academics are receiving bonuses for publishing in high-ranking journals. The idea is that a high-ranking journal is difficult to get into and voila, another quality standard is born. Duly, once you're high-ranking individual national science agencies begin dumping A's and similar rankings on you. More incentives for academics working under the influence of these agencies to publish in 'A' ranked journals. Of course, this all translates into creating self-fulfilling prophecies. It seems it hasn't occurred to anyone yet that a 'journal' publishing one article per year that gets cited a lot would have a stratospheric impact factor, and it would be difficult to get published in. So that useless journal with its one article per volume would be very 'prestigious' on the relevant counts.

This year ISI has increased the number of non-English journals it ranks, but there's an inherent bias in its ranking of these journals as ISI has no way to actually measure the citations of these journals reliably. As a result of the new inclusion policies these journals rank consistently low and assist in artificially boosting the group ranking of English language journals. For instance, a little-known English language bioethics journal that normally would have been safely ensconded on the bottom of the ranking is now being surpassed in the race to the bottom by Italian and German language bioethics journals.

Anyhow, this is just to report that Bioethics increased its impact factor to 1.136 while Developing World Bioethics, in its first entry scored a nice 1.256. Both journals managed to 'beat' quite a few very well-known competing publications. So all is good on the journals front. In a list of 34 journals in the 'ethics' category we made it to ranks 7 and 9 respectively,

Sunday, June 13, 2010

Should someone smack her or her parents?

I am not in favor of corporal punishment (really). Still, in the case of the recently rescued teenage woman who was determined to sail around the world, I can't help but think some should smack her for attempting this or her parents for permitting her to attempt this. Her voyage floundered in bad weather and a major rescue operation had to be launched, involving planes, boats and whatnot. I hope someone, someone please bankrupt this family for its selfish conduct. Sue them for the resources wasted in this unnecessary rescue mission. This woman should have entertained herself (and her ego) by staying at home and doing something useful (for crying out loud: help in the local homeless shelter, teach younger folks locally how to sail etc etc). Beats me why this kind of stuff happens again and again and again. What drove this family to permit her ill-prepared daughter to undertake this trip? And why should anyone other than the family pay for rescuing this person out of her self-inflicted problems?

On a more personal note, I will be away for about a week (working away from my homebase). I am likely unable to update the blog during this week.

Sunday, June 06, 2010

More corruption at UN?

Turns out what most interested observers have been arguing for a long time has been proven correct. The WHO's panic mongering in relation to the swine flu pandemic was just that, panic mongering. The primary beneficiaries were pharmaceutical companies whose products were stockpiled by many countries that responded to WHO recommendations. Finally, in-depth reports accuse WHO of exaggerating the real danger. The reports also note that on the WHO committee writing the report served several scientists who arguably had a conflict of interest (related to their relationships with pharmaceutical companies). The Washington Post wonders whether or not the WHO advert for flu medicines (aka its flu guidance) informed its member countries of these commercial conflicts of interest.

Do not trust a word BP is uttering

April 28 2010, BP - against the opinions of many qualified scientists - insists that a maximum of 5000 barrels of oil per day flows into the sea. The company is duly supported by US Pres (yes we can walk on vacuous pronouncements) Obama's experts. Well, today the company announces that its current fix results into them pumping 10000 barrels of oil per day to a ship above the leak. In case you still watch the live video from the leak, you will have noticed that despite this effort oil is leaking in large quantities into the ocean. 5000 barrels a day, BP, really?

Tuesday, June 01, 2010

Offense ain't a good reason for censorship

This debate about whether it's acceptable (with reference to free speech) to draw cartoons of the Muslim's prophet Muhammad or not is just weird. Let's be clear about what I mean by acceptable: Acceptable in the sense of unacceptable being a sufficient reason to prohibit (or prevent by threat of violence) someone else from drawing a cartoon of the prophet (both depicting him negatively or positively). Islam seems to have a prohibition to depict the prophet. That's all quite all right for adherents of that ideology who voluntarily agree not to draw such cartoons. However, what about the majority of people on the planet who happen to be adherents of other ideologies (or none)? Should they be bound (as in legally, or by threat of force) by such a prohibition?

The main rationale that I could find as a justification for declaring depictions of the prophet unacceptable (by my above definition) is that it offends Muslims. So, a lot has been made of good neighborly behavior (Christians, no doubt wouldn't appreciate cartoons of their Jesus as a gay guy who surrounds himself mostly with men, for instance - btw, I am not suggesting Jesus was gay, hey, I'm not even qualified to judge whether or not there's a historical Jesus to begin with). There's probably a point to be made that it would be nice if people stopped depicting the figureheads of major ideologies (religious or otherwise) as pinheads of some sort or other. Less people would be upset (the standard burning of flags and people by some Muslims in developing countries that routinely follows rumors of a new cartoon is, of course, distinctly unhinged and undoubtedly explainable by the low levels of education in such places), and so our world would be a more peaceful place.

However, is that a sufficient reason to declare such cartoons unacceptable (by my above definition)? I don't think so. One reason for this is that the most radical adherents of such ideologies would otherwise be able to dictate to the majority what kinds of cartoons may or may not be drawn and seen. Very clearly those most fanatic about the ideological convictions would also be most likely to be most offended by such speech acts (a cartoon is a kind of speech act after all). Should we really determine the permissibility of speech acts by whoever is the most fanatic? I don't think so.

The bottom line, to me, seems to be that no one has a right not to be offended. Freedom of speech is not absolute, but the right to offend must surely be included in any definition of free speech. All the time honored rationales for free speech are sufficient to justify this conclusion, but just as well, we got to realize that the consequences of allowing the most radical adherents of any given ideology to determine what's too offensive in public debate, are plain unpalatable.

Saturday, May 29, 2010

Gay men of integrity and spineless homosexuals

You might find this a very odd comparison, but it's kind of apt I think.

On the one hand there are Malawians Steven Monjeza, 26, and Tiwonge Chimbalanga, 33. They, were arrested in December 2009 after they threw themselves an engagement party at the Blantyre lodge where Mr. Chimbalanga worked as a cook and a housekeeper. They were eventually found guilty of some 'unnatural' (a contradiction in terms) or other by a Malawian court and sentenced to 14 years jail by a Christian judge keen on 'deterring' others from engaging in homosexual conduct in that country. Well, Malawi, being just another more or less failed African state depending on Western hand-outs, was told literally by the world (from the Canadian foreign minister to the newly elected UK Prime Minister to very many other people) to get a grip. The current UK's international development minister (ie the guy in charge of the Malawian international aid) is an openly gay man. The UN general secretary told Malawi's president that this verdict violated international human rights. Duly, and no doubt to the great disappointment of US evangelicals that usually have a hand in these sorts of homophobic actions, the Malawian president pardoned the gay men and they'd be free by now. There are a lot of aspects to this that are worth commenting on. However, I mean to compare the integrity with which these gay men have conducted themselves with the deeply embarrassing conduct of other gay men. Think of David Laws, the former UK Treasury Chief. He was caught with his hands in the till, well, sort of. Laws resigned after it became public knowledge today that as an MP he had himself reimbursed from the public purse for 'renting' a room in his same-sex partners properties. 'The Daily Telegraph disclosed that he claimed as much as £950 a month in parliamentary expenses for eight years to rent rooms in two London properties.The houses were owned by his partner, James Lundie, a political lobbyist. In 2006, MPs were banned from “leasing accommodation from a partner”. ' Laws says that he kept his sexual orientation a secret from both his family and the public, and hence did not disclose that his partner was his partner. Laws was probably not motivated by greed, being an independently wealthy former investment banker.

So, here's this rich guy then who doesn't have to worry about losing his job, who doesn't have to worry about jail sentences, who lives in a society where the civil rights of gay people are very well protected, and yet he engages in embarrassing shenanigans to hide what doesn't need to be hidden. He serves in a conservative-liberal government with other openly gay ministers, yet he remains in the closet. Worse, he's a member of the Liberal Democrats, so by any stretch of imagination he had no reason to worry about negative political repercussions if his sexual orientation ever became public knowledge. Compare Laws' lack of personal integrity with how the two Malawian gay men have conducted themselves under much much more difficult circumstances.

Strange times.

I have to be honest, I have no sympathy for gay people who choose to hide their sexual orientation (by means of living a life designed to deceive everyone around them, from their families to their business partners, friends etc etc) when there is no good reason to do so. All other things being equal, anyone who, like Laws, is independently wealthy, has little reason to reside in a closet. If you live in places where your life might be threatened or other serious repercussions are to be feared, you might have a reason to keep your sexual orientation a secret, but otherwise, you do not deserve any sympathy when you are found out (Laws being a case in point). This deceitful behavior is offensive to other gay people who are open about who they are.

Industry greed vs patient needs

Another chapter in the never-ending story of patient survival needs vs pharmaceutical industry greed. The Danish company Novo Nordisk, the world's leading supplier of insulin has decided to stop supplying near-bankrupt Greece with insulin, because the Greek government in a desperate attempt at saving money decreed a 25% price cut on all medicines. Patients are being held hostage here by a profit-driven organisation, to the extent that their well-being is at stake. So far for the myth that pharmaceutical companies are in the business of health... - One would hope that eventually the important lesson is learned by the powers that are that we cannot leave drug R&D more or less exclusively in the hands of for-profit operators. That the patients of whole societies can be held hostage by organizations such as Novo Nordisk, without recourse, is surely unacceptable.

Monday, May 24, 2010

Montreal's environmental rip-off

Montreal has this widely hailed scheme where you can rent bikes to travel about town. I think London is considering using the same scheme. The bikes are called Bixi, and they're kind of public bikes. The idea is great. There's plenty (I will get back to that one) locations (bike-racks) all over Montreal where you slot in your credit card and you can use the bikes. The idea is that you use them for short trips, quasi from bike-rack to bike-rack. You pay for the time that you use them. That's all dandy, until you realize that there's no bike-racks in lots of places. So, while working in Montreal last week I duly used the Bixi. Well, after a 15 minute ride I ended up where I had to go (by no means an off-the-beaten track location) and, surprise surprise, there were no bike-racks anywhere close by. In other words, I had no bike-rack to return my Bixi to, and had to keep on paying until my work meeting was over and I was able to return to where I picked it up. The result was a bill of 39.50 $. For that I could have rented a car for a full day or probably used a comfy limousine service forth and back. It's been a complete and utter waste of time and money! I suspect the rip-off scheme is hugely profitable for the city of Montreal.

So, here's my advice to Montreal, THINK prior to instituting such schemes. I for one won't touch your green bike scheme ever again. Let the buyer beware!

Sunday, May 16, 2010

Apologies for the brief hiatus

Folks,

I have been away for a week on Barbados. Sand, palmtrees, lukewarm water and rum ain't exactly my cup of tea, so I's worried about being bored out of my mind. Thankfully I got plenty of lifts around the porous island, but still, a week was more than enough. My suspicion about life on such places was kind of confirmed. All pretty to look at, but the reality is nonetheless dead boring. I've had a great time though and took my fair share of photos. Good enough for a week-long trip, but imagine you had to live there. Invariably there's an overwhelming number of God people, so there were training sessions preparing people for the Rapture on offer. How cool is that? In case you didn't know, it's coming on October 21, 2011. Oi wei. I uploaded my photos on a low-to medium-level size only, so they're not print quality. Feel free to browse. - We flew on JetBlue, and it's been a great experience. Highly recommended, just don't expect any service from their ground staff in Barbados. They're badly trained and pretty much useless. Other than that, beats air Canada at any time, both in terms of in-flight experience and in terms of price (by a long long stretch).

Well, coming back home I face more US brabrabra. Obama's Supreme Court nominee is rumored to be a lesbian woman. Bill O'Reilly, funny man at Fox News, decided that we've a right to know as she might have to vote on gay marriage. I kinda wonder why the same logic shouldn't apply to heterosexual, bisexual and other-sexual members of the court?

Wednesday, May 05, 2010

A study that should not have been done

Here is a piece Sean Philpott and I have published today in the Hastings Center Forum.

The New England Journal of Medicine in February published the results of a deeply flawed clinical trial in South Africa. The SAPIT (Starting Antiretroviral Therapy at Three Points in Tuberculosis Therapy) trial was designed to determine the most effective way to treat patients infected with HIV and tuberculosis. But it raises a number of disturbing questions about the oft-debated and vexing issue of appropriate standards of care in clinical trials undertaken in developing countries like South Africa. It also raises serious concerns about the quality of ethical review undertaken in those countries, and it highlights some surprising deficiencies in existing U.S. regulations regarding when ethical review should be undertaken by American IRBs.
In 2007 almost two million people died of TB and over nine million people were newly infected. TB-related morbidity and death is profound among people living with HIV/AIDS; nearly 7 percent of new cases and over a quarter of all TB-related deaths occur among people living with HIV/AIDS. Doctors treating TB in this population face a difficult challenge. Serious side effects can occur with concurrent HIV and TB treatment, leading some clinicians to suggest that antiretroviral therapy for HIV be delayed for several weeks after treatment for TB is started. But serious side effects are also a risk of delaying ART therapy. Guidelines state that ART therapy should be started as soon as possible, but there is disagreement over when that should be.
In the SAPIT trial, 642 individuals co-infected with HIV and TB were randomized to receive one of three treatments: early integrated ART (started during the intensive phase of TB therapy), late integrated ART (started during the continuation phase of TB therapy), or sequential ART (started after completion of TB therapy).
Individuals randomized to the two integrated arms received ART within three months of study entry. Antiretroviral treatment of individuals randomized to the sequential treatment arm, however, was delayed on average for almost nine months. For several unlucky study participants, ART was delayed even longer; mean time to initiation of ART in this group was six to 11 months (260±71 days), regardless of CD4 cell count, an indicator of HIV disease progression, at study entry. This matters, as patients with CD4 cell counts lower than 200 cells per cubic millimeter face a significantly increased risk of death.
Forty-four months after the first SAPIT participants were enrolled, the study’s Data Safety Monitoring Board stopped the sequential treatment arm and required that all of its participants be started on ART immediately. In its interim analysis, the DSMB had found that participants in the sequential treatment arm had a much higher rate of death than participants in the integrated treatment arms.
The majority of these deaths occurred among patients with CD4 counts below 200 cells per cubic millimeter at study entry. Twenty-seven of 213 participants, or 12.7 percent, in the sequential therapy arm died during the abbreviated treatment and observation period, of whom 21 had CD4 counts of less than 200 per cubic millimeter at study entry, while only 25 of 429, or 5.8 percent, in the integrated therapy arms died over the course of the study. Integrated HIV and TB treatment thus reduced the likelihood of death among study participants by more than twofold.
The trial conclusively showed that integrated HIV and TB treatment is more effective than sequential treatment. The question is whether obtaining that data justified the 10 or more preventable deaths that occurred among trial participants. Even before the study began, years of observational data had shown that the risk of HIV-related death among patients not receiving ART therapy was highest during the first few weeks of TB treatment, calling into question the need to conduct a randomized, controlled trial in which ART was delayed by as long as 11 months for some study participants.
The side effects of concurrent HIV and TB treatment can often be managed by observant clinicians; given this, the WHO Global TB/HIV Working Group recommended as far back as 2003 that “any decision on treatment should be individualized, based on response to anti-TB therapy, side-effects, and readiness for ART.” More recently, based primarily on data from the SAPIT trial, WHO urged that ART be given within eight weeks of starting TB treatment in co-infected individuals.
Current treatment guidelines recommend that patients infected with both TB and HIV should start ART as soon as possible. Where CD4 testing is routinely available, these guidelines recommend starting ART when CD4 cell counts drop below 350 cells per cubic millimeter, and they require ART once cell counts drop below 200 cellsper cubic millimeter. Where routine CD4 testing is not available, these guidelines suggest that HIV-infected individuals with TB should start ART immediately.
In a recent article in The Lancet, several of the SAPIT investigators argued that “an estimated 10,000 deaths could be prevented every year by the initiation of ART in HIV/tuberculosis co-infected patients with CD4-cell counts below 500 cells per cubic millimeter.” However, the level of care provided to participants in the sequential treatment arm of the SAPIT trial fell considerably below this standard. The level of treatment provided to these volunteers even violated existing domestic standards of care for patients in South Africa, which recommend starting patients with CD4 cell counts of less than 200 per cubic millimeter on ART after just two months of TB treatment.
Although the SAPIT investigators noted that trial participants’ primary care physicians were free to start them on ART as necessary – in keeping with the 2003 recommendations of the WHO Global TB/HIV Working Group – this ignores the reality of public sector HIV care and treatment in South Africa. It is unlikely that most of the study participants even had a primary care doctor, let alone a physician who would initiate ART despite the restrictions imposed by the SAPIT protocol. Who then could have started these patients on life-preserving treatment if not the clinician-investigators on the study? Individualized treatment decisions based on medical need were not made in the sequential arm of the study, despite the ethical obligation of study clinicians to ensure the safety and well being of individual study participants.
Aggravating these problems, the trial design violated the golden rule of ethical study design and conduct: No clinical equipoise existed between the trial arms. Given decades of research showing that untreated patients with CD4 cell counts of less than 200 cells per cubic millimeter are at great risk of HIV-related complications and death, coupled with observational data showing that this risk is even higher during the first few weeks of TB treatment for co-infected individuals, the sequential treatment arm never should have been considered a viable treatment strategy. Patients randomized into the sequential arm were knowingly subjected to substandard clinical care.
The fundamental ethical (and legal) issue is this: the SAPIT study caused foreseeable harms and preventable deaths for a substantial number of impoverished and poorly educated South African trial participants. In doing so, the trial violated the Declaration of Helsinki’s requirements on standards of care of the then-applicable 2000 revision:
The benefits, risks, burdens and effectiveness of a new method should be tested against those of the best current prophylactic, diagnostic, and therapeutic methods. This does not exclude the use of placebo, or no treatment, in studies where no proven prophylactic, diagnostic or therapeutic method exists.
For the South African researchers involved with the SAPIT trial, the Declaration of Helsinki is not only a moral exhortation but also a legally binding obligation. South Africa’s Good Clinical Practice Guidelines require that all investigators “follow fully the guidelines set out” in the Declaration of Helsinki, in addition to other national research ethics guidelines.
Organizations such as the Welcome Trust in the U.K. and the National Institutes of Health in the U.S. have directed millions of dollars to train members of African ethical review committees, and yet this trial was reviewed and approved by a committee in South Africa. The failure of this research ethics committee to recognize the clinical, ethical, and legal deficiencies in this study is shameful and, we hope, will be investigated by the relevant South African authorities.
Another issue is worth noting. As published in the New England Journal of Medicine, the study boasts a large number of authors. This is not an uncommon practice for large clinical trials like SAPIT. The authors of the article are located in South Africa and the U.S., and some authors list both South African and U.S. institutional affiliations. It is unfortunate, however, that U.S. research ethics guidelines (at least as interpreted by the American institutions involved) did not require these authors to submit the study protocol for ethical review by committees in the U.S.
If, as these institutions suggest, the study investigators were not acting on behalf of the U.S. institutions or were not engaged in what these universities define as human subjects research, it is worth asking why these institutions are listed on the published research papers. If they want to share in the academic glory associated with a study published in a prestigious journal like the New England Journal of Medicine, then they have the obligation to ensure that the trial meets accepted standards of ethical conduct and the responsibility to protect the rights and safety of all study participants. Further review might have made an appreciable difference to the ethical design and conduct of this study.
Sean Philpott is an assistant professor of bioethics at Union Graduate College and a former science and ethics officer for the Global Campaign for Microbicides. Udo Schüklenk holds the Ontario Research Chair in Bioethics at Queen's University, Canada, and is the joint editor-in-chief of BIOETHICS. 

Monday, May 03, 2010

Drill baby drill -2-

As an addendum to my April 29 post.

Turns out that the platform actually had a so-called blowout-preventer to prevent the disaster that happened. A German news agency has investigated these so-called blowout-preventers. There are at least 171 known cases where they failed to do their job. It's a bit of a misnomer then to call them blowout-preventers, isn't it? Makes you wonder why drill baby drill President Obama notices only now that there's a problem and he wants to investigate... and where is drill baby drill Sarah Palin? Lost in an oil spill?

Ethical Progress on the Abortion Care Frontiers on the African Continent

The Supreme Court of the United States of America has overridden 50 years of legal precedent and reversed constitutional protections [i] fo...