Ayudha Puja, a South Indian festival translated as “worship of the machines,” is a dramatic example of how religion and science intertwine in political life. Across South India, but especially in the state of Karnataka, scientists and engineers celebrate the festival in offices, laboratories, and workshops by attending a puja led by a priest. Although the festival is noteworthy in many ways, one of its most immediate valences is political. In this article, we argue that Ayudha Puja normalizes Brahminical Hinduism (...) within scientific culture through the inclusion of non-Hindus and through scientists' description of the festival as “cultural” rather than “religious.”. (shrink)

The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007. We describe ethically problematic practices in (...) Kenyan VMMC programmes revealed by our fieldwork, how the problems are related to the pursuit of targets and discuss possible approaches to their management. Although the establishment and pursuit of targets in public health can have many benefits, assessments of target-driven programmes tend to focus on quantifiable outcomes rather than the processes by which the outcomes are obtained. However, in order to speak more robustly about programmatic ‘success’, and to maintain community trust, it is vital to ethically evaluate how a public health initiative is actually implemented in the pursuit of its targets. (shrink)

More than 25 years into the HIV epidemic, in excess of 2 million new infections continue to occur each year. HIV prevention research is crucial for groups at heightened risk for HIV, but the design and conduct of HIV prevention research with vulnerable populations worldwide raises considerable ethical challenges. The HIV Prevention Trials Network (HPTN) is a global collaborative network that conducts clinical and behavioural studies on non-vaccine interventions to reduce the transmission of HIV. In 2003, the HPTN developed ethical (...) guidance to enhance the responsible conduct of its research activities and as a distinctive contribution to global research ethics. In what follows, the developments that motivated the drafting of a revised ethics document in 2009 are described, including the process by which that revision took place and some of the key differences between the HPTN ethics guidance and other relevant guidelines in the field. (shrink)

With the advent of new AIDS treatment initiatives such as the World Health Organization's “3 by 5” program and the United States' “President's Emergency Plan for AIDS Relief,” the ethical questions about AIDS care in the developing world have changed. No longer are they fundamentally about the conduct of research; now, we must turn our attention to developing treatment programs. In particular, we must think about how to spread limited treatment resources among the vast reservoir of people who need them.

ZusammenfassungIn der Literatur ist lange über Sinn und Funktion des wirkungsvoll inszenierten Spiels der Ringe in Lessings 1767 erschienenem Lustspiel Minna von Barnhelm sowie der Ringe, die im Zentrum der von Nathan erzählten Parabel im 1779 verfassten Drama stehen, debattiert worden. Allerdings fehlt bisher eine eingehende Erörterung der Frage, inwiefern die jeweiligen Ringe eine vergleichbare Rolle in den beiden Werken haben. Dieser Aufsatz untersucht das Lustspiel und das dramatische Gedicht, um zu zeigen, dass die jeweils verhandelten Ringe als Erinnerungs-Zeichen verstanden (...) werden sollen und dass die Vielschichtigkeit der Ring-Thematik eine grundsätzliche Ambivalenz in Lessings Verständnis von Erinnerung an den Tag legt. Jeder Ring stellt dementsprechend sowohl eine Wiederkehr zu vergangenen Wirklichkeiten und Versprechen dar als auch jene historischen Brüche und Veränderungen, die eine solche Wiederkehr verhindern. Darüber hinaus repräsentieren die Ringe der beiden Dramen den von Aleida Assmann geschilderten und sowohl emanzipatorischen als auch schwierigen Übergang von einem von der Memoria-Tradition geerbten und auf dem Prinzip einer Rückholung archivierter Inhalte basierenden Gedächtnismodell hin zu einem modernen Erinnerungsmodell gegenwartsbasierter Umformung und Erneuerung (Erinnerungsräume: Formen und Wandlungen des kulturellen Gedächtnisses [1999]). (shrink)

Significant inequalities in health between and within countries have been measured over the past decades. Although these inequalities, as well as attempts to improve sub-standard health, raise profound issues of social justice and the right to health, those working in the field of bioethics have historically tended to devote greater attention to ethical issues raised by new, cutting-edge biotechnologies such as life-support cessation, genomics, stem cell research or face transplantation. This suggests that bioethics research and scholarship may revolve around issues (...) that, while fascinating and important, currently affect only a small minority of the world's population. In this article, we examine the accusation that bioethics is largely dominated by Anglophone and industrialized world interests, and explore what kinds of positive contributions a 'bioethics from below' (as Paul Farmer calls it) can make to the field of bioethics in general. As our guide in this exploration, we make use of some experiences and lessons learned in our collaborative bioethics project in the Democratic Republic of Congo, Building Bioethics Capacity and Justice in Health. We conclude that while there is some evidence of increased attention to bioethical challenges in developing countries, this development should be further cultivated, because it could help expand the horizons of the field and enhance its social relevance wherever it is practiced. (shrink)

Web scraping involves using computer programs for automated extraction and organization of data from the Web for the purpose of further data analysis and use. It is frequently used by commercial companies, but also has become a valuable tool in epidemiological research and public health planning. In this paper, we explore ethical issues in a project that “scrapes” public websites of U.S. county jails as part of an effort to develop a comprehensive database to enhance HIV surveillance and improve continuity (...) of care for incarcerated populations. We argue that the well-known framework of Emanuel et al. provides only partial ethical guidance for the activities we describe, which lie at a complex intersection of public health research and public health practice. We suggest some ethical considerations from the ethics of public health practice to help fill gaps in this relatively unexplored area. (shrink)

Ethical challenges surrounding the implementation of male circumcision as an HIV prevention strategyResearchers have been exploring the possibility of a correlation between male circumcision and lowered risk of HIV infection almost since the beginning of the HIV/AIDS epidemic.1 Results from a randomised controlled trial in South Africa in 2005 indicate that male circumcision protects men against the acquisition of HIV through heterosexual intercourse,2 confirming the findings from 20 years of observational studies.3 Circumcised men in the South African trial were 60% (...) less likely to acquire HIV than their uncircumcised counterparts. A mathematical modelling study, based on the South African trial, estimates that the practice of male circumcision could avert two million new HIV infections and 300 000 HIV-related deaths over the next 10 years in sub-Saharan Africa.4 More recently, two randomised controlled trials in Kisumu, Kenya and Rakai, Uganda showed, respectively, 53% and 48% reductions in HIV acquisition among circumcised men than uncircumcised men in the trial.5 These results strongly suggest that male circumcision could play an important role in the struggle against the continued rise in new HIV infections. However, as observers noted at the 2006 XVI International AIDS Conference in Toronto, Canada, excitement about the potential epidemiological impact has overshadowed the debate over the difficult translation of research on male circumcision, into policy and practice.6 Similar calls for caution have been raised before and elsewhere.7,8The topic of male circumcision carries an enormous amount of ethical baggage. Male infants, worldwide, are circumcised for various medical, social and/or religious reasons. Circumcision is a cultural act and a surgical procedure; medical reasons are not the only reasons to circumcise that people have found and continue to find as compelling. Benatar and Benatar9 have argued that—when …. (shrink)

The study of rare diseases has long been an area of challenge for medical researchers, with agonizingly slow movement towards improved understanding of pathophysiology and treatments compared with more common illnesses. The push towards evidence-based medicine (EBM), which prioritizes certain types of evidence over others, poses a particular issue when mapped onto rare diseases, which may not be feasibly investigated using the methodologies endorsed by EBM, due to a number of constraints. While other trial designs have been suggested to overcome (...) these limitations (with varying success), perhaps the most recent and enthusiastically adopted is the application of artificial intelligence to rare disease data. This paper critically examines the pitfalls of EBM (and its trial design offshoots) as it pertains to rare diseases, exploring the current landscape of AI as a potential solution to these challenges. This discussion is also taken a step further, providing philosophical commentary on the weaknesses and dangers of AI algorithms applied to rare disease research. While not proposing a singular solution, this article does provide a thoughtful reminder that no ‘one-size-fits-all’ approach exists in the complex world of rare diseases. We must balance cautious optimism with critical evaluation of new research paradigms and technology, while at the same time not neglecting the ever-important aspect of patient values and preferences, which may be challenging to incorporate into computer-driven models. (shrink)

Objectives: This study aimed to determine attitudinal and self reported behavioural variations between medical students in different years to scenarios involving academic misconduct.Design: A cross-sectional study where students were given an anonymous questionnaire that asked about their attitudes to 14 scenarios describing a fictitious student engaging in acts of academic misconduct and asked them to report their own potential behaviour.Setting: Dundee Medical School.Participants: Undergraduate medical students from all five years of the course.Method: Questionnaire survey.Main measurements: Differences in medical students’ attitudes (...) to the 14 scenarios and their reported potential behaviour with regards to the scenarios in each of the years.Results: For most of the scenarios there was no significant difference in the response between the years. Significant differences in the responses were found for some of the scenarios across the years, where a larger proportion of year one students regarded the scenario as wrong and would not engage in the behaviour, compared to other years. These scenarios included forging signatures, resubmitting work already completed for another part of the course, and falsifying patient information.Conclusion: Observed differences between the years for some scenarios may reflect a change in students’ attitudes and behaviour as they progress though the course. The results may be influenced by the educational experience of the students, both in terms of the learning environment and assessment methods used. These differences may draw attention to the potential but unintentional pressures placed on medical students to engage in academic misconduct. The importance of developing strategies to engender appropriate attitudes and behaviours at the undergraduate level must be recognised. (shrink)

Over the past few years, a growing number of people have called for reconceptualizing participation in health research as a moral obligation. John Harris argues that seriously debilitating diseases give rise to important needs, and since medical research is necessary to relieve those needs in many circumstances, people are morally obligated to act as research subjects.1 Rosamond Rhodes claims that research participation is a moral obligation for reasons of justice, beneficence, and self-development: because we all benefit significantly from modern medicine, (...) we are all required to do our part in advancing the state of medical knowledge.2 Individuals who reap the benefits of medical knowledge without contributing .. (shrink)

The effectiveness of antiretroviral regimes (ARVs) to reduce risk of HIV transmission from mother to child and as post-exposure prophylaxis has been known for almost two decades. Recent research indicates ARVs can also reduce the risk of HIV transmission via sexual intercourse in two other ways. With pre-exposure prophylaxis (PrEP), ARVs are used to reduce risk of HIV acquisition among persons who are HIV negative and significantly exposed to the virus. With treatment as prevention (TasP), ARVs are used to reduce (...) risk of HIV transmission from persons who are already HIV positive. The development of these new prevention strategies raises a rationing problem: given the chronic shortage of ARVs for HIV-infected persons in need of treatment, is it ethically justified to allocate ARVs for PrEP and/or TasP? This article examines the intuitively appealing view that allocation of ARVs for treatment should be the highest priority, the use of ARVs for TasP should be a secondary priority, and that utilizing ARVs for PrEP would be unethical. I will argue that selective, evidence-based allocation of ARVs for prevention in certain cases could be ethically justified even when there is insufficient anti-retroviral access for all those needing it for treatment. (shrink)

Addressing groups of industrial or academic experts goes with my job as editor in chief of Scientific American, and I enjoy it, but I confess that it inevitably feels peculiar. The audience consists of people who, almost by definition, have expertise or experience in the subjects of discussion. Why should anyone listen to me? I am a journalist—what do I know? a.

In 2008, researchers reported that Timothy Brown , a man with HIV infection and leukemia, received a stem-cell transplant that removed HIV from his body as far as can be detected. In 2013, an infant born with HIV infection received anti-retroviral treatment shortly after birth, but was then lost to the health care system for the next six months. When tested for HIV upon return, the child had no detectable viral load despite cessation of treatment. These remarkable clinical developments have (...) helped reinvigorate the field of ‘HIV cure’ research. (shrink)

In numerous peripheral sense organs, external stimuli are detected by primary sensory neurons compartmentalized within specialized structures composed of cuticular or epithelial tissue. Beyond reflecting developmental constraints, such compartmentalization also provides opportunities for grouped neurons to functionally interact. Here, the authors review and illustrate the prevalence of these structural units, describe characteristics of compartmentalized neurons, and consider possible interactions between these cells. This article discusses instances of neuronal crosstalk, examples of which are observed in the vertebrate tastebuds and multiple types (...) of arthropod chemosensory hairs. Particular attention is paid to insect olfaction, which presents especially well‐characterized mechanisms of functional, cross‐neuronal interactions. These examples highlight the potential impact of peripheral processing, which likely contributes more to signal integration than previously considered. In surveying a wide variety of structural units, it is hoped that this article will stimulate future research that determines whether grouped neurons in other sensory systems can also communicate to impact information processing. (shrink)

Mathematical modelling has played an increasingly prominent role in public health responses, for example by offering estimates of how infectious disease incidence over time may be affected by the adoption of certain policies and interventions. In this paper, we call for greater research and reflection into the ethics of mathematical modeling in public health. First, we present some promising ways of framing the ethics of mathematical modeling that have been offered in the very few publications specifically devoted to this subject. (...) Second, to draw out some issues that have not yet been sufficiently considered, we bring in the case of mathematical modeling in voluntary medical male circumcision (VMMC) initiatives for HIV prevention in Africa. We argue that greater attention should be paid to ethical considerations in mathematical modeling, particularly as its use is becoming more widespread and its potential impacts are becoming greater in the ‘big data’ era, as witnessed during the COVID-19 pandemic. (shrink)

RESUMO Neste artigo, analiso um conjunto de seis cartões comerciais pertencentes a uma duradoura campanha de marketing da Liebig Extract of Meat Co. A análise crítica dos textos promocionais produzidos na virada do século XX oferece insights significativos sobre os mecanismos discursivos que contribuíram para a hegemonização do capitalismo burguês. Diferentemente de outras formas de publicidade, os cartões comerciais não são rapidamente descartados e esquecidos; pelo contrário, eles podem se distanciar dos produtos anunciados para se tornar parte dos discursos populares (...) de instrução em massa. Como produtos e produtores de ideologias capitalistas, os anúncios são um local privilegiado de inscrição do capitalismo e, portanto, se prestam a uma análise crítica. Minha análise mostra como os textos selecionados se baseiam e texturizam os discursos do progresso, impregnados como crenças colonialistas e desencadeando uma cadeia de ações pela qual, mesmo antes de realmente obterem os cartões, são promulgadas ações e crenças capitalistas. ABSTRACT In this paper, I analyze a set of six trading cards belonging to Liebig’s Extract of Meat Co. long-standing marketing campaign. The critical analysis of promotional texts produced at the turn of the 20th century offer meaningful insights on the discursive mechanisms that contributed to the hegemonization of bourgeois capitalism. Unlike other forms of advertising, trading cards are not rapidly discarded and forgotten; on the contrary, they can detach themselves from the advertised products to become part of popular discourses of mass instruction. As both products and producers of capitalist ideologies, ads are a privileged site of inscription of capitalism, and thus lend themselves to a critical analysis. My analysis shows how the selected texts draws on and textures the discourses of progress, inculcated as colonialist beliefs and triggering an actional chain whereby, even before they actually obtained the cards, capitalist actions and beliefs are enacted. (shrink)

The American Journal of Bioethics, Volume 12, Issue 5, Page 38-39, May 2012.

In the Democratic Republic of Congo, only an estimated 2% of all AIDS patients have access to treatment. As AIDS treatment access is scaled‐up in the coming years, difficult rationing decisions will have to be made concerning who will come to gain access to this scarce medical resource. This article focuses on the position, expressed by representatives of Médecins sans Frontières (MSF), that the practice of AIDS treatment access rationing is fundamentally unethical because it conflicts with the ideal of universal (...) treatment access and the human right to health. The conclusion is that MSF's position lacks coherence, has negative practical implications, and is unfair to governments struggling to increase patient's access to AIDS treatment in unfavorable circumstances. (shrink)

Back in 2017, Moodley and Rennie published a paper in the Journal of Medical Ethics entitled ‘Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against.’1 As the title suggests, we took a critical view towards penile transplantation as a way of responding to the problem of young men in South Africa experiencing genital mutilation and amputation as a result of traditional circumcision practices. Our main conclusion was that prevention is key: social, cultural (...) and political strategies to prevent mutilations and amputations should be prioritised, rather than surgical solutions, particularly in low-resource communities. Van der Merwe, who led the surgical team for the first successful penile transplantation in Stellenbosch, South Africa, has responded to our views, and in what follows, we will distill and evaluate his main arguments. Cost and access to services : Van der Merwe states that our position is mostly based on costs, that is, that penile transplantation is expensive and it is unrealistic to think that young men in traditional communities will be able to avail themselves of such services. Against this, Van Der Merwe argues that the actual cost of penile transplantation can be favourably compared with another, more established medical intervention, that is, renal transplantation. Of course, cost comparisons are difficult with a new intervention when it is …. (shrink)

This study analyzes the morphophonemic variations among Kinamayo dialects. Purposeful sampling, in-depth interviews, sorting and classifying of words according to phonological and morphological structures in data analysis were used. Results revealed that the phonemic inventory of the Kinamayo dialects consisted of twenty segmental phonemes, fifteen consonants: /n/, /g/, /d/, /s/, /l/, /w/, /r/, /p/, /m/, /k/, /t/, /y/, /h/, /b/, /ŋ/; five basic vowels: /a/,/,/i/, /ɪ/, /u, /ʊ/; vowel lengthening: /a:/, /u:/ and three diphthongs: /aʊ/, /aɪ/, /ᴐɪ/. Consonant clusters are (...) mostly borrowed words and occur in the onset of the syllables. The analysis of Kinamayo phonology and morphology will serve as the basis for designing a functional orthography and lexicon of the language. Classification based on morphological structure revealed that the morphological processes common to Kinamayo are affixation, reduplication, deletion and derivation of one-word class from another. Affixation is the most productive morphological process in Kinamayo. Variation among the dialects was observed to involve phonological and morphological processes, voicing or phonation, and in terms of prefix for the markers in the past tense. Peculiarities in the phonological and morphological processes of dialects, as well as their areas of differences were observed to be associated primarily on geographical distribution. Keywords - Linguistics, morphophonemic variation among Kinamayo dialects, case study, Surigao del Sur, Philippines. (shrink)