Paying for researchThe writer describes her experience
undertaking a study related to anaesthesia. Typical of developing
countries, patients recruited as research participants not only paid for their
treatment but also funded the research component of their treatment.
There
are many ethical conflicts in this common practice: the researcher makes a
career gain from the study; the physician's primary duty to the patient is
compromised; the doctor-patient relationship is exploited and patients are less
able to refuse participation; and they bear the cost of the research and the
inherent risks, with little or no additional direct benefits to themselves.
The writer calls for recognition of this problem, for the development of
appropriate informed consent procedures, for institutions to support research,
and for a change in the 'publish or perish' climate.
Khan Robyna I.
Paying the price of research SciDev.Net November 10, 2004http://www.scidev.net/dossiers/index.cfm?fuseaction=dossierreaditem&dossier=5&type=3&itemid=331&language=1
What ethics review is all aboutThis article suggests
that while ethics committees might be a safety net for grossly unethical
research, they are not the truly thoughtful bodies needed to ensure ethical
research. This is frightening because committee decisions dilute
responsibility at various levels. EC members uncomfortable with a decision let
it pass because the others have agreed. Researchers, too, are free from
responsibility once the EC passes the proposal, with the mandatory changes to
the consent form and so on.
"Perhaps the most essential preparation for
members of research ethics committees is not studying the content of the
Statement or the relevant law, but undertaking a week of intensive training in
critical thinking. Perhaps we all must consider how best to deal with situations
about which not all agree, and about which objections are morally relevant.
Furthermore, there are many issues that are not well addressed by guidelines or
law."
Loff Bebe and Black Jim. Research ethics committees: what is their
contribution? Med J Aust 2004; 181: 440-441.
Need 'zero tolerance' of cheatingAcademic
dishonesty is widely prevalent in many Indian medical colleges. It can range
from copying at exams to cooking up records, cooking up data, forging teachers'
signatures, proxies' attendance, plagiarism, and so on. For faculty and
administrators, dishonesty can range from tolerating dishonesty to actively
promoting it by tampering with marks or falsifying records to meet regulatory
needs. It is done in different ways by good students and bad, by
under-graduates, post-graduates, faculty and administrators. It is condoned;
much of it is so open that it would be stopped with rudimentary supervision. The
author calls for a 'zero tolerance' policy and suggests various responses
including an institutional policy on academic honesty with a list of
punishments.
"The 'unchallengeable honesty' and commitment seen in most of
the faculty of yesteryears may still be seen in a handful of individuals in
every institution. It is up to these individuals to curtail the current rot that
pervades the medical establishment in India."
Gitanjali B. Academic
dishonesty in Indian medical colleges. J Postgrad Med 2004;50:281-284.
May pharmacists refuse to fill a
prescription?Pharmacists have sometimes refused to fill
prescriptions for emergency contraception, citing personal moral grounds. This
raises important questions about individual rights and public health. The
article presents the arguments in favour of patients' rights to the drug as well
as pharmacists' right to conscientious objection. They conclude that although
health professionals may have a right to object, they should not have a right to
obstruct.
Cantor J et al. The limits of conscientious objection - may
pharmacists refuse to fill prescriptions for emergency contraception? New Engl J
Medicine 2004; 351:2008-2012.
Polish up your prescriptionsThis article describes the
quality of prescriptions by medical practitioners, based on a seven-day survey
of prescriptions dispensed at a busy pharmacy in Goa.
Almost 84% of the 990
prescriptions collected were from private practitioners. Information to identify
the practitioner was incomplete in more than a third of the prescriptions;
information to identify the patient was incomplete in more than half the
prescriptions. The majority of written instructions did not give clear
instructions on how to take the medicines.
More than half the prescriptions
contained at least three medicines; 40% included a vitamin or tonic preparation
and one quarter included an antibiotic and an analgesic. Over 90% of
prescriptions contained only branded medicines. Private practitioners prescribed
significantly more medicines and were more likely to prescribe vitamins and
antibiotics, and branded medicines.
Patel V et al. Irrational drug use
in India: a prescription survey from Goa. J Postgrad Med 2005;51:9-12.
Campaign against unsafe injectionsA safe injection
is one that is medically indicated and that does not harm the recipient, the
provider (through needle stick injury) or the community at large (through unsafe
management of sharps waste). According to WHO estimates people in
developing and transitional countries receive an average of 3.4 injections per
year. Of these, 39% were given with unsterilised but reused injection devices,
believed to account for 22 million hepatitis B virus infections, 2 million
hepatitis C virus infections and 260,000 HIV infections in the year 2000.
This is preventable by implementing national policies to decrease injection
overuse; teaching safe injecting practices, providing the necessary
equipment and supplies, and managing sharps waste.
The authors describe the
progress of such policies in India since the late 1990s when studies suggested
that unsafe injections were a substantial public health problem. One result is
that the national immunisation programme will use auto-disable syringes.
However, this is just a beginning as the majority of unsafe and unnecessary
injections are administered in the private sector. Most physicians realise that
injections are overused, but believe patients want them and there is nothing
they can do about it. In fact, the authors note, a large body of evidence
suggests that prescribers can effectively influence injection use. Most patients
are open to alternatives to injections if their doctors take the time to explain
to them that oral medication will be sufficient or that they do not require any
treatment at all.
Yvan J F et al. Acting upon evidence: progress
towards the elimination of unsafe injection practices in India. Indian
Pediatrics 2005; 42:111-115.
When you can't explain the symptomsMany doctors are
uncomfortable managing patients whose physical symptoms cannot be explained
medically. As a result, they may downplay the importance of these symptoms, or
ignore the associated distress. The result is dissatisfied patients, who
may go shopping for another doctor. Between 17% and 46% of patients at primary
care facilities suffer from common mental disorders. The author, a
psychiatrist, proposes a protocol for managing patients with unexplained
medical symptoms, consisting of building a therapeutic relationship, providing
alternative explanations, suggesting therapeutic options and offering continued
support.
Jacob K S. A simple protocol to manage patients with unexplained
somatic symptoms in medical practice. Natl Med J India 2004; 17:
326-328. 
