Indian journal of medical ethics最新文献

In this brief commentary, we share our experience of obtaining informed consent from older persons living in the community, dependent on their sons, daughters or in-laws. We present a scenario in which for our community-based cluster randomised controlled trial on diabetes peer support groups for diabetes self-management, we attempted to obtain informed consent from an older person living in a dependent state with her daughter. While the older woman herself was interested in participating in the study initially, later she declined to consent, probably influenced by her daughter and son-in-law with whom she was living. In this article, we reflect on this unique social dynamic in India where many older persons are in a dependent relationship with their primary caregivers; and what this relationship means to autonomy in research participation. We propose that engaging with primary care givers of older persons before approaching them for research participation may be a crucial step in this social context.

Occupational health is a public health emergency, long ignored in India, primarily as it is considered more of a class issue than a public health problem. The economic impact of mortality and morbidity associated with occupational diseases (OD) and accidents at work is nowhere a priority, resulting in the absence of reliable estimates and credible data on ODs. There are no laws for the protection and preservation of health at work for over 90% of workers in the unorganised sector. These should be a priority across economic sectors, along with laws to compensate workers and citizens for environmental contamination. In spite of the Employees' State Insurance Act, 1948 for the workers in the organised sector, and the Employees' Compensation Act, 1923 for both, organised and unorganised sectors, most of the victims have to depend upon doles paid by the State schemes for financial assistance in case of silicosis.

Medical students face authorship issues as they are increasingly involved in research. Senior researchers often claim undue credit, while students lack support and awareness of their rights. The fear of retaliation and power imbalance worsens the issue. Solutions such as ethics training, student representation on research committees, and mandatory formal authorship agreements have been proposed. These can create a more ethical research environment for future medical professionals.

Indira Chakravarthi's critique relates to our paper published in the British Medical Journal in 2021 titled "Effect of screening by clinical breast examination on breast cancer incidence and mortality after 20 years: prospective, cluster randomised controlled trial in Mumbai". The study addressed the unanswered questions as to whether clinical breast examination (CBE) conducted by female health workers would lead to a reduction in mortality from breast cancer. Chakravarthi raises multiple issues relating to our study and we provide in this paper point-by-point responses to these issues. The results of our study show that two-yearly CBE screening can reduce death rate from breast cancer by 30% in women above the age of 50 and to a lesser extent to those below this age. CBE screening if implemented in low- and middle-income countries can save thousands of lives globally each year.

From the late 1940s to 1991, the adverse effects of prescription drugs were primarily established through the publication of detailed case studies by doctors in medical journals. Subsequently, pharmaceutical companies would change the labels of medicines accordingly. This will be called "evident-based medicine" in this paper. After 1991, what is now called "evidence-based medicine" offers a markedly different view on establishing the adverse effects of a treatment, with randomised controlled trials (RCTs) held up as the gold standard. The differences between evidence- and evidence-based medicine are often framed in terms of the differences between specific and general causation. This article outlines the origins of these distinctions and the confusions they generate among both clinicians and the general public.

Despite the urgency for new leads towards Alzheimer's disease (AD) interventions, the impact of such basic research on patient welfare and potential socioeconomic repercussions are considered remote. Nonetheless, basic science research in AD must adhere to the highest level of ethical stringency. Even preliminary advances in AD basic research offer hope that percolates along the line from researchers to patients. A promising basic research result that is subsequently proven unreliable due to irreproducibility or research misconduct would not only dash hopes but might also misdirect downstream efforts. Furthermore, such misadventures could quash promising research directions that, if otherwise carefully and meticulously interrogated, could yield useful leads. Stringency and reproducibility in biomedical research should thus be framed in accordance with the principle of non-maleficence, which I posit should take priority over loose attempts at beneficence that offer more hype than hope.

Processing payments (reimbursements or honoraria) to study participants by researchers working in institutional setups can raise ethical concerns, as the institute's administration and finance departments control the procedural mandate of this issue. This commentary discusses this critical and often ignored aspect and provides suggestions that could help minimise the risk of violating research participants' anonymity.

This May, the World Health Assembly (WHA) will vote on re-establishing a mandate for the World Health Organization (WHO) to address the health consequences of nuclear weapons and war [1]. Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war.

The Government of India recently disbanded the National Apex Committee for Stem Cell Research and Therapy (NAC-SCRT). This decision followed expert and public consultations held last year and will significantly alter the review processes for human stem cell research in India. The NAC-SCRT played a crucial role in crafting and updating regulatory guidelines, fostering research and national discourse in human stem cell research, and defining safety and quality standards. The Institutional Ethics Committees are now being tasked to review stem cell research at the organisation level after due inclusion of two stem cell experts. The decision to merge regulatory frameworks is a welcome step, reflecting a dynamic regulatory landscape that is responsive to scientific advancements and aims to reduce the compliance burden. The effective implementation of the revised mechanism, however, necessitates further clarity on which agency will now be responsible for tasks earlier mandated to NAC-SCRT.

Kay Redfield Jamison, an author, clinical psychologist, and professor at Johns Hopkins University School of Medicine, grapples with bipolar disorder - shaping her professional focus. She dealt with manic-depressive disorder as a professor of psychiatry and a successful medical professional. What was that experience like? In her memoir, An Unquiet Mind: A Memoir of Moods and Madness, she navigates the inherent conflict of explaining her own condition while delving into the discomfort of taking, as well as being on different, "sides". Through a close reading of select chapters, this paper explores the nuanced approach needed to understand the complexity of human experiences and perspectives amidst the challenges of mental illness.