2018

Urgent Need for an International Declaration to End Cross-Border Surrogacy

[Supported]
Author(s): Olinda Timms

As one country responds with a ban on commercial surrogacy, the market just shifts to the next unregulated destination. An international declaration will thus send the right message against exploitation of women.

2018

Deep brain stimulation for people with Alzheimer's disease: Anticipating potential effects on the tripartite self

[Supported]
Author(s): John Noel Viaña,Frederic Gilbert

2018

Situated stem cell ethics: beyond good and bad

[Supported]
Author(s): Jennifer Liu

A burgeoning literature in bioethics addresses questions of how we might govern emerging biomedical technologies
that have global and species-level stakes while still acknowledging the significance of local jurisdictional and cultural
contexts. Many of these scholars have asked how bioethics, rooted in strands of western moral philosophy, might
work in contexts with indigenous moral and ethical systems; and they ask whether a global bioethics is possible.
In competitive fields of stem cell research (SCR), some countries have used governance structures to establish
regulatory gradients that may confer a strategic advantage.
SCR, and regenerative medicine more broadly, has generated significant international attention regarding its
therapeutic and market potential as well as the ethical questions it raises. At the heart of much of this attention is the
question of what constitutes good stem cell science. Scholars working in science and technology studies (STS, also
science, technology and society) examine the sociality of science, the co-production of sciences and social orders,
and the varied stakes and interests that inhere in scientific knowledge production and its applications. They pay
close attention to the specific contexts of science and to the questions of what counts as good or bad science.
Here, I offer a short discussion of a few prominent STS scholars’ consideration of good science. Next, using
specific international examples, I further problematize what counts as good science and I ask how we might move
beyond dominant notions of ‘the good’ in science. Finally, drawing on examples from the US, UK and Taiwan, I
show the complications and myriad factors that shape determinations of the good and bad in the complex actual
situations of ethical scientific decision making. I suggest that ‘the good’ exists in the rich social interactions that
surround emerging science and policymaking rather than strictly in principles, rules or practices of that science.

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2018

Medical professionalism of foreign-born and foreign-trained physicians under close scrutiny: A qualitative study with stakeholders in Germany

[Supported]
Author(s): Corinna Klingler

Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders’ opinions and attitudes towards FB&FT physicians—which likely influence how these physicians settle in—and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians’ work performance. Participants criticized FB&FT physicians’ work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration.

2018

Vendor-based restrictions on pesticide sales to prevent pesticide self-poisoning - a pilot study

[Supported]
Author(s): Manjula Weerasinghe

2018

Including all voices in international data-sharing governance

[Supported]
Author(s): Jane Kaye

The governance frameworks that have been developed to support biomedical research are not well equipped to deal with the complexities of international data sharing. This system is nationally based and is dependent upon expert committees for oversight and compliance, which has often led to piece-meal decision-making. This system tends to perpetuate inequalities by obscuring the contributions and the important role of different data providers along the data stream, whether they be low- or middle-income country researchers, patients, research participants, groups, or communities. As research and data-sharing activities are largely publicly funded, there is a strong moral argument for including the people who provide the data in decision-making and to develop governance systems for their continued participation.

2018

The Big Data Agenda

[Supported]
Author(s): Annika Richterich
By theme: Other

2018

Towards a functioning retail health market

[Supported]
Author(s): Freddy Kitutu
By theme: Global health, Other

Abstract
Kitutu, F. E. 2018. Towards a functioning retail health market. Evaluating the integrated Community Case Management Intervention for Pediatric Febrile Illness in Drug Shops in Rural South Western Uganda. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1494. 102 pp. Uppsala: Acta Universitatis Upsaliensis.
ISBN 978-91-513-0439-7.
Objectives: This thesis examined the health systems effects of implementing the integrated Community Case Management (iCCM) intervention for paediatric febrile illnesses in a retail health market in South Western Uganda. More specifically, it evaluated drug seller interpretation of malaria Rapid Diagnostics Test (RDT) results (study I), adherence to iCCM guidelines (study II) and the intervention effect on households’ perceived quality of drug seller fever care and care-seeking choice. Study IV qualitatively analysed the iCCM intervention implementation and
causal mechanisms for observed effects. Improved understanding of such retail health markets will inform policy decisions and interventions for Universal Health Coverage.
Methods: The study used mixed-methods design with an intervention and comparison arm, and pre-test assessment in both study arms. Data collection methods included care-seeker drug shop exit interviews and household surveys using structured questionnaires, focus group discussions, in-depth interviews, review of secondary data and a laboratory analysis of fingerprick capillary blood samples.
Results: Among those tested for malaria parasites, there was 93% (95% CI 88.3, 96.2) agreement between drug sellers and laboratory scientist re-reading and with a kappa value of 0.84 (95% CI 0.75, 0.92) (Study I). The drug seller compliance with the reported malaria RDT results was 92.5% (95% CI 87.9, 95.7) (Study I). The iCCM intervention improved appropriate treatment for uncomplicated malaria by 34.5% (95% CI 8.6, 60.4), for pneumonia symptoms
by 54.7% (95% CI 28.4, 81.0) and reduced appropriate treatment for non-bloody diarrhoea
-11.2% (95% CI -65.5, 43.1), after adjusting for extraneous variables (Study II). Implementing the iCCM intervention in drug shops decreased the odds of households perceiving drug seller fever care as good but increased the household odds of choosing to seek care from private health facilities versus within the community (Study III). Drug sellers operated in a retail market system influenced by knowledge and actions of care-seekers, CHWs, government health workers and regulators, and also how formal and informal rules and norms were applied (Study
IV). Implementation of the iCCM intervention at drug shops was modified and shaped by the emerging actor perceptions and behaviours (Study IV).
Conclusions: This thesis demonstrates the implementation, causal mechanisms and contextual factors of the iCCM intervention in a rural retail health market. Fidelity and quality of iCCM intervention by drug sellers was acceptably high, probably as a result of co-interventions. Interventions in retail health markets should comprise of components that target the multiple actors or influences that shape that market. Multi-component health system interventions are complex to implement and also create complexity in their evaluation. When technologies are involved, their analysis should go beyond their substance as products and view them as items that
encapsulate interests of different actors, some of which maybe converging with or competing against societal goals.