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I am participating in a summer public health research internship and was required to take this training about ‘human subject protection’ in research before I begin my work.

We’ve spoken a lot throughout the class about ethics and human rights in research studies and I thought this could be interesting for anyone who wants to read what the actual protocols for ethics in human research studies are. It largely discusses informed consent, rights of children, prisoners, and other vulnerable populations, and a lot of other topics that came up this semester in Global Access to Medicine.

Anyone who wants to complete the training or just review some of the information it provides can sign up on

phrp.nihtraining.com/users/login.php

.    –Click on the Register Button
.    –Complete the Registration form with your email and personal information.  Institutional affiliation should be either college/university or medical school depending upon your primary current institution.  The state entered should be the state where your current (or immediate past) academic institution is located.  Click Create Account button when finished and you can begin the training.

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Acupuncture in America

Something that we’ve spoken about very much over this semester was what actually falls under the umbrella of “access to medicine”.  We’ve spoken about big pharmaceutical companies and TRIPS and about the unfair pricing of medicine, but this article brings up how valuable alternative treatment methods could be in fighting illness.  I do believe that in some instances you do need a “Western” approach to fighting an illness; it’s been proven over and over that antibiotics are an effect way to kill certain kinds of pathogenic bacteria that cause us to get sick.  But there is a grey area of medicine (especially in the realm of pain management) that has room for a more open interpretation.  Especially going into the field of health of physical therapy, I am very open to the idea of treatment that looks at the body as a whole instead of just the immediate problem.  As a PT, many times someone might have pain in their feet from say, plantar fasciitis, which is inflammation of the connective tissue on the bottom of someone’s feet.  Although you must treat that immediate pain, a good PT will also explore what else is going on in your body to produce such pain; hip weakness or sometimes tight calves could be the culprit.  The point is, in the long run what will alleviate this person’s pain?  Homeopathic medicine often does this as well; how can the body be improved beyond what its condition was prior to the illness being treated.  Many times alternative medicine comes under fire as being “voodoo” because there are no FDA regulations and because, well, honestly people are just very skeptical of home remedies and something that isn’t made in a lab.  But the truth of the matter is that more and more people are realizing their health is a reflection of their body’s imbalances, and often you don’t need very much to push yourself back into alignment.  One of the bigger picture problems that is on the horizon is because of the skeptics, many times insurance companies will refuse to pay for homeopathic treatment (such as acupuncture), so people are very often left to pay out of pocket.  Isn’t it my right to be able to chose my own treatment?

Throughout this semester we have discussed many issues pertaining to access to medicine. Most of our discussions have centered on the removal of negative restrictions that limit an individual or groups access to necessary medications.

New York State implemented an assisted outpatient treatment, involuntary treatment, law after two people were assaulted in the subway system by untreated men. The law is known as Kendra’s Law, named after one of the victims. DJ Jaffe writes for Forbes.com:

Studies over 10 years have shown Kendra’s Law helps the seriously mentally ill by reducing homelessness (74%); suicide attempts (55%) and substance abuse (48%); keeps the public safer by reducing physical harm to others (47%) and property destruction (43%); and saves money by reducing hospitalization (77%); arrests (83%) and incarceration (87%). Surprisingly, 81 percent of those ordered into treatment said AOT helped them get and stay well.

Forced medication seems to benefit the individuals who receive the treatment. Does the fact that these people do not seek the initial treatment themselves constitute a violation of their rights? Or is forced treatment a mechanism that seeks to protect the human rights of the greater portion of society? Jaffee argues that the New York State Office of Mental Health does not go far enough, and does not extend treatment to a large enough population. I am not sure how I feel about this. Jaffe is founder of Mental Illness Policy Org, a pro-treatment organization. The organizations overwhelming website has vast amounts of information in support of forced medication.  

Implied within Jaffe’s argument is mental health patients are a violent threat to society, and therefore should be forced to take medication. I do acknowledge that there have been violent acts committed by patient who may have been well served by medication, but these acts represent a minority of cases.

This week South Korea is chemically castrating a repeat sex offended. This is the first time the judiciary of the nation is implementing this punishment after its allowance by a 2010 law. The offender is pending release from prison, conditional upon regular injections to decrease his level of testosterone. The injections deal with his deviance on a hormonal level, though they do not serve to socially rehabilitate his condition. 

In discussing the rights of the patient who receive involuntary treatment- Is it possible that these procedures are a violation of individual civil rights, while concurrently serving to protect the human rights of a larger society?

A trial for an HIV vaccine had to be stopped before the trail could be completed because the vaccine was doing the complete opposite of what it was supposed to do. A number of 1,836 were followed and 172 of them contracted the virus.  It was found to be making some men MORE LIKELY to get HIV.  Men that were uncircumcised and received the vaccine were more vulnerable to acquiring the virus after getting the vaccine even when not participating in risky behaviors.  This higher susceptibility however, lessen after 18 months.

Why is it that when researchers realized that the vaccine was not protecting anyone from getting HIV and when they had suspicions hat it was making some men more susceptible to HIV that this faulty vaccine being administered?  Did this pharmaceutical company figure that their profits would be worth more than the lives of these men that were put in danger?

This is an example of a human rights violation because Merck, the pharmaceutical company, should have been a guardian of health and stopped administering this vaccine once they had suspicions that the drug was failing men.

http://www.nytimes.com/2012/05/18/health/research/trial-vaccine-made-some-more-vulnerable-to-hiv-study-confirms.html?_r=1&ref=health

 
Often we don’t think about how policy outside of healthcare can have major impacts on our health. This becomes a question of rights to an environment in which one can live a healthy lifestyle, rather than the rights to healthcare access. We don’t always realize how environmental factors that are often determined through politics and policy can either fail to address or create the health issues that then need to be addressed through healthcare. These policies have a broad scope from FDA approval of chemicals and ingredients used in medicines and food, to amounts of fumes and pollutants allowed, to school lunches, and much, much more. However, for the moment I would like to focus on the policies surrounding drinking water quality, especially in the New York region.
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Over the past couple of months I’ve heard arguments against private institutions being forced to cover birth control pills for their employees. Perhaps I’m biased as a female myself and believing that is every woman right to have the choice and access to all forms of contraception including birth control pills. Most legal arguments presented simply stated that the government has no say in what type of health care private institutions provide since they are not receiving any government funding. However I was still appalled to hear the language and stereotypes which fueled some of the other arguments.

One such argument which I found particularly offensive is that these institution should be made to pay for birth control, so that women can be as promiscuous as they please. I found this to be shocking that such a stereotype was still so heavily present. A man carrying a condom is considered smart, however a woman on birth control pills is considered a “slut”? Do woman not have the right to protect themselves and have ownership over their bodies?

Another argument made was since there are still cheaper alternatives to birth control such as condoms, it wasn’t essential for women to have birth control pills. First I believe that this places all of the responsibility on men and women should take equal responsibility when it comes to contraception. More importantly for women birth control pills are not only used for contraceptive proposes, but also for dealing with serve cramps, hormone imbalances, and acne. This brings up the question of are birth control pills an essential medication? I know many women who suffer from serve cramps and would considered it comparable to torture. They often have to miss work or school due to their symptoms. Wouldn’t it then be an essential medicine for those who are suffering?

Finally an argument was made that if women want or need birth control medication they should just purchase it themselves and not force their employer to pay for it. This was fueled by the belief that since there are so many birth control pills currently on the market, that it must be affordable. However birth control medication is different for everyone women, since each of our bodies are different. The generic or cheaper brands may not compatible with all women and with some birth control pills costing as much a 60 dollars a month, it is not within everyone reach. So should those women who can’t afford it be denied access to proper birth control medication?

Today this argument is back on the table with the many recent lawsuits of the Catholic groups against the Obama administration’s birth control mandate. The addition of religion to the argument brings an entirely new discussion of rights. Now there is the addition of the right to freedom of religion. Does one right trump another right?

I do not believe that one right takes precedence over another. However I’m concerned with the rights of students or employees of institutions such as the University of Notre Dame which has also recently  filed lawsuit against this mandate, though they did so hesitantly. It is understandable that the government has no right to interfere with the church itself. But does that mean the church as the right to force their beliefs and practices on individuals which attend or work for educational institutions such as Notre Dame? In the past there has also been the case of Georgetown Law School in which a student sued for not having have access to contraceptive coverage. Although I highly doubt a student would ever choose not attend an esteemed educational institution due to lack of contraceptive coverage. But should there even have to be choice between right to an education and right to access of medicine?

Read more on current legal battle:
http://www.washingtonpost.com/national/on-faith/analysis-catholic-bishops-divided-in-legal-battle-against-obama-birth-control-mandate/2012/05/23/gJQAvb0KlU_story.html

I spent last weekend at school participating in a Southern African simulation game. Two sections of Southern African politics classes were divided into a dozen groups: African National Congress (ANC govt), common people, trade union, businesses, United States, etc. The goal of the game was for each team to advance its position in South Africa and for students to experience the complexities of working within an international economy and making decisions that are beneficial for both their individual team’s interests as well as for the people of the region.

As a member of the white business team, I had the difficult task of creating policies that would not only financially advance my team but also improve public opinion. The idea that rich white people hold a special responsibility to aid the less privileged is a global one, and in order for our team to be embraced by the common people, we had to create an image of caring and generosity.

Between the common people group and their Occupy South Africa movement and the government group’s general inaction, my team decided to create the Caring Corp foundation which would allocate charitable funds to various causes including education grants, building hospitals, tackling HIV/AIDS, etc.

One of the most surprising realizations throughout the game was the sheer neglect of all health-related concerns. South Africa has the one of the worst HIV/AIDS epidemics in the world, with 5.6 million infected in 2009. And yet the ANC ignored the problem and said that they had more urgent concerns within the context of the game. South Africa has a history of AIDS denial– former President Thabo Mbeki claimed that the cause of AIDS was not a virus, but poverty; this led to hundreds of thousands of preventable deaths.

Participating in this simulation game, I began to think about the right to health, and the parties responsible for maintaining that right for all people. If health is indeed a human right, is it then the government’s obligation to protect this right by providing access to healthcare? In our game, which accurately mirrored reality, the government was unresponsive to concerns over the growing AIDS problem and other access to health matters that affect the common people. In our attempt to improve our image within society, the white businesses teamed up to give back to the community, but in reality, how much can a few billionaires (and their billions) really do? Is it our responsibility to provide some short term relief (I say short term here because the nature of our charity depends upon rich peoples’ kindness, which like other kindnesses, is a temporary and fleeting resource).

This game taught me that health should not be a charitable endeavor in which the many poor must rely on the few rich for support. It also taught me that governments are constantly bombarded with urgent issues that need attention–and chronic lack of access to health take a backseat to economic and foreign affairs.