SciDev.Net

This series of five articles outlines new challenges and unsolved problems since the journal's last series in 2005. The first article ([189kB]) predicts the disease burden and economic losses that developing countries would face from chronic diseases such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. In the 23 countries that the authors incorporated into a model, chronic disease was responsible for 50% of the disease burden in 2005. If no action is taken, they say, about US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. The second article ([105kB]) looks at how to scale-up strategies to fight chronic diseases in developing countries. The authors review evidence to identify which methods are cost-effective and financially feasible, and therefore ready to be scaled-up.

Tobacco control, salt reduction (both of which are detailed in the series' third paper ([177kB])), and a multidrug strategy to treat individuals with high-risk cardiovascular disease (see an in-depth look in paper four ([220kB])) are prime candidates for scaling-up. What effect improving health systems has on the level of chronic diseases should be properly evaluated, say the authors. For some health interventions, such as preventing or controlling diabetes, there is little cost-effectiveness data for low or middle-income countries, but their scientific effectiveness is so compelling that countries should consider how best to incorporate them. The final paper ([92kB]) is a call to action to incorporate existing interventions into healthcare programmes, which in 2005 was costed at US$5.8 billion.

1990 saw the first major effort to estimate the main causes of illness and the biggest killer diseases in different countries. The data are important for public-health officials to allocate their resources wisely but also for feeding into estimates to plan for the future. Importantly, these need to be regularly updated to ensure that health programmes are still going in the right direction. This paper updates the 1990 study and offer predictions up to 2030.

The most forceful change in disease trends is in developing countries, with the proportion of people affected by non-communicable diseases set to increase. Proportionally, the number of people with infectious diseases is set to fall, though not when it comes to HIV/AIDS.

Because the authors also rely on predicting socio-economic development trends, they created best-case and worst-case scenarios for economic growth. In the pessimistic scenario, by 2030, the three leading causes of illness will be HIV/AIDS, depression, and ischaemic heart disease; in the optimistic scenario, road-traffic accidents will replace heart disease as the third leading cause.

In this research article, Victor Konde of the University of Zambia argues that industrial biotechnologies can improve food security in Africa through improved livestock feeds and vaccines, as well as biotechnological pesticides, fertilisers and herbicides. He adds that biotechnology can also help farmers process crop and livestock products for new markets.

But Africa must first overcome a number of key challenges, says Konde — including restrictions on agricultural exports, weaknesses in scientific capacity and investment, and a lack of diplomatic strength to effectively promote its interests in international negotiations.

The author proposes ways for African policymakers to encourage biotech enterprise and investment, collaborative and interdisciplinary research, strategic alliances and public–private partnerships.

A debate is now underway within the relief community about the proper ethical guidelines to apply when doing research in refugee populations and among internally displaced peoples. Refugees are vulnerable subjects for research for several reasons. For example, they are often part of complex emergencies where human rights abuses are rampant, and because they have limited political rights.

International guidance on research ethics, such as the Declaration of Helsinki and CIOMS guidelines, do not address the special circumstances raised when enrolling refugees in research. Jennifer Leaning explains that the debate pivots on the tension between the need to develop evidence-based emergency health measures and the need to protect vulnerable populations from possible exploitation or harm. The article contains a summary of proposed guidelines to reduce the risk of unethical research being conducted amongst refugee populations.

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In October 2000 — a time when there was great attention and intense public controversy surrounding clinical (especially multinational) research — the World Medical Association (WMA) adopted the 5th revision of the Declaration of Helsinki. These revisions are the most substantial adaptations to be made for 27 years. A commitment to revise the declaration acknowledged that deficiencies and disagreements in interpretation needed to be corrected, and that ethical standards evolve.

This article presents an overview of the process of revision and the major changes made to the declaration. While the authors acknowledge that several of the revisions are clear improvements on the previous version, they also highlight a number of concerns and complain that the new revision is "imprecise and ambiguous". A number of potentially controversial additions to the declaration are specifically identified, including provisions relating to conflicts of interest, monitoring and oversight of research, what should happen after research is over, benefits from research, vulnerable populations, research on those unable to consent and the use of placebo controls.

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This article discusses the challenges of applying ethical principles in epidemiological research (including respect for people, non-maleficence, beneficience, and justice) to population research on domestic violence, an area where poorly designed research could put women in violent relationships at substantial risk. The article draws on experiences from the WHO Multi-country Study on Women’s Health and Domestic Violence Against Women, from the International Research Network on Violence Against Women, and one author's research in Nicaragua. Examples from a number of developing and developed countries are discussed.

Concerns include ensuring the safety of respondents in a context in which many live with their abuser, protecting confidentiality when breaches could provoke an attack, and ensuring the interview process is affirming and does not cause distress. The article concludes that the inherent risks involved in such research can only be justified if, during interviews, information on available services is provided and immediate referrals are made when necessary, if high-quality data are obtained (which requires minimising the under-reporting of violence), and if findings are used to raise awareness of, and improve services for, women who experience domestic violence.

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Although the human rights movement and the sphere of research ethics have overlapping principles and goals, there has been little attempt to incorporate external political and human rights contexts into research ethics codes or ethics reviews.

Every element of a research ethics review — the balance of risks and benefits, the assurance of rights for individual participants, and the fair selection of research populations — can be affected by the political and human rights background in which a study is done. For example, research that at first seems to be low in risk may become high in risk if implemented in a country where the government might breach the confidentiality of study results or where results might be used to deport a refugee group.

Chris Beyrer and Nancy Kass advise that researchers should determine whether research could or should be done by consulting human rights organisations and when possible a trusted colleague, to learn the background political context and human rights conditions of the settings in which they propose to do research.

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