Ensuring that traditional medicines are safe and effective is a major challenge. This study uses mathematical models to show that the treatments that become popular through communities and get passed down through generations are not necessarily the most efficacious. Often, ineffective treatments that are based on superstition can spread because, the authors say, their very ineffectiveness means that patients use the treatment for longer than medicine that actually works.

According to the author of this review, only 7.4 per cent of complementary and alternative medicine (CAM) — which includes homeopathy and acupuncture — is evidence-based. The author evaluates research evidence from clinical trials and systematic reviews to reach this conclusion. By contrast, he says, more than half of all interventions in general internal medicine, and more than 65 per cent in psychiatry are based on sound evidence, including results from randomised controlled trials.

This series of commentaries and papers, published by The Lancet, examines the challenges to achieving a balance between trade and health.

It includes analyses of the WHO and World Trade Organisation (WTO), arguing that they facilitate trade before the health of poor people. Other authors explore issues such as global trade governance, intellectual property rights on life-saving drugs, and how trade practices adversely affect diet and exploit workers.

Richard Smith, from the London School of Hygiene and Tropical Medicine, and colleagues outline an agenda for action to strengthen the evidence on trade and health links, build capacity within health on trade issues and assert health goals in trade policy. They make specific recommendations for the WHO and WTO, donors, governments, nongovernment organisations and academics.

Schizophrenia is relatively rare — affecting 1% of the world's population — but is arguably one of the most severe mental illnesses. Diagnosing and treating it can be hard enough in developed countries; the challenges are magnified in developing nations with inadequate health systems; few trained staff; and pervasive social stigma. So how best to treat it? In this debate, three psychiatrists offer their different viewpoints.

Vikram Patel, at the London School of Hygiene and Tropical Medicine, says the shortage of mental health specialists means that the most effective way of spreading the expertise around might be for non-specialist health workers or community representatives to be trained to bear the brunt of providing first-line mental health services. Saeed Farooq, at Pakistan's Lady Reading Hospital, argues that the principles of the WHO's DOTS TB programme, in which patients are given an uninterrupted supply of medication taken under close supervision, could be used to treat schizophrenia. The rationale is that missing medication for schizophrenia, which can be common given the cognitive impairment associated with the illness, has serious consequences and can lead to much higher risks of relapse. R. Thara, director of the Schizophrenia Research Foundation, Chennai, India, advocates tackling stigma by offering proper treatment. In India at least, he says, the mystification of mental illness is intensified by a lack of awareness about schizophrenia and also by "magico-religious" beliefs. Effective treatment that shows the symptoms to be an illness rather than a religious curse is the best antidote to stigma, he says.

Worldwide, cancer kills more people than HIV/AIDS, malaria and TB put together. In developing countries where chronic diseases are now growing alongside infectious diseases, new strategies need to be developed.

This article outlines how to develop an effective cancer strategy in African countries on the basis of discussions at the recent African Cancer Reform convention. A cancer control plan clearly needs to take into account African countries' financial constraints and the authors outline six key essentials that would offer most health gain for money invested. These are: setting up cancer intelligence units to collect data on cancer incidence; controlling tobacco use; early diagnosis and prevention; offering treatment wherever possible; palliative care when treatment is no longer useful; and training and educating future generations of African oncologists.

Developed countries can offer crucial expertise and experience and collaborate on cancer information networks. Educating local communities about a disease that is relatively new but growing quickly will also be essential to stop it spiralling when many cancers are preventable or treatable when detected early enough.

This joint publication between the World Health Organization and the Global Forum for Health Research reveals mental health research capacity in 114 low-income and middle-income countries in Africa, Asia, and Latin America and the Caribbean. The extensive review identified over 10,000 articles, 4,633 mental health researchers and 3,829 other stakeholders. The authors argue that this is "the first systematic attempt to confirm the pressing needs of improving research capacity in mental health".

The publication provides useful details in table and charts, analysed by group of stakeholders and by region, on topics such as: researchers' profiles; priority-setting process; amount and type of research production; services and technical support available to them; courses and trainings offered; funding patterns; and dissemination of research findings. The appendix provides two extensive lists — by country — of policy and practice that resulted from research evidence, as well as research evidence that was never translated into policy and practice.

Nine recommendations indicate how the management of mental health research can be strengthened so that it meets the national needs of the countries as well as contributes to the global fund of knowledge. The authors say their report thus enables evidence-based decision-making in funding and priority setting in the area of mental health research in low-income and middle-income countries.

In this article Brian Vastag looks at the initial mixed response to the October 2000 revision of the Declaration of Helsinki, in particular those provisions relating to the use of placebos and the availability of therapies to participants after research is over.

The views range from enthusiastic support — Delon Human, Secretary General of the World Medical Association suggests that the revision is an ideal that sets an ethical standard "which I don’t think can be set high enough" — through to disapproval — Robert Temple MD, director of the FDA’s Office of Drug Evaluation comments, "I think it’s scientifically and ethically incorrect".

The article goes on to outline ongoing controversies about what standards of care are ethical in research in developing countries. It concludes that while the question of who should meet the costs of satisfying the Declaration's requirements is unclear, the revised Declaration provides developing countries with "the leverage to demand more consideration from medical researchers".

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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