A Review of intellectual property rights: The weak link with the African Traditional knowledge

Protecting traditional knowledge (TK) has been acknowledged in various discussions under the umbrella of a number of inter-governmental organizations that deal with biodiversity, the environment, indigenous peoples’ rights, human rights, among others. It has, however, been difficult to arrive at a consensus on the proper modality that can serve the needs and desires of Indigenous and Local Communities (ILCs) in their economic and cultural participation. The paper examines the requirements for the protection of TK and explores the modalities of TK protection at the international level for regulating the control of, access to and utilization of biodiversity associated with it. It is argued that any modality of TK protection should incorporate defensive and positive protection that address gaps in protecting TK. Protection of TK should, therefore, involve identifying different modalities, including those based on Intellectual Property, to fit the nature and use of TK in particular contexts. The paper makes a case for a shift in strategy for protecting TK by adopting pluralistic modalities that address the protection needs of ILCs, depending on the purpose and the context in which the knowledge is practiced.

Voluntary and Involuntary Nonadherence: Terminology for Labeling Patient Participation

The descriptions and labels healthcare providers place upon patients can greatly determine the quality and availability of the healthcare they receive. When that patient is given the label nonadherent or noncompliant within healthcare, it can have a detrimental impact on the patient. But patient adherence is a more complicated issue than can be express with a binary determination; is or is not, yes or no. Therefore, additional terminology should be utilized to properly convey the patient’s participation status when the patient does not fully engage in care. This paper proposes the implementation of additional qualifying language: involuntary nonadherence and voluntary nonadherence. Involuntary nonadherence is defined as when the patient desires to participate in care but is unable to do so because of factors outside of his/her control. These could involve inadequate means of transportation, difficulties with schedule flexibility, etc. These patients are demonstrating nonadherence by current standards but would participate if circumstances allowed – outside pressures are influencing the decision to be nonadherent. Contrast that with voluntary nonadherence, defined as when the patient gives informed refusal to participate, and the patient is fully able to participate but actively chooses not to. This additional qualifying language could ensure protection for patients from being labeled and potentially dismissed due to circumstances outside of their control.

Ethical Assessment of Post-Exposure Prophylaxis Guidelines in Sexual Assault Patients Suspected of Hepatitis B Viral Infection

More than 400,000 sexual assaults are reported annually in the United States in females and males above the age of 12. Victims are likely to include members of vulnerable populations such as the disabled, homeless persons, and immigrants. Victims of such assaults are at heightened risk of contracting the Hepatitis B virus (HBV) from their assailant. Unfortunately, approximately two-thirds of people with chronic HBV are unaware of their own status, exposing for victims the risk viral transmission, disease-related cirrhosis, and hepatocellular carcinoma. Victims are also at increased risk for posttraumatic stress disorder (PTSD). Although immediate vaccination of the assaulted victim is recommended, protective levels of antibody are not present for fourteen days post vaccination. Complementary treatment with a Hepatitis B immune globulin (HBIG), however, may provide immediate protective serum concentrations. Prompt prophylactic therapeutic intervention may not only protect patients from risk of infection but may also prevent the effects of PTSD by providing victims with psychological and emotional benefit. Yet, existing Centers for Disease Control and Preventions (CDC) recommendations for suspected HBV infection in sexual assault patients recommend initiating immunoprophylaxis only in cases where the perpetrator’s HBsAg status is known, a guideline that perpetuates inequities and injustice for those equally subject to the harms of sexual assault. This paper presents an ethical assessment of prophylactic treatment for sexual assault patients suspected of HBV exposure. In the absence of equitable guidelines, we argue for the clinician’s duty to rescue sexually assaulted patients from future harm and to protect the public through mitigation of transmission using currently available and evidence-based treatment modalities. The paper concludes with an ethical foundation to advocate for modification of current guidelines in view of existing prophylactic regimens.

Ethical and Practical Implications of COVID-19 Vaccine Hesitancy among College Students: A Pilot Study

According to WHO, one of the most effective ways to protect people against COVID-19 is with the use of vaccines. As academic institutions prepare to fully re-open in the fall of 2021 and COVID-19 vaccines being readily accessible to all ages twelve and older in the U.S., college students are also getting ready to go back to normal campus operations for traditional in-person education. This raises the need to assess students’ attitudes toward the COVID-19 vaccines by identifying and addressing reasons for their hesitancy. One major threat to the impact of vaccination in preventing disease and deaths from COVID-19 is low utilization of vaccines by some groups. We conducted a pilot study and interviewed 55 undergraduate science students enrolled in summer school in 2021. The majority of the students were female, younger, Hispanic, or Latino, and at the junior or senior level. More than half of them have been vaccinated (62%) and indicated that it is important to attend classes while vaccinated (75%). While there were a variety of reasons for hesitancy ranging from lack of concern to lack of initiative, 17% of participants stated that religion played a role in their decision. Evidence-based recommendations strategies based on religion, ethical, and social implications are provided.

Black Disparities in Targeted Therapy Clinical Trials – A Call for Future Reset

Studies show marked disparities in the relative risk of cancer death between Black Americans and White Americans even after adjusting for the stage at diagnosis and age. This may be explained by disparities in different aspects of cancer care including providing equal screening opportunities, availability of proper treatment options and inclusivity in clinical trials. To our knowledge, our study is the first descriptive study on Black disparities in targeted therapy clinical trials. We collected data on Black inclusivity from pivotal clinical trials as well as trials of special interest involving targeted therapies in some of the commonly encountered cancers. Our results show that most targeted therapy trials included in our review were multinational including some participating countries with very few or no Blacks and therefore had very poor Black representation with an average of around 1-3%. Also, some trials lacked transparent data on the racial demographics raising concerns on the generalizability of data when extrapolated to treat the Black population. We have reviewed existing literature on differences in cancer biology and host biology depending on the race and end with suggestions to improve Black inclusivity in clinical trials.

Ethical Data Stratification and Analysis to Eliminate Unconscious Bias in Learning Health Systems for Palliative Medicine

Learning Health Systems (LHS) produce analyses supporting medical decision making. Though algorithms are chosen to eliminate bias, we are left with unconscious bias present in data, due to lack of representation for marginalized populations. This is especially problematic in palliative care. Medical practitioners lack historical foundations for decision making for patients in these underrepresented populations. This paper first reviews the ethical foundations that drive our approach, then describes data stratification and analysis supporting a data-ethical LHS. Kaplan-Meier curves are generated for each of the stratum, demonstrating the value of palliative care and its impact on survival. Data were collected from government and foundation sources, stratified and analyzed to more appropriately weight medical history and characteristics to improve decision making for all populations. “Very well. Sea,” cried Canute, “I command you to come no further! Waves, stop your rolling! Surf, stop your pounding! Do not dare touch my feet!”

Counterfeit/Fake and Substandard Medicines – A Global Bioethical Issue Requiring A Global Approach

Counterfeit drugs are a global problem and a public health hazard. Nearly 10 percent of all medicines sold worldwide are fake, leading to an estimated 100,000 deaths each year, equating to an additional economic burden of close to $200 billion annually. Counterfeit medicines also thwart public health efforts to control infectious diseases like Covid-19 and Tuberculosis and lead to the worsening of other public health crises such as anti-microbial resistance (AMR). According to the CDC, more than 2.8 million antibiotic-resistant infections in the U.S each year, with more than 35,000 people dying, have been reported. Globalization and the internet's expansion have led to the rapid spreading of poor-quality medicines due to the high demand for cheap goods and lack of access - before adequate detection and intervention are possible. Moreover, selling counterfeit medicine is more profitable with lesser penalties, even in the U.S. As a clandestine market, there is no precise magnitude of how the counterfeit-medicine market flows. The WHO is alarmed by the lack of available data to demonstrate the extent and impact of fake/substandard medicines. Controlling counterfeit drugs' availability will not be easy; however, it has become necessary to protect public and global health. Through the lens of a case in Bangladesh that demonstrates how easy it is to sell and get away with selling fake medicines in developing countries - this paper discusses how counterfeit medicines negatively contribute significantly to human lives and sufferings in developing and developed countries. No single policy will be effective based on the different issues faced on multiple fronts due to fake/substandard medicines. However, a broad-based concerted effort across the various stakeholders to combat this counterfeit drug problem and secure the global supply chain is urgently needed.

Death Education: An Educational Approach to Death and Dying

This paper explains the importance of education in the dying process and outlines a full curriculum to create a society more prepared for difficult end-of-life situations. This course is structured to be taught as a high school elective course in which the principles and approaches to death and dying are discussed in depth. For a high school student, death can be approached from diverse perspectives. Within these perspectives, there are several vital topics to understand in order to ensure a student’s proper education on death. The complexity of death is represented by the titles of the nine chapters of the course. Chapter One, titled “Definition of Death, Consciousness, and Persistent Vegetative State,” highlights the development of death throughout history, the general consensus about death today, and the morality of different levels of treatment for dying patients. Chapter Two, “End Stage Medical Conditions,” outlines the most common end-of-life health conditions along with their symptoms and possible treatments. In Chapter Three, titled “Bad News and Communication,” the course introduces patient-physician communication, the current shortcomings of medical education in this vital area, and the possible protocols for effectively conveying both truth and support to a patient. Chapter Four, labelled “Do Not Resuscitate Orders, Living Wills/Advance Directives, and Durable Powers of Attorney for Health Care,” presents the appropriate options available to prepare for a patient’s inability to make informed decisions autonomously. Chapter Five, “Ordinary vs. Extraordinary Means: The Issue of Tube Feedings,” discusses the distinction between different types of end-of-life treatment and when certain treatments can be morally excused. Chapter Six, titled “Palliative Care and Hospice: A Paradigm for End-of-Life Care,” gives effective options for terminally ill patients that ensure care is never stopped and a patient's dignity is never lost. Chapter Seven, “Pain Management,” highlights the difficulties and recommendations for establishing proper pain management. Chapter Eight, entitled “Medical Futility,” presents the debate surrounding patient autonomy with physician’s beneficence and nonmaleficence, forgoing and requesting treatments, and the values associated with this issue. Finally Chapter Nine, titled “Spirituality and End of Life Care,” emphasizes the inevitable linkage between healthcare, death, and spirituality and the benefits of proper support for a patient. This paper also highlights the ethical implications surrounding the death and dying process. The importance of this subject lies within the death-denying reality that society is today in which death is avoided and human dignity is increasingly sacrificed as a result. Discussions and education among society’s youngest adults can improve general knowledge about the dying process and lead to overall better preparation for handling this inevitable stage of humanity.

The untold story of plight of Ayurveda in pre and post-independent India

India will exceed WHO recommended Doctor: population ratio of 1:1000 in 2024 with only MBBS doctors. Thereafter 8 lac registered ISM&H doctors will become surplus. They will have no place to go and no means to survive. Otherwise also as a doctor they were never a part of modern medicine oriented public health care sector. Occasionally whenever they are entertained in this sector, care is taken to keep their status and wages lower than that of a nursing personnel. Delivery of Ayurveda services was never allowed through public health care sector since pre-independence. The script of this neglect was written by Bhore committee in 1946. The Indian administrators in post-independent India, followed the same script. Outside the government, in absence of clear policy on permission or prohibition to practice modern medicine, and without any appropriate training, Ayurveda practitioners, facing occasional prosecutions, continued to practice modern medicine. Today their fate remains undecided. Still 50000+ ISM&H graduates come out every year from Universities to try their luck. This is totally unethical on the part of every responsible Indian and the concerned authorities. This is amounting to mass unemployment and frustration among this youth power. Prohibition on delivery of Ayurveda service through public health service, keeping ambiguity on the issue of permission or prohibition of practice of modern medicine by Ayurveda practitioner, allowing exposure of people to Ayurveda practitioners for receiving modern medicine treatment, when the Ayurveda practitioner is not trained for delivery of such service and allowing exponential increase in number of ISM&H practitioners to the tune of 52000 every year in absence of assured survival means; all these activities are extremely unethical on the part of government authorities. Immediate steps need to be taken to stop these unethical practices and save this deterioration and plight of Ayurveda.