hippocritical oath?

Reading  Subrata Chattopadhyay's paper "Bioethical concerns are global, bioethics is Western" I found familiar mention about the very Euro-North American bias in medical ethics.  Individualism, medicine as business, yeah, yeah, yeah... that's my day job.  But Chattopadhyay spoke specifically about the Hippocratic oath part way through, and my Med I ears perked up.  He commented about how bioethicists quote Kant and Locke and Socrates, but not Buddha, Confucius or Ghandi.  We pledge the oath that came from the Greeks when other disciplines have equally relevant contributions to make. 

He mentioned the Sollemn Oath pledged in Ayurvedic Medicine in Ancient India.  And after a little poking around I found it.  Not only is a physician expected to be a Good Doctor, but a Good Person.  As though the two were inextricably linked...

“ Day and night however thou mayest be engaged, thou shalt endeavour for the relief of the patient with all thy heart and soul. Thou shalt not desert or injure the patient even for the sake of thy life or thy living. Thou shalt not commit adultery even in thought. Thou shall not covert others possessions. Thou shalt be modest in thy attire and appearance. Thou should not be a drunkard or a sinful man, nor should thou associate with abettors of crime.

Thou should speak words that are gentle, pure and righteous, pleasing, worthy, true, wholesome and modest. Thy behaviour must be in consideration of time and place and heedful of past experience. Thou shalt act always with a view to the acquisition of knowledge.

Though possessed of knowledge, one should not boast very much of his knowledge. Most people are offended by the boastfulness of even those who are otherwise good and well informed.

There is no limit at all which the knowledge of Ayurveda can be acquired, so thou should apply thyself to it with diligence. This is how thou should act. Again, thou should learn the skill of practice from one another without carping. The entire world is a teacher to the intelligent and the foe to the unintelligent. Hence, knowing this well, thou should listen and act according to the words of instruction of even an unfriendly person, when they are worthy and such as bring fame to you and long life, and are capable of giving you strength and prosperity.”

This is given in Charaka Samhita, a compedium on Ayurveda authored by Charaka-a renowned authority on Ayurvedic Medicine who lived sometime between the 2nd Century B.C. and 2nd Century A.D.

Code Of Ethics :

• We shall always maintain the Highest Standard of Professional Conduct.
• We shall not be influenced merely by Motives of Profit.
• We shall endeavor to maintain Dignity of Manner.
• We will not do anything that will Weaken, Physically or Mentally, a client.
• We take Patient's Welfare as the first consideration.
• We shall always do our best to provide the most Appropriate Treatment.
• We shall Treat a client / Patient in Complete Confidence.
• We shall always be abiding to the Principles and Practices of Ayurveda.
• We shall provide the Related Services for which we are duly Qualified.

I have to say that the line "Thou should speak words that are gentle, pure and righteous, pleasing, worthy, true, wholesome and modest" is truly remarkable.   Can you imagine?  Doctors in a row, lining up in their sharp coats, promising to speak gently.  Words that are gentle and modest.  <sound of the script of Grey's Anatomy going up in flames>  I find it hard to imagine.  Equally stunning, the phrase "thou should listen and act according to the words of instruction of even an unfriendly person" is totally foreign to a Western physician.  Yet doctor-patient relationships, doctor-nurse relationships, doctor-administration relationships would be totally altered by such an approach!

Quakers teach a kind of intentional listening that is part of their faith experience; to hear that which is divine in the words of others.  The assumption is that each person has equal access to Truth and to the Divine, and that there are fragments of both in everything we say.  Now, I'm not going to get into the metaphysics of divinity here, but there is something deeply instructive about Quaker listening that is attuned to the Ayurvedic code. 

I am a student.

I have been a student of the human experience since the day of my birth and I won't survive my graduation from that discipline.  It's up to me to learn and deepen that study, or to coast, copy or cheat my way through.  And as the oath above suggests, life is the classroom, right?  Compassion = education.  This code of conduct should not be exclusive to physicians, but should be asked of all of us. 

Emergency wards are a classroom...

Patients frequently present at the E.R. with non-emergent maladies - they feel sorry for themselves, have an overdeveloped sense of their own urgency, create drama and resent waiting.  Beneath that, however, is evidence of their life story.  These individuals likely had to clamour to see their needs met when they were young; they have been overlooked and under-appreciated; they have encountered an unsympathetic world and if they don't feel sorry for themselves, maybe no one will care.  They are afraid and isolated, perhaps distrustful of their own bodies, but certainly distrustful of their community to protect their interests... perhaps to even take interest in their interests.  Each one of these patients is a keen lesson in sharp focus that compassion, engagement and protective relationships are essential to human confidence.  When we diminish the experiences of our children (oh, don't be silly), our friends (get over it), and our partners (you think you've had a bad day!) we diminish their humanity, and those injuries add up.  Even the most obnoxious patients are instructors if we listen closely enough.

They tell a truth.

Even if someone is a self-pitying, pouty poopy pants, that doesn't mean their pain doesn't hurt.  The fact that their threashhold may be low might be a result of their need for endurance - people who live in emotional pain suffer physical pain far more acutely.  Are they wimps or are they suffering in ways we just can't see?  Obnoxious patients can teach physicians to remember that context is everything and that illness does not exist in a vacuum.  Pain is subjective and is experienced in layers.  Instead of learning from one another, however, we insert ourselves in the stories we hear:  "that wouldn't bother me" we think, forgetting that is totally irrelevant.  It bothers someone, so that must mean it's bothersome!

Speak words that are gentle, pure and righteous, pleasing, worthy, true, wholesome and modest. Thy behaviour must be in consideration of time and place and heedful of past experience. Thou shalt act always with a view to the acquisition of knowledge... The entire world is a teacher.

I think I may try my own hand at writing an oath... something that will guide my own physicianhood, beyond the formulas of a promise that may be rather incomplete.



Chattopadhyay S, DevRies R (2008) Bioethical concerns are global, bioethics is Western, Eubios Journal of Asian and International Bioethics, 18(4): 106–109

o brother who art thou?

"i will maintain the honor and noble traditions of the medical profession.  

My colleagues will be my brothers and sisters."

- hippocratic oath, geneva 1948

on august 24th i will wear white and i will pronounce vows of lifelong dedication and fealty.  perhaps someone will throw rice.

the event won't take place in church but it takes me back to many a hymn - songs dense with rhyming creed that often would be a lie to sing.  i used to improvise on the spot, swapping out offending terms or principles for something i could comfortably put to tune.  other times i would just let the line go by in silence, unable to repair the sentiment of wretchedness or trite absolution that didn't taste quite right in my mouth.  likewise, the statement above makes me reach for a glass of water.

sharpened to an even finer point by my recent work in biomedical ethics, i feel strongly that one need wield the hippocratic oath with care and sincerity.  this pledge is not just an elaborate password to get into the clubhouse, but is a thousands-years-old covenant, invoking history and tradition - once upon a time even the name of apollo!   i believe in promises, in the power of saying "i will" and meaning it.  i see the hippocratic oath as the vow that physicians commit to all their future patients (not to the college, each other, or the school), till death do them part... and for a time afterwards too, in fact.

but i have a hard time with this particular piece.  "the honor and noble traditions," hey?  oh but those words hang heavy and limp on the lapel of medical history.  and by history i mean present, too.  what nobility drives the pharmaceutical race to gold; run on tracks made of vulnerable populations, hurdling laws and human-rights in a single bound?  what honor is in fear-based medicine that is more invested in avoiding litigation than in equitable access of all people to care?

how can i say that sentence with integrity?

and my brothers and sisters.  it's sweet to use inclusive language, but i don't think that way.  from where i sit, medicine is a brotherhood.  now, granted, women are allowed to join.  but as far as i can tell, that is more a result of their efforts to masculinize their thinking, discourse and demeanor rather than a true inclusion.  so what will i MEAN when i pledge siblingness to my profession?  an image of a roomful of docs bickering over which channel to set the television comes to mind :)

i think the most important bit for me?  is to keep present where i am and with whom i will recite my oath.  yes, medicine as an institution is RIDDLED with inequities and has an embarrassing legacy of abuses of power.  yes, it is a boys-club and will likely continue to be for many many more years.  but inside the machinery are people.  and inside those people there is Good.  i bet there is honor too.  and like diamonds in otherwise forgettable oar, there are shards of nobility.  i read their writing every day, right now.  and in my mind i see these individuals, privately and professionally both, striving to create healing... whether with bandaids or policy reforms... these are the big brothers and big sisters, the Older Cousins perhaps that i can look up to and hope to emulate some day.  ordinary dumb people, like all of us, who are doing their best.

and i think i may change a word in there, if no one minds.  "honor and noble visions" i can get behind.  i can cheer on and find inspiration in those.  the tradition, i dunno, man. 

i make no promises.

if the shoe fits?

i don't wear shoes at work.  i'm not sure when that started but it's kind of a thing.  it's ironic because i love to acquire footwear (the less sensible the better) yet am eager to kick it off at the first opportunity.  my favourite shoeless moment was in the coffee-corner at a bustling (dare i say frantic?) television production house.  my feet in the altogether, i nursed a mug of caffeine (which always was selected to subliminally coordinate with my outfit) only to be be asked if i kept my tootsies bare to "be closer to the earth" for creative purposes.  blink.  sip.  what?  "oh yeah.  totally.  how'd you guess?"  she beamed with the satisfaction of puzzle-solvery and i wondered fleetingly if she was stoned.

people are my favorite.  :D

working in television, one is afforded certain eccentricities.  i brought my cartoon of a wiener dog to work almost daily for a year.  she was an improvement on the neighboring director's shedtastic golden, who was a "sweet-of-heart if not -of-scent" allergy hazard of the first degree.  i had colleagues who worked almost exclusively at night in the spook and quiet of the sleeping building... the phantoms of the opera edita.  another who rigged an admittedly ingenious exhaust system out of CPU cooling fans to vent pot smoke from his office as he worked under the haze of his favorite herb.

even now, working in a philosophy department, i'm in a hotbed of unique-ity, though here the herbs are not consumed... but far more prolific.  even the bathroom stalls contain shrubbery.

but come august 23rd i will enlist in a nation of conformity.  a profession built upon sensible shoes and dress codes.  i have never worn a uniform in my life.   oh, and no one trucks around the ward with nude feet.

medicine simply is not the place to bare your soles.

eccentricity is limited to the colour of your stethoscope as far as i can gather (mine is green on principle but it's admittedly such a dark green it might as well be black.  they have pink but that's a little too Pepto-Barbie for me).  and sitting at the orientations, amid a sea of straightened hair, tall boots 'n' leggings, the appearance of a subspecies seemed to form.  the men almost all had the same kind of "precision-tousled" american eagle look to accessorize their staggering youth; the women were evenly tanned at the "lightly toasted" setting of their generation... and everyone had shoes on.  no exception.

mental note: don't shave your head again, heather.  you'll be fed to the crocodiles.

i have spent over a decade in the indulgent and playful world of entertainment.  i make bad jokes with a passion, employ cartoon voices on a regular basis, and do my best to make fun of myself whenever opportunities arise.   i say "no" to employers and defend my position (something i am sure has served me both well and quite poorly).  i'm not just 10+ years senior to my class-of-2015 contemporaries, i am an openly opinionated, do-my-own-thing, shoeless goofball with two kids and a mortgage!  demographic anomaly meets misfit in general.

i like to think of myself as anti-conformist, but that's as easily said as done in an environment that loves nothing more.  i like to think that i will successfully retain my sense of individuality as i climb aboard the U.S.S.Medschool... but i am a visitor to this foreign culture.  there is a degree of "when in rome" that is requisite to my residence there.  indeed the first vow of the hippocratic oath is one of fealty to the brotherhood of medicine (future blogs on THAT one forthcoming), and it is morally incumbent upon me to honour those words.

it all begins with the first step.

i will require a pair of sensible shoes.  and i'll have to wear them, too.




heavens, what what i done?

No one asks to be colonized… do they?

So here’s the sitch.  Big Pharma (the catchall phrase to indicate all of the major pharmaceutical companies like Pfizer, Unilever, etc) has the most powerful lobby mechanisms in history.  Our government is so enamoured of BP (pun intended) that it smacks of an episode of the Bachelor – one swanky dude swarmed by a fleet of preening fans, each desperate to bat her eyelashes most prettily.  However, the BP privilege is far greater than its vote-swaying ways.  To explain my point, I suggest we call it something other than a collection of corporations.

Big Pharma is a nation state.  It has an ever expanding populous, a specific and defined culture, system of laws and independent governance.  This last point is of particular import – as evidenced by CETA and other trade agreements, the patent system and its myriad of revisions to protect BP, this nation is not answerable to any other government outside of influences from the UN or World Bank… like any other country.

Now, Canada is home to 34 million residents.  These residents have a wide range of health care needs.  Canadians also consider the tending of such needs to be a basic human right.  We contribute our tax dollars willingly to the common good of medical access for all citizens.

When BP first arrived on our shores, in its pillbottle Mayflower, it brought promise of treasures we’d not known before.  Penicillin, polio vaccines… Viagra.  Our distinctly Canadian culture created the socialized distribution of these drugs, grateful for the explorers who had come to elevate us from our ignorance.  Over the years, like any good colonist would do, BP constructed an increasingly dependant relationship with the savages they found on our land.  Each promising new drug that our public money saw through preliminary trials was scooped up by our landholding visitors – very good, little farmer, we’ll take that.  Don’t you worry your pretty little heads about completing the final stages now that you’ve invested so much time and money already!  Here’s a shiny nickel… run along.  Take some potatoes with you.

Today the nation of Big Pharma controls almost all of Canadian access to life-saving medications and interventions.  They also control almost all of Canadian access to agricultural products that allow us to compete in the food production markets, upon which our ecosystems are now dependant; products with health hazards sometimes requiring drugs from the BP States.  If the BPs were to withdraw their presence in Canada for only one month, thousands of people would die – starved of insulin, heart medications, antibiotics – and others would go mad – suddenly bereft of antipsychotic regimens – while our chemically dependant crops would fail miserably.  Sure, BP would suffer losses in the millions, but with profit margins in the billions they can afford the inevitably unwavering deference that such an act would purchase.

Like the Spanish invasion of South America and the Philippines, the Dutch and French in Africa, the British in India and Native America, the BPs have gained economic control over our ability to sustain our most basic survival, cloaked in the paternalistic guise of working in “our best interest” with technology we don’t have, and wealth we didn’t imagine.  It wasn’t as obvious, of course.  There weren’t red coats and rifles.  The colonization was political and economic.  The lobbies are their tanks, rolling over our self-determination, flatting it to the ground.   Committee canons blow holes in policies intended to uplift the less fortunate, while the firing squads shoot pink slips at MPs who resist.   Local culture (altruism, peacekeeping) is undermined by increasing privatization of health care, in an effort to impose the colonist’s profiteering values.  Evasive maneuvers (closed-doors) drew in the powerful members of the World Bank and UN to skew the law. CETA is part of the growing worship of a foreign god, as BP is not only mainstreamed but revered.

Canada has been colonized.  Only, unlike the Mayans, Pakistanis, Congalese … we asked for it.

But we can still learn from our international sisters and brothers.  India did not find independence in a day.  Like any revolution, we need to start grassroots.  Small steps to build an infrastructure that can bear the medical burden that will collapse upon us when BP is overthrown.  We need to construct pharmaceutical self-governance, making increasingly public that which is privately held unjustly.  Publicly funded research needs to hang onto its patents.  We need public entities to produce and distribute medicines (employing Canadians instead of making American stockholders more wealthy).  They may offer us treaties, but we will know better.   We know that “trickledown economics” is more trick than economical, that the disparities between the rich and poor grow as nations like BP gain international power.   That our economy is not dependent on this particular arrangement any more than the US was to Britain – economy is fluid, elastic, stretching and snapping as values pull it in different directions.  It will adapt.  Instead of feeding the insatiable appetite of the BP elite, we can nurture the visionaries of our future, like Martin Luther turning over the Bible to the masses, repealing patent-sanctity and making medical access as public as it should be!

History, as it tends, has repeated itself.  But if we take care, take notice, and take action, the story of colonization will cycle through to the coup we require.  Our health is too valuable to leave in the hands of a nation that, like other BPs before it, will be all to ready to make an irreparable mess, say oops, and cash in early retirement while those whose lives have been tarred struggle to clean up the spill.

would not a rose by any other name smell as swe...aty?

once upon the time (and by that i mean "in the 80s") the world's poorest countries were call the Third World.  canada was a First World country, and like all of the other popular countries it loved going to the mall, chewing bubble gum, and  feeling sorry for the Third World - especially when those foster parents plan commercials interrupted The Fresh Prince of Belair - but mostly we just really liked our nikes.  this phrase, however, went out of vogue when someone came along and said, "uh, 'First World?'  doesn't that imply that you richie mcrichipants think you're better than everyone else?"  to which the wealthy nations said "well, of cour--- i mean no!  no, not at all.  slip of the tongue.  Two-Thirds World, we meant to say.  because 66% of the planet is poor... get it??  go team poverty!"  this expression was clumsy and, let's be honest, no one likes fractions.  so, it didn't last long.  in the optimism of the 90s we started to call the poor nations "developing."  it seemed hopeful, full of promise, whole countries budding tiny breasts!  the wealthy countries were called "developED."  we're done growing, thank you very much and frankly if north american boobs get any bigger they will be visible from space.  that same guy from the 80s was like "yeah but isn't it a little arrogant to suggest that you're all grown up?  sounds like you don't think you have anything left to learn?"  and the powerful nations states said "uh huh," and blinked.  and the guy suggested that they think of something better at least until they could understand his remark.  they had a big meeting and someone suggested "the expendable nations" but no one could spell that and besides, it didn't work well with Tears for Fears lyrics.  "hobos" was stricken from the list - it was copyrighted by the Littlest.  the group was stymied.  it was important to label the poor countries properly; everyone remembered the whole 'Indians' debacle and didn't want to be caught with their maps down again.  "what is the real difference between Us and Them?" the chair of the meeting inquired.  i suspect it goes without saying that none of Them were invited to the meeting, after all, and since none of Us knew much of anything about Them, this question was a stumper.  "wellllll..." someone offered.  "they're poor.  and we're not."  ahhhh, the group sighed.  too true, too true.

an acronym was born that day.  LMIC.   i know what you're thinking.  it sounds like a good name for a rapper.  but it stands for the new millennium catchphrase Low-to-Middle-Income-Country.  (i believe it's known on the radio as honkytonk but never mind).  alternately there are High-Income-Countries, which are paradoxically abbreviated as HIC's.

but no one really wants to be a HIC cuz that's honkytonk for sure.  and it's too easy to generate the typo HIV, and THAT was gonna cause some serious confusion!

and so a geographical term has emerged for this decade.  the North refers to the wealthy, developed nations (sorry australia) and the South refers to... everyone else (sorry everyone else).  it seemed more polite not to put so fine a point on the whole "haves and havenots" business (awkwarrrrd) and most people feel like it's a little more egalitarian.  directions on a compass aren't right or wrong, they're just relative.  just like a family (insert hearts and happy faces)

and so here i study, the north versus the south in a kind of ethicotheoretical civil war.  and i will write about these topics using the whole gamut of terminology.  i like Two-Thirds World actually for the visual reminder of inequity that it offers.  LMIC is almost as to-the-point as it gets.  and north & south encapsulate the binariness of it all.  but mostly i will use simpler words.  rich and poor, perhaps.  is that so wrong?

... probably.

hwb

men can be mothers too ...?

it was a heckuva visual.  the first (okay, only) time that i saw a man breastfeed a baby.

don't worry, i'm not going anywhere; you can re-read that sentence if you need to.

i was at a talk (i love how this verb gets turned into an "event" when a PhD is leading the conversation) a few weeks ago about birth practices and other such wizardry, when a woman at the back stood to ask a question.  i turned to see who spoke.

one row ahead, there he was - shirt wide open and chest exposed, tenderly cradling an infant.  "skin-to-skin contact" i thought, "awwwww..." i added mentally.  "funny," my brain said, "he's holding the baby as if he's nurs---"  it is not often that even my mind  is at a loss for words.  he was nursing.  a tiny feed tube ran along his chest, aligned with his nipple and disappeared, avec said nipple, into the slurping mouth of the babe.  i thought several things in sequence:

1.  oh.  my.  crap.
2.  oops knee-jerk reaction.  think rationally heather.  rational.
3.  but oh my crap!
4.  simmer down.  don't be a prude.  how is this any different than a woman nursing?
5.  ps: crap crappity crap crap?
6.  a nipple is a nipple is a nipple right?
7.  really?  you nurse anyone else's baby li'l miss interchanganip?
8.  he is clearly a very devoted father
9.  does devoted parenthood usually cause you to stare with your mouth hanging open at a perfect stranger in a crowded room?  do you even know what dr. odent is talking about now?
10.  ah crap.

that startling image stayed with me well after the talk concluded.  while i confess it left me with an unmistakable "no" feeling, i couldn't really justify it to myself.  what if the man had lost his wife during childbirth; if he and his husband had adopted an infant - either way there was a very compelling argument to be made about the connectivity of gaining nourishment via skin-to-skin contact.  given those circumstances should not a baby have access to that kind of tenderness?  i suspect that two groups of infants, both raised on breast milk, but one fed by bottle and other by flesh, would show a difference - my instinct is that the breast fed babies would fair better.  i have no data to back me up on that, but hey this is a blog - who needs data when you can have opinion?

nevertheless, i felt unnerved.  what will that child say, 13 years from now,  to reminiscences of chest feedings from daddy?  is this father self-sacrificing, bearing the inevitable brunt of crap from people like me, in order to provide loving nourishment to his child because it's in Baby's best interest?  or is he selfish, seeking attention at the expense of the child's future confusion?  in related news "is heather in any position to draw any conclusion or to validate/invalidate this man's experience in the first place?"  right.  <ahem>

keeping my conclusions to myself, how would i respond if keith had asked to chest feed our children?  if he expressed a deep longing to connect and provide in that way... what would i say?   if my brother had taken up the practice, would i try to persuade him otherwise, or defend his choice to others in an effort to protect him from the crap that is out there (and by out there i mean in here)?

what about you?  should breastfeeding be ladies first, or ladies only?

hwb

who do you think you are?

researchers can be catty.

whole articles are dedicated to poo-poo-ing someone else's theory or ideal, or simply pouting about the language with which it was conveyed.  the worst of these kinds of papers succeed only in pointing out another's philosophical shortcomings, proposing no alternatives or real suggestions aside from the academic version of "get a life."

that said, there can be illuminating critique, offering close-but-no-cigar something to actually put in its pipe and smoke.

dr. terese lysaught wrote a very compelling article about the political nature (and think germain greer here, the personal is the political etc etc) of medical research.  there is a lot of talk about resources, economics, power imbalances and culture gaps in transnational research - north american researchers are often called "mosquitos" ... they fly in, collect blood, and fly away again leaving everyone a little more itchy than they had been.  but at the end of the day, medicine (research or clinical) comes down to the experiences of individual bodies, trying to be alive.

applauding some thinkers and dismissing others, lysaught referred to a colleague, dr. rita rhodes who proposed that, like military service in some countries and jury duty in most, participation in medical research should be obligatory for all citizens.  we all stand to benefit from its discoveries, so why should we not equally contribute to its efforts?

most of the world's medical discoveries take place on north american soil.  most north american people are over the age of 30 and are middle class.  but most research is largely performed on university students or upon vulnerable populations -- institutionalized, incarcerated or impoverished people who need the system as much as it needs them.  perhaps by virtue of proximity we should discern whether university students are in fact a vulnerable population as well...?

while lysaught crouched to lay a steamer on rhodes' theories (which are extremely... extreme) i wondered if rita wasn't onto something.

what is so special about middle aged, middle class bodies that exempts them from biomedical research?  all of this effort and energy is spent belaboring the question of "how can high income countries conduct research with low income countries with SANS exploitation?"   but maybe the better question is to really examine "why are the high incomes there in the first place?"  viagra, the world's top-selling drug was tested in the "Third World."  really?  is erectile dysfunction really the issue in Uganda?

there are very good, passionate physicians who want nothing more than to create opportunities to heal, say, the HIV pandemic in africa, and they conduct their research where the disease lives.  but alongside, Big Pharma has built its barn in the developing world to cut overhead, circumvent ethical guidelines that govern research in north america, and most of all to gain access to an almost limitless source of bodies to test.  if the bodies under scrutiny were middle aged middle class (and, imagine, maybe even UPPER class!) north americans, with their compliment of self-assigned entitlements, biomedical ethics would be lightyears ahead of where it is now.  with the vast VAST majority of experimentation having been conducted on vulnerable persons, it is only the voice of advocates - first informed, then compelled and finally resourced sufficiently to speak out about mistreatment of patients/participants alike - that have driven the momentum behind bioethical change.  imagine how much faster that would have transpired if the research subjects were CEOs and CMAs and even MDs in the first place!

i haven't been a guinea pig for anything more complicated than a beep-test during psychology 101.  kind of hard to justify becoming a medical professional if i'm not willing to be a lab rat for a day.  just who do i think i am?  

who does the biomedical community think that people in the poorest countries aren't?

if i were made queen for a day, i would want to implement a new layer of ethical requirement.   researchers submit their proposals for ethics-board scrutiny, but they have never been asked to justify the locale of their learning.  but shouldn't research for a given treatment/disorder be conducted upon its target population... tested upon the persons for whom it is designed?

there are no disposable bodies in the human family.  until we can genuinely appreciate that and abandon the practice of farming vulnerable populations for inexpensive and compliant test materials there cannot BE ethical research in transnational practice.

hwb

Lysaught, MT (2009).  Docile Bodies:  Transnational Research Ethics as Biopolititcs.  Journal of Medicine and Philosophy, 34:384-408