Asunto(s)
Investigación Biomédica/ética , Ética en Investigación , Radiografía Intervencional/ética , Radiología Intervencionista/ética , Conflicto de Intereses , Difusión de Innovaciones , Sector de Atención de Salud/ética , Humanos , Consentimiento Informado/ética , Seguridad del Paciente , Asociación entre el Sector Público-Privado/ética , Radiografía Intervencional/efectos adversos , Revelación de la Verdad/éticaRESUMEN
In the ambitious new book The Perils of Partnership: Industry Influence, Institutional Integrity, and Public Health, Jonathan Marks argues that far too much baggage is being piled on an old workhorse, conflict of interest. It's an important concept, he asserts, but public-sector actors can transgress their ethical obligations even when their relations with industry don't create conflicts of interest. Yet policy-makers have been immersed in public-private partnerships for so long that they do not see the broader implications of such relationships. Marks aims to move the discourse from reassuring terms like "engagement" and "inclusiveness" to concepts that capture the problematic side of the liaisons, like "webs of influence" and "agenda distortion." Above all, he issues a challenge to public health policy-makers: Ditch the comfortable hand-in-hand industry relationships, which prioritize efficacy over ethics, threatening both the public's health and the integrity of public health institutions. Adopt instead a paradigm that is "mano a mano," involving tension, struggle, and, at times, direct conflict with private industry.
Asunto(s)
Relaciones Interinstitucionales , Salud Pública , Asociación entre el Sector Público-Privado/ética , Conflicto de Intereses , Humanos , Política PúblicaAsunto(s)
Compensación y Reparación/ética , Conflicto de Intereses , Radiografía Intervencional/ética , Radiólogos/ética , Revelación de la Verdad/ética , Difusión de Innovaciones , Humanos , Relaciones Interinstitucionales , Relaciones Médico-Paciente/ética , Formulación de Políticas , Guías de Práctica Clínica como Asunto , Asociación entre el Sector Público-Privado/ética , Radiografía Intervencional/economía , Radiólogos/economía , ConfianzaRESUMEN
Families of children with diabetes increasingly obtain health information from a variety of sources. Doctor-patient relationships have accordingly become more fluid and dynamic with input from other parties. These outside parties include representatives from the diabetes health care industry-industry third parties (ITPs). This review is an exploration of the ethical principles and cognitive processes involved when doctors and patients negotiate around health care practices and the role of ITPs in that dialogue. Ethical principles of conflicts of interest, beneficence (act in the best interests of the patient), non-maleficence (act so as to do no harm) and justice (act so as to allocate resources fairly or justly) are relevant considerations. Reflexive and analytic thinking and various cognitive biases also play a significant part in clinical decision making. A complex case example is analyzed to highlight a process of ethical cognition in decision making to ensure high-value care and optimal patient outcomes.
Asunto(s)
Toma de Decisiones/ética , Diabetes Mellitus Tipo 1/terapia , Industria Farmacéutica/ética , Pediatría/ética , Asociación entre el Sector Público-Privado/ética , Niño , Diabetes Mellitus Tipo 1/epidemiología , Humanos , Pediatría/métodos , Pediatría/normas , Relaciones Médico-Paciente/ética , Rol Profesional , Racionalización , Terapias en Investigación/ética , Terapias en Investigación/métodosAsunto(s)
Conflicto de Intereses , Industrias/ética , Industrias/organización & administración , Asociación entre el Sector Público-Privado/ética , Asociación entre el Sector Público-Privado/organización & administración , Apoyo a la Investigación como Asunto/organización & administración , Comités Consultivos , Sesgo , Organizaciones de Beneficencia/economía , Organizaciones de Beneficencia/organización & administración , Organización de la Financiación/organización & administración , Humanos , Industrias/economía , National Institutes of Health (U.S.)/economía , National Institutes of Health (U.S.)/organización & administración , Asociación entre el Sector Público-Privado/economía , Apoyo a la Investigación como Asunto/ética , Estados UnidosAsunto(s)
Conflicto de Intereses , National Institutes of Health (U.S.)/ética , Política Organizacional , Asociación entre el Sector Público-Privado/ética , Consumo de Bebidas Alcohólicas , Centers for Disease Control and Prevention, U.S./ética , Industria Farmacéutica , Humanos , National Institutes of Health (U.S.)/organización & administración , Trastornos Relacionados con Opioides , Apoyo a la Investigación como Asunto/ética , Apoyo a la Investigación como Asunto/normas , Estados UnidosAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Administración Financiera/organización & administración , Organización de la Financiación/economía , Malaria/prevención & control , Tuberculosis/prevención & control , Síndrome de Inmunodeficiencia Adquirida/economía , Organización de la Financiación/estadística & datos numéricos , Salud Global/ética , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Malaria/economía , Masculino , Asociación entre el Sector Público-Privado/ética , Tuberculosis/economíaRESUMEN
OBJECTIVE: In the last two decades international public-private partnerships have become increasingly important to improving public health in low- and middle-income countries. Governments realize that involving the private sector in projects for financing, innovation, development, and distribution can make a valuable contribution to overcoming major health challenges. Private-public partnerships for health can generate numerous benefits but may also raise some concerns. To guide best practice for public-private partnerships for health to maximize benefits and minimize risks, the first step is to identify potential benefits, challenges, and motives. We define motives as the reasons why private partners enter partnerships with a public partner. STUDY DESIGN: We conducted a systematic review of the literature using the PRISMA guidelines. METHOD: We reviewed the literature on the benefits and challenges of public-private partnerships for health in low- and middle-income countries provided by international pharmaceutical companies and other health-related companies. We provide a description of these benefits, challenges, as well as of motives of private partners to join partnerships. An approach of systematic categorization was used to conduct this research. RESULT: We identified six potential benefits, seven challenges, and three motives. Our main finding was a significant gap in the available academic literature on this subject. Further empirical research using both qualitative and quantitative approaches is required. From the limited information that is readily available, we conclude that public-private partnerships for health imply several benefits but with some noticeable and crucial limitations. CONCLUSION: In this article, we provide a description of these benefits and challenges, discuss key themes, and conclude that empirical research is required to determine the full extent of the challenges addressed in the literature.
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Países en Desarrollo , Cooperación Internacional , Salud Pública , Asociación entre el Sector Público-Privado/organización & administración , Conflicto de Intereses , Accesibilidad a los Servicios de Salud/economía , Humanos , Asociación entre el Sector Público-Privado/ética , Medición de Riesgo , Responsabilidad SocialRESUMEN
The engagement of the for-profit private sector in health, social and humanitarian services has become a topic of keen interest. It is particularly contentious in those instances where for-profit organizations have become recipients of public funds, and where they become key decision-makers in terms of how, and to whom, services are provided. We put forward a framework for identifying and organizing the ethical questions to be considered when contracting government services to the for-profit sector, specifically in those areas that have traditionally remained in the public or not-for-profit spheres. The framework is designed to inform both academic debate and practical decision-making regarding the acceptability, feasibility and legitimacy of for-profit organizations carrying out humanitarian work. First, we outline the importance of posing ethical questions in government contracting for-profit vs. not-for-profit organizations. We then outline five key areas to be considered before then examining the extent to which ethics concerns are warranted and how they may be safeguarded.
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Sector Privado/ética , Política Pública , Asociación entre el Sector Público-Privado/ética , Sistemas de Socorro , Contratos , Toma de Decisiones , Humanos , Organizaciones sin Fines de LucroRESUMEN
OBJECTIVES: Public-private partnerships (PPPs) are considered key elements in the development of effective health promotion. However, there is little research to back the enthusiasm for these partnerships. Our objective was to describe the diversity of visions on PPPs and to assess the links between the authors and corporations engaged in such ventures. METHODS: We reviewed the scientific literature through PubMed in order to select all articles that expressed a position or recommendation on governments and industries engaging in PPPs for health promotion. We included any opinion paper that considered agreements between governments and corporations to develop health promotion. Papers that dealt with healthcare provision or clinical preventive services and those related to tobacco industries were excluded. We classified the articles according to the authors' position regarding PPPs: strongly agree, agree, neutral, disagree and strongly disagree. We related the type of recommendation to authors' features such as institution and conflicts of interest. We also recorded whether the recommendations were based on previous assessments. RESULTS: Of 46 papers analysed, 21 articles (45.6%) stated that PPPs are helpful in promoting health, 1 was neutral and 24 (52.1%) were against such collaborations. 26 papers (57%) set out conditions to assure positive outcomes of the partnerships. Evidence for or against PPPs was mentioned in 11 papers that were critical or neutral (44%) but not in any of those that advocated collaboration. Where conflicts were declared (26 papers), absence of conflicts was more frequent in critics than in supporters (86% vs 17%). CONCLUSIONS: Although there is a lack of evidence to support PPPs for health promotion, many authors endorse this approach. The prevalence of ideas encouraging PPPs can affect the intellectual environment and influence policy decisions. Public health researchers and professionals must make a contribution in properly framing the PPP issue.
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Conflicto de Intereses , Promoción de la Salud/métodos , Asociación entre el Sector Público-Privado/ética , Asociación entre el Sector Público-Privado/normas , Conducta Cooperativa , Humanos , Salud PúblicaRESUMEN
Pharmaceutical and device manufacturers fund more than half of the medical research in the U.S. Research funding by for-profit companies has increased over the past 20 years, while federal funding has declined. Research funding from for-profit medical companies is seen as tainted by many academicians because of potential biases and prior misbehavior by both investigators and companies. Yet NIH is encouraging partnerships between the public and private sectors to enhance scientific discovery. There are instances, such as methods for improving drug adherence and post-marketing drug surveillance, where the interests of academician researchers and industry could be aligned. We provide examples of ethically performed industry-funded research and a set of principles and benchmarks for ethically credible academic-industry partnerships that could allow academic researchers, for-profit companies, and the public to benefit.
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Investigación Biomédica/economía , Industrias/economía , Apoyo a la Investigación como Asunto/economía , Benchmarking , Conflicto de Intereses , Ética en los Negocios , Humanos , Asociación entre el Sector Público-Privado/ética , Asociación entre el Sector Público-Privado/normas , Apoyo a la Investigación como Asunto/ética , Apoyo a la Investigación como Asunto/normas , Apoyo a la Investigación como Asunto/tendencias , Estados UnidosAsunto(s)
Países en Desarrollo , Salud Global/economía , Salud Global/ética , Cooperación Internacional , Asociación entre el Sector Público-Privado , Países en Desarrollo/economía , Desarrollo Económico , Humanos , Sector Privado/economía , Sector Privado/ética , Sector Privado/normas , Sector Privado/tendencias , Sector Público/economía , Sector Público/ética , Sector Público/normas , Sector Público/tendencias , Asociación entre el Sector Público-Privado/ética , Asociación entre el Sector Público-Privado/organización & administración , Asociación entre el Sector Público-Privado/normas , Asociación entre el Sector Público-Privado/tendencias , Naciones Unidas , Estados UnidosRESUMEN
Reproductive human cloning is prohibited in Hungary, as in many other countries. Therapeutic human cloning is not prohibited, just like in many other countries. Stem cell therapy is also allowed. Article III, paragraph (3) of the Hungarian basic law (constitution) strictly forbids total human cloning. Article 1 of the Additional Protocol to the Oviedo Convention, on the Prohibition of Cloning Human Beings (1998) stipulates that any intervention seeking to create a human being genetically identical to another human being, whether living or dead, is prohibited. In Hungary, according to Article 174 of the Criminal Code, total human cloning constitutes a crime. Article 180, paragraph (3) of the Hungarian Act on Health declares that embryos shall not be brought about for research purposes; research shall be conducted only on embryos brought about for reproductive purposes when this is authorized by the persons entitled to decide upon its disposal, or when the embryo is damaged. Article 180, paragraph (5) of the Hungarian Act on Health stipulates that multiple individuals who genetically conform to one another shall not be brought about. According to Article 181, paragraph (1) of the Hungarian Act on Health, an embryo used for research shall be kept alive for not longer than 14 days, not counting the time it was frozen for storage and the time period of research.
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Clonación de Organismos/legislación & jurisprudencia , Crimen , Investigaciones con Embriones/legislación & jurisprudencia , Investigación con Células Madre/legislación & jurisprudencia , Argumento Refutable , Derecho Penal , Humanos , Hungría , Asociación entre el Sector Público-Privado/ética , Asociación entre el Sector Público-Privado/legislación & jurisprudencia , Factores SocioeconómicosRESUMEN
There has been a huge expansion in the private health-care sector over the past two decades, particularly in South Asia, resulting in over 80% of patients seeking care from private health providers. Despite concerns about the quality and equity of private sector service provision, most government public health bodies recognize that the private sector reaches individuals that public institutions cannot cater to, thereby being important in moving closer to universal health coverage. Numerous initiatives have been launched and are being planned to involve private practitioners in effectively diagnosing, reporting and managing infectious diseases such as tuberculosis. However, there is a notable dearth of papers discussing which elements of private sector engagement strategies are more or less successful and the ethical issues that arise when engagement strategies are operationalized. This article brings together the authors' experiences of working on projects to engage private allopathic health providers in Pakistan, Bangladesh and India for improved tuberculosis control. Motivations of and strategies required to engage private allopathic heath providers, specifically doctors, diagnostic laboratories and pharmacies, and some of the ethical issues that arise when designing programmes for engagement are discussed.
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Sector Privado/ética , Asociación entre el Sector Público-Privado/organización & administración , Tuberculosis/prevención & control , Asia , Atención a la Salud/normas , Ética Médica , Hospitales Privados/organización & administración , Humanos , Médicos/psicología , Sector Privado/organización & administración , Asociación entre el Sector Público-Privado/ética , Cobertura Universal del Seguro de SaludAsunto(s)
Industria Farmacéutica/economía , Educación Médica Continua/economía , Pautas de la Práctica en Medicina/ética , Competencia Clínica/economía , Industria Farmacéutica/ética , Educación Médica Continua/ética , Ética Médica , Administración Financiera , Humanos , Medicina Interna/economía , Medicina Interna/educación , Pautas de la Práctica en Medicina/economía , Asociación entre el Sector Público-Privado/economía , Asociación entre el Sector Público-Privado/éticaRESUMEN
Public-private partnerships have become widespread in the pursuit of both health-related research and public health interventions--most notably, in recent measures intended to address obesity. Participants emphasize synergies between the missions or goals of the public and private partners. However, the missions usually diverge in significant ways. Consequently, these partnerships can have serious implications for the integrity of, as well as trust and confidence in, the public partners. In this article, I highlight systemic concerns presented by public-private partnerships related to food and health. These include research agenda distortion and framing effects--not least, the characterization of obesity primarily as a question of individual behavior, and the minimization or neglect of the role of food systems and other social and environmental factors on health. Prevailing analytical approaches to public-private partnerships tend to downplay or ignore these systemic effects and their ethical implications. In this article, I offer guidance intended to help actors in the public sector fulfill their mission while thinking more critically and systemically about the ethical implications of public-private partnerships.
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Conducta Alimentaria , Estado de Salud , Obesidad/terapia , Salud Pública/ética , Asociación entre el Sector Público-Privado/ética , Humanos , Obesidad/prevención & control , Estados UnidosRESUMEN
Employing mostly women and producing for major U.S. labels, Lesotho's primarily foreign-owned garment industry undertook efforts to become "sweat-free" in 2006; simultaneously, it also began producing for the Product(RED) campaign. This article explores the parameters and ethical challenges of an industry-wide, public-private partnership providing HIV prevention and treatment services in this industry. Here, HIV services are intimately bound up in emerging patterns of humanitarian consumption and the production of an ethical industry. Within this ethical production zone, all is not what it seems: Labor violations persist, workers confront occupational hazards, and an elaborate theatrics of ethical practice plays out on the factory floor during routine inspections. This article explores the place and purpose of HIV treatment in the context of such humanitarian fetishism, highlighting the uses to which worker bodies are put and the conceptions of bodily well-being that prevail in these new "moral" economies.