[afro-nets] Bulletin of the World Health Organization (BLT)

[Dieter Neuvians MD <neuvians@mweb.co.za>]

Bulletin of the World Health Organization (BLT)
-----------------------------------------------
 
Volume 82, Number 10, October 2004, 719-810
 
Available in Adobe PDF format at:
http://www.who.int/bulletin/volumes/82/10/en/


IN THIS MONTH'S BULLETIN
Special theme: Bridging the Know?Do Gap in Global Health; In-
creasing health research uptake; Applying ethical standards; De-
veloping countries need more researchers; Patented drugs vs ge-
nerics
 
Using health systems research to shape government policy
(p. 723)
 
The need to translate knowledge into action to prevent and treat 
disease is the focus of the editorial by Bjorn Melgaard. In par-
ticular, he discusses why two papers from Thailand published in 
this month?s Bulletin demonstrate the potential of good research 
to shape national health policy. The first, by Pisake Lumbiganon 
et al. (pp. 746?749), looks at how policy-makers have used re-
search findings to come up with a national antenatal programme 
that is more cost-effective than the current model. The authors 
applied the findings of a WHO antenatal care randomized trial to 
the situation in Thailand and found that a model involving fewer 
antenatal visits could be introduced in Thailand without adverse 
consequences for woman or fetus. Thailand started implementing 
the new model this year. The second paper, by Viroj Tangcharoen-
sathien et al. (pp. 750?756), examines how research into the fi-
nancing of health systems is helping policy-makers implement 
their October 2001 decision to create a universal health-care 
system in Thailand.
 
 
Bridging the gap between knowledge and action for health 
(pp. 724?731)
 
Both developed and developing countries fail to implement health 
interventions that have been shown to be cost-effective in high 
quality research studies. In their review, Andy Haines et al. 
argue that, despite a growing body of evidence on ways to im-
prove the utilization of research findings, there are several 
barriers that hinder their uptake. They conclude that research-
ers, practitioners and policy-makers should do more to promote 
the uptake of research and to translate this into evidence-based 
interventions.
 
 
Building capacity in health research in the developing world 
(pp. 764?770)
 
Not enough attention is paid in developing countries to building 
capacity in health research. This is the conclusion reached by 
Mary Ann Lansang & Rodolfo Dennis in their review of a large 
body of literature. The authors outline four ways in which de-
veloping countries could develop human resources in health re-
search: through graduate or post-graduate training, by learning 
on the job, through institutional partnerships between developed 
and developing countries and through efforts to create out-
standing research groups at national and international level. 
They conclude that, in addition to providing funds for the re-
search itself, countries must invest more in human resources to 
build up their health research systems capacity.
 
 
Applying ethical standards to research everywhere 
(pp. 771?777)
 
Informed consent is widely regarded as a fundamental component 
of ethical conduct of research across the world. In his paper, 
Zulfiqar Bhutta argues that current guidelines on the ethical 
review and conduct of research recommend procedures for informed 
consent which are difficult to implement in developing coun-
tries. These guidelines, which are usually written, are not nec-
essarily easily understood or voluntarily adopted when drawing 
up research protocols, he concludes. Examining several examples 
of informed consent guidelines in developing countries, he makes 
general suggestions about how to improve them.
 
 
Knowledge ownership: patents in the pharma industry 
(pp. 784?787)
 
In his round table base paper, Carlos María Correa concludes 
that developing countries need to design and implement patent 
laws that prevent industry from restricting access to essential 
medicines. He argues that patents are often used to delay the 
development of generic products. John H. Barton, one of the four 
discussants, endorses Correa?s proposed changes to patent law, 
but adds that other issues also affect the balance between drug 
development incentive and access. Amir Attaran then argues that 
there is no evidence to suggest that society benefits less from 
today?s growing multiplicity of patents. Harvey E. Bale & Boris 
Azais reject Correa?s arguments, saying that his policy pre-
scription is based on an inaccurate diagnosis of the problem and 
on a flawed study. Finally, Christopher Garrison agrees with 
Correa that developing countries should pay more attention to 
their patent examination and granting procedures.
 
 
Contemporary view of 1753 Treatise of the scurvy 
(pp. 791?792)
 
Iain Milne & Iain Chalmers look at how James Lind?s 1753 ground-
breaking paper entitled ?A treatise of the scurvy? helped to 
change the public health policy of his day and, in turn, improve 
public health. The authors describe how the Scottish naval sur-
geon recognized that there was widespread confusion over the di-
agnosis, prevention and cure of scurvy in the eighteenth century 
and how he sought to fill the knowledge gap with his paper. They 
review Lind?s clinical experiments, methodology and conclusions 
as well as the effect of his work: within two years of ordering 
more generous provision of lemon juice scurvy had virtually dis-
appeared from the ranks of the Royal Navy.
 
 
MDG goals unlikely to be attained and tackling social determi-
nants for health 
(pp. 805?807)
 
Two news features focus on this month?s theme of translating 
knowledge into action. First, Clare Nullis-Kapp reviews a series 
of interim reports which show that ­ unless something dramatic 
happens ­ the world will fall far short of most of the Millen-
nium Development Goals to reduce poverty and improve health in 
developing countries by 2015. Next, Pete Moore looks how govern-
ments have been quick to recognize that social factors are a key 
determinant of health, but few have tried to tackle the problem 
head-on.