Who has responsibility for access to essential medical drugs in the developing world?

L’accès aux traitements de base est un enjeu crucial pour la santé, la pauvreté et le développement. La responsabilité en matière d’accès est alors une question essentielle. Le huitième Objectif du Millénaire pour le Développement postule qu’en coopération avec les firmes pharmaceutiques, l’accès aux traitements essentiels doit être assuré. Les principales parties prenantes qui doivent engager leur responsabilité pour l’accès aux médicaments sont (1) l’industrie pharmaceutique, (2) les gouvernements, (3) la société au sens large, et (4) les individus (qu’ils soient ou non malades). Quatre approches permettent d’appréhender la responsabilité: (a) l’approche déontologique; (b) l’utilitarisme; (c) l’égalitarisme; (b) l’approche basée sur les droits de l’homme. Ces quatre arguments peuvent être utilisés pour assigner une responsabilité aux gouvernements dans l’accès aux médicaments. Le papier conclut qu’il est parfois difficile de distinguer entre ces quatre approches et qu’un « glissement-d’échelle » de la responsabilité est une voie utile pour appréhender les rôles des quatre principales parties prenantes dans l’accès aux médicaments, dépendant du pays ou de la région et de son environnement interne.Access to basic medical treatments emerges as cause and effect of health, poverty and development. Where the responsibility for improving access to essential medicines lies is, therefore, a crucial question. Millennium Development Goal (MDG) number 8, states, "In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries" (UN 1). The key stakeholders who may take responsibility for access to drugs are (1) the pharmaceutical industry, (2) governments, (3) society at large, and (4) individuals (both with and without disease). Four lenses through which responsibility can be viewed are: (a) deontological; (b) utilitarian; (c) egalitarian; and (d) human rights-based approaches. All four arguments can be used to assign responsibility for improving access to drugs to the governments, especially utilitarian and human-rights approaches. The paper concludes that it is sometimes difficult to distinguish between the four ethical approaches and that a “sliding-scale” of responsibility is the most useful way to view the roles of the four main players in access to essential drugs, depending on the country or region and its internal environment. Mots-clefs : enfants des rues, ville, travail, Cameroun, Madagasca

Liquid State Machine with Dendritically Enhanced Readout for Low-power, Neuromorphic VLSI Implementations

In this paper, we describe a new neuro-inspired, hardware-friendly readout stage for the liquid state machine (LSM), a popular model for reservoir computing. Compared to the parallel perceptron architecture trained by the p-delta algorithm, which is the state of the art in terms of performance of readout stages, our readout architecture and learning algorithm can attain better performance with significantly less synaptic resources making it attractive for VLSI implementation. Inspired by the nonlinear properties of dendrites in biological neurons, our readout stage incorporates neurons having multiple dendrites with a lumped nonlinearity. The number of synaptic connections on each branch is significantly lower than the total number of connections from the liquid neurons and the learning algorithm tries to find the best 'combination' of input connections on each branch to reduce the error. Hence, the learning involves network rewiring (NRW) of the readout network similar to structural plasticity observed in its biological counterparts. We show that compared to a single perceptron using analog weights, this architecture for the readout can attain, even by using the same number of binary valued synapses, up to 3.3 times less error for a two-class spike train classification problem and 2.4 times less error for an input rate approximation task. Even with 60 times larger synapses, a group of 60 parallel perceptrons cannot attain the performance of the proposed dendritically enhanced readout. An additional advantage of this method for hardware implementations is that the 'choice' of connectivity can be easily implemented exploiting address event representation (AER) protocols commonly used in current neuromorphic systems where the connection matrix is stored in memory. Also, due to the use of binary synapses, our proposed method is more robust against statistical variations.Comment: 14 pages, 19 figures, Journa

Disparities by Social Determinants of Health: Links Between Long COVID and Cardiovascular Disease

Long COVID has been defined by the World Health Organisation as “continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation.” Cardiovascular disease is implicated as a risk factor, concomitant condition, and consequence of long COVID. As well as heterogeneity in definition, presentation, and likely underlying pathophysiology of long COVID, disparities by social determinants of health, extensively studied and described in cardiovascular disease, have been observed in 3 ways. First, underlying long-term conditions, such as cardiovascular disease and its risk factors, are associated with incidence and severity of long COVID, and previously described socioeconomic disparities in these factors are important in exacerbating disparities in long COVID. Second, socioeconomic disparities in management of COVID-19 may themselves lead to distal disparities in long COVID. Third, there are socioeconomic disparities in the way that long COVID is diagnosed, managed, and prevented. Together, factors such as age, sex, deprivation, and ethnicity have far-reaching implications in this new postviral syndrome across its management spectrum. There are similarities and differences compared with disparities for cardiovascular disease. Some of these disparities are in fact, inequalities, that is, rather than simply observed variations, they represent injustices with costs to individuals, communities, and economies. This review of current literature considers opportunities to prevent or at least attenuate these socioeconomic disparities in long COVID and cardiovascular disease, with special challenges for research, clinical practice, public health, and policy in a new disease which is evolving

Using national electronic health records for pandemic preparedness:validation of a parsimonious model for predicting excess deaths among those with COVID-19-a data-driven retrospective cohort study

OBJECTIVES: To use national, pre- and post-pandemic electronic health records (EHR) to develop and validate a scenario-based model incorporating baseline mortality risk, infection rate (IR) and relative risk (RR) of death for prediction of excess deaths.DESIGN: An EHR-based, retrospective cohort study.SETTING: Linked EHR in Clinical Practice Research Datalink (CPRD); and linked EHR and COVID-19 data in England provided in NHS Digital Trusted Research Environment (TRE).PARTICIPANTS: In the development (CPRD) and validation (TRE) cohorts, we included 3.8 million and 35.1 million individuals aged ≥30 years, respectively.MAIN OUTCOME MEASURES: One-year all-cause excess deaths related to COVID-19 from March 2020 to March 2021.RESULTS: From 1 March 2020 to 1 March 2021, there were 127,020 observed excess deaths. Observed RR was 4.34% (95% CI, 4.31-4.38) and IR was 6.27% (95% CI, 6.26-6.28). In the validation cohort, predicted one-year excess deaths were 100,338 compared with the observed 127,020 deaths with a ratio of predicted to observed excess deaths of 0.79.CONCLUSIONS: We show that a simple, parsimonious model incorporating baseline mortality risk, one-year IR and RR of the pandemic can be used for scenario-based prediction of excess deaths in the early stages of a pandemic. Our analyses show that EHR could inform pandemic planning and surveillance, despite limited use in emergency preparedness to date. Although infection dynamics are important in the prediction of mortality, future models should take greater account of underlying conditions.</p

The developing world in The New England Journal of Medicine

BACKGROUND: Rampant disease in poor countries impedes development and contributes to growing North-South disparities; however, leading international medical journals underreport on health research priorities for developing countries. METHODS: We examined 416 weekly issues of the New England Journal of Medicine (NEJM) over an eight-year period, January 1997 to December 2004. A total of 8857 articles were reviewed by both authors. The content of each issue was evaluated in six categories: research, review articles, editorial, correspondence, book reviews and miscellaneous. If the title or abstract concerned a topic pertinent to any health issue in the developing world, the article was reviewed. RESULTS: Over the eight years covered in this study, 1997–2004, in the three essential categories of original research articles, review articles and editorials, less than 3.0 percent of these addressed health issues in the developing world. Publications relevant to DC were largely concerned with HIV and communicable diseases and constituted 135 of the 202 articles of which 63 were devoted to HIV. Only 23 articles addressed non-communicable disease in the DC and only a single article – a book review – discussed heart disease. CONCLUSION: The medical information gap between rich and poor countries as judged by publications in the NEJM appears to be larger than the gap in the funding for research. Under-representation of developing world health issues in the medical literature is a global phenomenon. International medical journals cannot rectify global inequities, but they have an important role in educating their constituencies about the global divide

Long COVID and cardiovascular disease: a learning health system approach

Cardiovascular disease is both a risk factor and potential outcome of the direct, indirect and long-term effects of COVID-19. A recent analysis in >150,000 survivors of COVID-19 demonstrates an increased 1-year risk of numerous cardiovascular diseases. Preventing and managing this new disease burden presents challenges to health systems and requires a learning health system approach