Breaking Down Link Rot: The Chesapeake Project Legal Information Archive’s Examination of URL Stability

Ms. Rhodes explores URL stability, measured by the prevalence of link rot over a three-year period, among the original URLs for law- and policy-related materials published to the web and archived though the Chesapeake Project, a collaborative digital preservation initiative under way in the law library community. The results demonstrate a significant increase in link rot over time in materials originally published to seemingly stable organization, government, and state web sites

70 Years of Human Rights in Global Health: Drawing on a Contentious Past to Secure a Hopeful Future

The Universal Declaration of Human Rights, adopted on Dec 10, 1948, established a modern human rights foundation that has become a cornerstone of global health, central to public health policies, programmes, and practices. To commemorate the 70th anniversary of this seminal declaration, we trace the evolution of human rights in global health, linking the past, present, and future of health as a human right. This future remains uncertain. As contemporary challenges imperil continuing advancements, threatening both human rights protections and global health governance, the future will depend, as it has in the past, on sustained political engagement to realise human rights in global health

“Big” Food, Tobacco, and Alcohol: Reducing Industry Influence on Noncommunicable Disease Prevention Laws and Policies

The food, tobacco and alcohol industries have penetrated markets in low- and middle-income countries (LMICs), with a significant impact on these countries’ burden of noncommunicable diseases (NCDs). Tangcharoensathien and colleagues describe the aggressive marketing of unhealthy food, alcohol and tobacco in LMICs, as well as key tactics used by these industries to resist laws and policies designed to reduce behavioural risk factors for NCDs. This commentary expands on the recommendations made by Tangcharoensathien and colleagues for preventing or managing conflicts of interest and reducing undue industry influence on NCD prevention policies and laws, focusing on the needs of LMICs. A growing body of research proposes ways to design voluntary industry initiatives to make them more effective, transparent and accountable, but governments should also consider whether collaboration with health-harming industries is ever appropriate. More fundamentally, mechanisms for identifying, managing and mitigating conflicts of interest and reducing industry influence must be woven into – and supported by – broader governance and regulatory structures at both national and international levels

The United States\u27 Engagement in Global Tobacco Control: Proposals for Comprehensive Funding and Strategies

Tobacco use kills more people annually than HIV/AIDS, tuberculosis, and malaria combined. Unless action is taken, tobacco-related diseases will kill hundreds of millions more in coming decades, mostly in low- and middle-income countries. Beyond its effects on morbidity and mortality, tobacco use has dramatic social and economic consequences, consuming healthcare budgets, robbing families of their primary wage earners, and hindering economic development. Tobacco consumption is shifting from industrialized to developing countries, spurred by rising incomes, trade liberalization, and intensive marketing. Although Congress empowered the U.S. Food and Drug Administration to regulate tobacco domestically, the United States has failed to lead globally. The United States is among a small minority of countries that has signed, but not ratified, the World Health Organization (WHO) Framework Convention on Tobacco Control. A tiny percentage of U.S. funding for global health is dedicated to international tobacco control. U.S. trade policy has supported and enabled the industry to expand tobacco use overseas. In this Commentary, we argue for robust U.S. engagement in global tobacco control, first explaining why it is in the national interest of the United States and then suggesting a comprehensive strategy for supporting tobacco control in low- and middle-income countries

Stemming the Global Trade in Falsified and Substandard Medicines

Drug safety and quality is an essential assumption of clinical medicine, but there is growing concern that this assumption is not always correct. Poor manufacturing and deliberate fraud occasionally compromises the drug supply in the United States, and the problem is far more common and serious in low- and middle-income countries with weak drug regulatory systems. An Institute of Medicine consensus committee report identified the causes and possible solutions to the problem of falsified and substandard drugs around the world. The vocabulary people use to discuss the problem is itself a concern. The word counterfeit is often used innocuously to describe any drug that is not what it seems, but some NGOs and emerging manufacturing nations object to this term. These groups see hostility to generic pharmaceuticals in a discussion of counterfeit medicines. These groups see hostility to generic pharmaceuticals in a discussion of counterfeit medicines. Precisely speaking, a counterfeit drug infringes on a registered trademark, and trademark infringement in not necessarily a problem of public health consequence. Instead of talking broadly about counterfeit drugs, the WHO and other stakeholders should consider two main categories of drug quality problems. Falsified medicines misrepresent the product’s identity or source or both. Substandard drugs fail to meet the national specifications given in an accepted pharmacopeia or the manufacturer’s dossier. In practice, there is often considerable overlap between categories. There is considerable uncertainty about the size of the falsified and substandard drug market. Improved pharmacovigilance, especially in developing countries, give a better picture of the scope of the problem. In the United States, tighter regulatory controls on the wholesale market and a mandatory drug tracking system would improve drug safety. In developing countries, development finance organizations should invest in small- and medium-sized pharmaceutical manufacturers, and governments should use tools such as franchising, accreditation, low-interest loans, and task shifting to encourage private sector investment in drug retail. Finally, the WHO should work with stakeholders such as the UNODC and the WCO to develop an international code of practice on falsified and substandard drugs

The dilemmas of risk-sensitive development on a small volcanic island

In the Small Islands Developing State (SIDS) of St Vincent and the Grenadines in the Caribbean, the most destructive disasters in terms of human casualties have been the multiple eruptions of La Soufrière volcano situated in the north of St Vincent. Despite this major threat, people continue to live close to the volcano and national development plans do not include risk reduction measures for volcanic hazards. This paper examines the development options in volcanic SIDS and presents a number of conundrums for disaster risk management on the island of St Vincent. Improvements in monitoring of volcanic hazards and ongoing programmes to enhance communications systems and encourage community preparedness planning have increased awareness of the risks associated with volcanic hazards, yet this has not translated into more risk-informed development planning decisions. The current physical development plan in fact promotes investment in infrastructure in settlements located within the zone designated very high-hazard. However, this is not an anomaly or an irrational decision: severe space constraints in SIDS, as well as other historical social and economic factors, limit growth and options for low-risk development. Greater attention needs to be placed on developing measures to reduce risk, particularly from low-intensity hazards like ash, limiting where possible exposure to volcanic hazards and building the resilience of communities living in high-risk areas. This requires planning for both short- and longer-term impacts from renewed activity. Volcanic SIDS face multiple hazards because of their geography and topography, so development plans should identify these interconnected risks and options for their reduction, alongside measures aimed at improving personal preparedness plans so communities can learn to live with risk

The International Response to Climate Change: An Agenda for Global Health

As the international community negotiates a successor to the Kyoto Protocol of the United Nations Framework Convention on Climate Change (UNFCCC), there is new reason to hope that meaningful action might be taken to prevent devastating climate change. Even the more ambitious mitigation targets currently under negotiation, however, will not be sufficient to avoid a profound effect on the public\u27s health in coming decades, with the world\u27s poorest, most vulnerable populations bearing the disproportionate burden. The influence of historic and current emissions will be so substantial that it is imperative to reduce global emissions while at the same time preparing for the effects. Recently, the UNFCCC has begun to turn its attention to adaptation—changes to human systems to ameliorate the consequences of climate change. This Commentary proposes a new agenda for mitigation as well as adaptation approaches that emphasize the considerable health effects of climate change, which include increasingly intense and more frequent natural disasters, potential increases in vector-, food-, and water-borne infectious disease, and exacerbation of cardiovascular and respiratory disease. The effects of climate change will be experienced in every region but will disproportionately burden the global poor, exacerbating global health disparities and challenging the international community to address the inevitable questions of global social justice. Three key recommendations are proposed: (1) focus mitigation targets on broader health impacts, rather than framing climate change as a coastal issue; (2) incorporate land-use and agricultural approaches to mitigation alongside measures in the energy and transportation sectors to take advantage of co-benefits for health; and (3) fully fund adaptation projects as a global priority with an emphasis on strengthening health systems

Quantification and expert evaluation of evidence for chemopredictive biomarkers to personalize cancer treatment.

Predictive biomarkers have the potential to facilitate cancer precision medicine by guiding the optimal choice of therapies for patients. However, clinicians are faced with an enormous volume of often-contradictory evidence regarding the therapeutic context of chemopredictive biomarkers.We extensively surveyed public literature to systematically review the predictive effect of 7 biomarkers claimed to predict response to various chemotherapy drugs: ERCC1-platinums, RRM1-gemcitabine, TYMS-5-fluorouracil/Capecitabine, TUBB3-taxanes, MGMT-temozolomide, TOP1-irinotecan/topotecan, and TOP2A-anthracyclines. We focused on studies that investigated changes in gene or protein expression as predictors of drug sensitivity or resistance. We considered an evidence framework that ranked studies from high level I evidence for randomized controlled trials to low level IV evidence for pre-clinical studies and patient case studies.We found that further in-depth analysis will be required to explore methodological issues, inconsistencies between studies, and tumor specific effects present even within high evidence level studies. Some of these nuances will lend themselves to automation, others will require manual curation. However, the comprehensive cataloging and analysis of dispersed public data utilizing an evidence framework provides a high level perspective on clinical actionability of these protein biomarkers. This framework and perspective will ultimately facilitate clinical trial design as well as therapeutic decision-making for individual patients

The Taint of Torture: The Roles of Law and Policy in Our Descent to the Dark Side

Was the Bush administration’s decision to employ “enhanced interrogation techniques” a mistake of policy, a violation of law, or both? This essay responds to Philip Zelikow’s insider account of how the decision to use these techniques was reached. The author suggests that while Zelikow makes a strong case that the decision to authorize the CIA to use coercive interrogation tactics was a mistaken policy judgment, it is important not to lose sight of the fact that it was also illegal. The latter conclusion demands a different response than the former. In particular, it underscores the necessity for accountability. The author of this essay makes the case that the policy was in fact illegal, and that the nation must hold the architects of the plan accountable. He also offers brief thoughts on the legal and policy issues surrounding detention and targeted killing in the ongoing conflict with Al Qaeda, stressing that while neither is flatly impermissible in an armed conflict, accountability and democracy concerns demand greater transparency