Neglecting to confront conflicts of interest in industry-sponsored research unfairly burdens early career researchers

As public funding shrinks, industry-sponsored research may be a remedy. But Rebecca Cassidy reports back from a workshop on how the pressure caused by scarcity of funding and conflicts of interest in certain fields falls disproportionately on early career researchers, the most vulnerable members of the higher education precariat. Those who have yet to build up the social capital which comes from publication and funding records may be faced with the choice between either accepting industry funding or leaving the field entirely

Changing understandings of HIV and AIDS through treatment interactions

The problem of HIV internationally has many wide ranging impacts on people, communities and countries’ development. In the last decade antiretroviral (ARV) treatment has emerged as the major scientific-technical solution, albeit a costly one. Access to ARV treatment is of vital importance across Africa and around the world. Resources for HIV treatment, care and support are transferred globally on a massive scale. However, how such programmes operate ‘on the ground’ in different contexts is still unclear. This research contributes to understanding the experience of the people who access such treatment programmes in different contexts. This research focuses on this gap, exploring how treatment programmes are experienced, how the availability of treatment impacts both on people’s experience of being HIV+ and how the availability of treatment may also change perceptions of what it means to be HIV+, both individually and at a societal level. This research focuses on the lives and experiences, particularly the treatment experiences, of people living with HIV in peri-urban Gambia. Low prevalence countries such as The Gambia can provide a compelling example of the ways in which meanings and understandings of HIV are created. Here, entering a field of health pluralism and fluid knowledge creation around HIV-infection, came large scale actors providing a high-profile ARV treatment programme through clinic-based medicine, and an effective de-pluralisation of the medical field in relation to HIV, inviting scrutiny of how such knowledge relations and differences are experienced. Although not anticipated at the outset of the research, in parallel the Gambia has become the locus of a major, politically-backed, ‘alternative’ AIDS treatment programme. This has thrown the personal and societal meanings of HIV into a new and sensitive context, compelling research attention into how knowledge, status and meanings around HIV are negotiated, and how people make choices amongst different treatment options

The Cognitive Ageing, Nutrition and Neurogenesis trial: Design and progress

Introduction: Cohort studies indicate that long-chain n-3 polyunsaturated fatty acids and flavonoids may improve cognition and reduce dementia risk. The neuroprotective effects of these dietary components indicate that they are likely to be additive and potentially synergistic. Methods: The Cognitive Ageing, Nutrition and Neurogenesis trial hypothesizes that an intervention comprising long-chain n-3 polyunsaturated fatty acids (docosahexaenoic acid and eicosapentaenoic acid) and cocoa flavan-3-ols (n-3 FLAV) will mitigate the cognitive decline anticipated to naturally occur over 1 year in older adults with mild cognitive impairment or subjective memory impairment. A double-blinded, placebo-controlled parallel design is used. Two hundred fifty-nine adults (aged ≥55 years) with mild cognitive impairment or subjective memory impairment were recruited and randomized to a control or n-3 FLAV group (1.5 g docosahexaenoic acid + eicosapentaenoic acid and 500 mg n-3 FLAV daily) for 12 months. Cognitive performance was measured three times over the 1-year intervention, at 0 (baseline), 3, and 12 months. The primary end point is hippocampus-sensitive cognitive function (e.g., number of false-positives on the Picture Recognition Task of the Cognitive Drug Research test battery). Secondary outcomes include additional cognitive measures, brain atrophy and blood flow (assessed by magnetic resonance imaging), vascular function, circulating biomarkers of cardiovascular and cognitive health, gut microflora speciation and metabolism, red blood cell fatty acid status, and urine flavan-3-ol metabolites. The intervention arms were matched for sex and apolipoprotein E4 status to allow retrospective exploratory analysis of the impact of these variables on response to intervention.  Results: Screening began in 2015, with all baseline visits completed in March 2017. The intervention was finished in March 2018.  Discussion: Cognitive Ageing, Nutrition and Neurogenesis aims to identify an effective diet-based intervention to prevent or delay cognitive impairment in cognitively at-risk individuals, which could ultimately contribute to a reduced population burden of dementia

Global expectations and local practices: HIV support groups in the Gambia

This paper looks at the ways that people living with HIV in the Gambia, as members of HIV support groups, engaged with the programmes available to them in this context. People living with HIV engage with the global in a variety of ways. Following Ong and Collier this paper analyses the way in which people in this context experience and negotiate with the “global assemblage” around international HIV work. This can be observed in everyday practice in the formation of networks and partnerships linking people and their activities into international structures. Using qualitative methods and a grounded theoretical approach, the research followed events around HIV treatment in the Gambia 2006–2007. Looking at the support societies and their members' struggles to gain some material support, findings show how support group members negotiated and expressed agency within the available structures. They make use of accepted frames of international action which bypass the state, presenting an internationally linked “biological citizenship” which brings associated opportunities to access resources. Through the intervention of the president and his “cure” programme, this case also illustrates that people's commitment to the value structures implicit in these funding streams may not be as strong as might be assumed. In these circumstances two alternate treatment programmes, linked to very different values, were on offer, both backed up by the powerful machinery of either the state or international funding. The negotiation by people living with HIV of these avenues through which to acquire benefits and so support and health, calls into question assumptions of a “buy in” to global ideas and values without further scrutiny of the ways in which such assemblages function in different contexts

How Corporations Shape our Understanding of Problems with Gambling and their Solutions

A collection of case studies providing interdisciplinary empirical analysis of the impact of corporations on global health and global health governance across a broad range of industrial sectors and issue areas

Women In the weighing room: gender discrimination on the thoroughbred racetrack

Women jockeys are a small minority on the thoroughbred racetrack and securesignificantly fewer racing mounts than their male counterparts. This suggests female jockeys are facing discriminatory barriers, in one of the only major professional sportswhere men and women compete against each other on equal terms. This exploratorystudy considers discriminatory barriers that exist and the effects they have on women’scomparative profile and participation in the flat racing industry. Six participants wererecruited for the study from different areas within the industry, and with at least threeyears experience. Information was derived from semi structured individual interviews. The data was analysed using discourse analysis techniques. Five main themes wereevident: a culture of sexism, including the sense that women are more nurturing;opportunities, including for women to become trainers; body shape and strength; riskand danger; industry fashion and trends. The results from this study suggest women face discrimination in horseracing onaccount of a number of factors, the three main perceived reasons are due to theirphysical strength, body shape and the tradition and history embedded within theindustry. Whilst there is a shift starting to occur where more women are coming throughin flat racing, this is slow. Participants consider that women may find these barriers andperceptions held by others difficult to overcome, which may result in their inability toachieve equality in this sport. Given the exploratory character of the study, conclusionsare tentative and we propose a number of areas for further research

Systems Thinking as a Framework for Analyzing Commercial Determinants of Health.

Policy Points: Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community. One reason is the considerable influence of the "commercial determinants of health": NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking. This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions. CONTEXT: The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health community's narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual-level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors. METHODS: Drawing on Donella Meadows's systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy. FINDINGS: Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions. CONCLUSIONS: It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges

Fair game? Producing and publishing gambling research

This brief article reviews the findings of Fair Game (2014) and discusses their implications for journals publishing gambling research. Drawing parallels with critiques in tobacco and alcohol, it adds to the growing number of voices arguing for reform of the gambling field