Critical reflections on evidence, ethics and effectiveness in the management of tuberculosis: public health and global perspectives

BACKGROUND: Tuberculosis is a major cause of morbidity and mortality globally. Recent scholarly attention to public health ethics provides an opportunity to analyze several ethical issues raised by the global tuberculosis pandemic. DISCUSSION: Recently articulated frameworks for public health ethics emphasize the importance of effectiveness in the justification of public health action. This paper critically reviews the relationship between these frameworks and the published evidence of effectiveness of tuberculosis interventions, with a specific focus on the controversies engendered by the endorsement of programs of service delivery that emphasize direct observation of therapy. The role of global economic inequities in perpetuating the tuberculosis pandemic is also discussed. SUMMARY: Tuberculosis is a complex but well understood disease that raises important ethical challenges for emerging frameworks in public health ethics. The exact role of effectiveness as a criterion for judging the ethics of interventions needs greater discussion and analysis. Emerging frameworks are silent about the economic conditions contributing to the global burden of illness associated with tuberculosis and this requires remediation

Louise Müller e o Jogo da Filosofia Africana: Lopes, Marcos Carvalho. Louise Müller e.o. Jogo Da Filosofia Africana." In Tcholonadur: Entrevistas Sobre Filosofia Africana, edited by Marcos Carvalho Lopes, 183-95. São Carlos: Pedro & João Editores, 2023.

Louise Müller e o jogo da filosofia africana*“O conhecimento é como um baobá, nenhuma pessoa sozinha pode abraçá-lo”. Esse é um provérbio Akan que pode ser combinado com outro que diz “Que nenhuma cidade (polis) possui sozinha a verdade”. Nenhuma cidade poderia almejar a posse integral da verdade. É nesse sentido que a filósofa holandesaLouise Müller, especialista na cultura akan, tem se dedicado à filosofia africana, desenvolvendo diálogos interculturais, assim como, buscando se aprofundar nos conhecimentos de línguas e culturas africanas.Modern and Contemporary Studie

Addiction in the Light of African Values: Undermining Vitality and Community

In this article I address the question of what makes addiction morally problematic, and seek to answer it by drawing on values salient in the sub-Saharan African philosophical tradition. Specifically, I appeal to life-force and communal relationship, each of which African philosophers have at times advanced as a foundational value, and spell out how addiction, or at least salient instances of it, could be viewed as unethical for flouting them. I do not seek to defend either vitality or community as the best explanation of when and why addiction is immoral, instead arguing that each of these characteristically African values grounds an independent and plausible account of that. I conclude that both vitalism and communalism merit consideration as rivals to accounts that Western ethicists would typically make, according to which addiction is immoral insofar as it degrades rationality or autonomy, as per Kantianism, or causes pain or dissatisfaction, à la utilitarianism

Between universalism and relativism: a conceptual exploration of problems in formulating and applying international biomedical ethical guidelines

In this paper, the author attempts to explore some of the problems connected with the formulation and application of international biomedical ethical guidelines, with particular reference to Africa. Recent attempts at revising and updating some international medical ethical guidelines have been bedevilled by intractable controversies and wrangling regarding both the content and formulation. From the vantage position of relative familiarity with both African and Western contexts, and the privilege of having been involved in the revision and updating of one of the international ethical guidelines, the author reflects broadly on these issues and attempts prescribing an approach from both the theoretical and practical angles liable to mitigate, if not completely eliminate, some of the problems and difficulties

Effect of the new H2-receptor antagonist mifentidine on gastric acid secretion in the cat: comparison with cimetidine and ranitidine.

The effect of the H2-receptor antagonist mifentidine (DA 4577) was studied in conscious fistula cats in comparison with cimetidine and ranitidine. Two series of experiments were carried out. In the first, submaximal gastric secretion was induced by continuous intravenous infusion of dimaprit (a selective H2-agonist). Once a plateau of gastric secretion had been reached, antagonists were infused intravenously at increasing doses for 3 hr. Mifentidine, ranitidine, cimetidine or saline were administered in different days at random order. In the second set of experiments, equiactive doses (that is the respective ED50s calculated from the previously established dose-response curves) of all the compounds were infused during dimaprit-induced acid hypersecretion, in order to evaluate their duration of action. All the compounds inhibited acid secretion in a dose-dependent fashion. Calculated ED50s were 0.39 +/- 0.05, 0.49 +/- 0.04 and 10.13 +/- 0.33 mumol.kg-1.hr-1 for mifentidine, ranitidine and cimetidine respectively. After the infusion of the equiactives doses, the half-life (that is the time taken to return to 50% inhibition) was 76.4 +/- 14.7 min for mifentidine, 38.3 +/- 10.1 min for ranitidine and 33.6 +/- 2.9 min for cimetidine. These data demonstrate that mifentidine is a potent antisecretory compound with a duration of action longer than that of cimetidine and ranitidine