Disease, Morality and Bioethics: An Ethnographic Study of a TB Vaccine Trial Site in South Africa

This thesis offers an ethnographic account of the work of a research institute called the South African Tuberculosis Vaccines Initiative (SATVI), which has been running tuberculosis (TB) vaccine trials in the Western Cape since 2001. The chapters show that SATVI has become deeply embedded in the local socioeconomic and healthcare landscape through the ground-level conduct of its vaccine trials. However, the significance of the trials in people’s lives goes beyond providing access to resources against the backdrop of withdrawing state structures. The focus is on how the trials have become entangled in people’s attempts to craft lives that they consider to be valuable, moral and respectable in conditions that have been rendered precarious by centuries of racialised domination, control and stereotyping. The thesis firstly shows that that the post-apartheid health system has retained residues of authoritarianism through the democratic transition and that TB control focuses attention upon individual behaviour and lifestyles through the neoliberal language of ‘responsibility’. Against this backdrop, SATVI’s trials generated novel relationships and possibilities gravitating around the pursuit of the ‘greater good’ of a new TB vaccine and the bioethical ideal of the autonomous, rights-bearing ‘human subject’. Within these research relationships, participants not only felt valued, respected and included. Participants and research staff also engaged with health and wellbeing in ways that contest the common perception in the government clinics that residents are unwilling or unable to ‘take responsibly’ in matters of personal and community health. What emerges from this thesis is a moral economy surrounding trial participation that, firstly, challenges the bioethical construction of ‘vulnerability’. Secondly, it unsettles a tendency in social science research to emphasise the material dimensions of trial participation at the expense of a broader spectrum of imperatives and subject positions from which people approach and interpret medical science

The Common Link in Failures and Scandals at the World’s Leading Banks

This Article argues that both the root cause of the crisis and the route to restoring trust and confidence is to be found in ascertaining how to regulate culture across mandates, processes, and use of discretion. Part II identifies the internal and external failings of four of the most recent global banking scandals within the CEDAR matrix. Part III discusses the regulatory challenges faced when compliance serves no practical function and the consequent material risk to market integrity. This Article concludes by suggesting that it is unsustainable for regulation to be decided, implemented, and monitored at a national level. Global oversight has become an imperative to reduce the conflicts of interest that may create profitable industries, but not socially beneficial ones

The Common Link in Failures and Scandals at the World’s Leading Banks

This Article argues that both the root cause of the crisis and the route to restoring trust and confidence is to be found in ascertaining how to regulate culture across mandates, processes, and use of discretion. Part II identifies the internal and external failings of four of the most recent global banking scandals within the CEDAR matrix. Part III discusses the regulatory challenges faced when compliance serves no practical function and the consequent material risk to market integrity. This Article concludes by suggesting that it is unsustainable for regulation to be decided, implemented, and monitored at a national level. Global oversight has become an imperative to reduce the conflicts of interest that may create profitable industries, but not socially beneficial ones

Opening up ‘fever’, closing down medicines

Rising concerns about antimicrobial resistance have sparked a renewed push to rationalise and ration the use of medicines. This article explores the case of the Integrated Management of Childhood Illness (IMCI) guideline, a periodically updated ‘global’ algorithm that shapes and normalises the centrality of medicines to care in low- and middle-income countries and, increasingly, the imperative to ration them. Using ‘classification work’ as analytic frame, we firstly consider the IMCI algorithm as a blueprint for global health that classifies illnesses, patients, and care in particular ways relative to available medicines. Zooming in on this blueprint, we then offer a classificatory reading of ‘fever’ over time, tracing ‘nonmalarial fever’ from being malaria’s residual ‘other’ category to becoming increasingly legible through attention to diagnostics and antibiotic (over)use. Our reading suggests that an apparent refinement of the ‘fever’ category may concurrently entail the closing down of medicine options. This raises the possibility that an increasingly high-tech but ‘empty’ form of pharmaceuticalised care is being incidentally worked into the infrastructure of weak health systems

An Investigation of First-Year Teacher Induction Programs in Jesuit Secondary Schools within the California Province

This mixed methods study invited principals (n=5) and first-year teachers (n=25) in five Jesuit secondary schools in the California Province to participate. Online surveys and follow-up online interviews were designed to assess the degree to which the schools met 11 standards that constituted the conceptual framework for the study: (a)Program vision, goals, and institutional commitment, (b)Formation of the Ignatian educator, (c)Program administration and communication, (d)Principal engagement, (e)Program assessment, evaluation, and accountability, (f)Assessing first-year teacher practice, (g)First-year teacher professional development and learning communities, (h)Mentor role and responsibilities, selection, assignment, and assessment, (i)Mentor professional development and learning communities, (j)Focus on instructional practice, and (k)Focus on equity and universal access. Ten of the 11 standards were adapted with permission from the New Teacher Center\u27s (2011)Induction Program Standards. The second standard regarding Ignatian formation was adapted from the Jesuit Secondary Education Association\u27s (2011)Profile of an Ignatian Educator. Overall, the study revealed that all five schools developed and implemented some form of an induction program for their first-year teachers during the 2012-2013 academic year. The perception data indicated that all five schools demonstrated a strong commitment to (b)Formation of the Ignatian educator. In contrast, the respondents reported the most need for growth in (e)Program assessment, evaluation, and accountability. The respondents showed modest support for the remaining nine standards, indicating the potential for improvement. For example, first-year teachers reported the need for the presence of mentor teachers who play a supportive role throughout the academic year. The results of this study invite administrators in Jesuit secondary schools to develop and implement robust first-year teacher induction programs

Deferred Prosecutions in the Corporate Sector: Lessons from LIBOR

Since 2008, the global economic downturn has significantly in-creased operating pressures on major corporations. Additionally, there has been a corresponding increase in corporate tolerance for corruption, which has coincided with a marked preference by regulators in settling, rather than litigating, enforcement actions. This Article argues that the expansion of prosecutorial authority without appropriate accountability restraints is a major tactical and strategic error. It evaluates whether the mechanism can be made subject to effective oversight. It argues that the current frame-work in the United States is highly problematic, leading to settlements that generate newspaper headlines but not necessarily cultural change. It also runs the risk of privileging a form of enforcement that operates out-side appropriate legal safeguards. The approach canvassed by the British authorities offers only a partial improvement in this process. For negotiated prosecutions to be truly effective, they require a much firmer normative basis

Deferred Prosecutions in the Corporate Sector: Lessons from LIBOR

Since 2008, the global economic downturn has significantly in-creased operating pressures on major corporations. Additionally, there has been a corresponding increase in corporate tolerance for corruption, which has coincided with a marked preference by regulators in settling, rather than litigating, enforcement actions. This Article argues that the expansion of prosecutorial authority without appropriate accountability restraints is a major tactical and strategic error. It evaluates whether the mechanism can be made subject to effective oversight. It argues that the current frame-work in the United States is highly problematic, leading to settlements that generate newspaper headlines but not necessarily cultural change. It also runs the risk of privileging a form of enforcement that operates out-side appropriate legal safeguards. The approach canvassed by the British authorities offers only a partial improvement in this process. For negotiated prosecutions to be truly effective, they require a much firmer normative basis