Metronomics Global Health Initiative

Powerful Ideas for Global Access to Medicines

2017-02-09T05:32:00Z

In this piece from the latest issue of the New England Journal of Medicine, Suerie Moon from the Global Health Centre, Graduate Institute of International and Development Studies, Geneva; and the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, proposes ideas to promote & facilite access to medicines in LMIC as well as new ways of delivering innovation even for HIC where the price of both old and new medicines is "rocketering".

The full text is pasted bellow and available freely on the NEJM website here
From the Global Health Centre, Graduate Institute of International and Development Studies, Geneva; and the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston.One of the few issues uniting U.S. voters in the 2016 election was outrage over the high prices of medicines. From the quadrupling of EpiPen prices to $1,000-per-pill hepatitis C treatments, from six-digit pricing of cancer drugs to the 55-fold price increase on a 62-year-old toxoplasmosis drug, the scandals keep coming. In Europe, where government involvement in price negotiations means that new drugs, diagnostics, and vaccines (“medicines”) can cost less than half their U.S. prices, there is nevertheless serious concern that yearly price increases will break health system budgets. Worldwide drug spending grew by about 9% in 2014 and 2015, outpacing both overall health expenditures and economic growth.1
But what has recently been headline news in high-income countries has long been a concern everywhere else. Whether low- and middle-income countries (LMICs) are struggling to treat millions of people living with HIV or to immunize refugee children against pneumonia, unaffordable prices mean that many people simply go without. Meanwhile, despite billions of public and private dollars invested in pharmaceutical research and development, urgent needs for new antibiotics and tools for other public health priorities go unmet. Unaffordable medicines and inadequate innovation have become global issues. Like climate change, they require new public policies and international cooperation.
Responding to concerns raised by patients and health advocates worldwide, in 2015 United Nations (UN) Secretary General Ban Ki-Moon convened a High-Level Panel on Access to Medicines led by two former heads of state, Ruth Dreifuss of Switzerland and Festus Mogae of Botswana, together with 13 international experts with wide-ranging perspectives. Even before the report was published in September 2016 (www.unsgaccessmeds.org/final-report), it had attracted an unusual degree of attention — both positive and negative — from governments, the pharmaceutical industry, and civil society. Some of the reaction, epitomized by the U.S. Chamber of Commerce statement “condemn[ing the] U.N. report attacking patents,”2 reflected a decades-old debate over the appropriate relationship between intellectual property monopolies and medicine prices. Yet the report does not generally go beyond preexisting international agreements on patents. Rather, the true source of consternation may be that it reframes the access-to-medicines challenge not only as involving prices in LMICs, but also as requiring systemic changes to the prevailing research-and-development business model for the sake of all countries. The panel then advances some powerful ideas regarding such changes.
One of those ideas is transparency. Reliable, thorough public information is not generally available on the safety, efficacy, prices, patent status, sources of investment, and costs of developing lifesaving medicines. Given its profound implications for the public interest, the drug-development system is shrouded in a disproportionate degree of secrecy. The panel recommended that governments mandate disclosure of information on various aspects of pharmaceutical development, including research-and-development costs. Depending on the information source and the methods used, estimates of the cost of developing a new drug vary by a factor of 40 or more — ranging from $92 million to $4.2 billion.3 Transparency could introduce some measure of reason and evidence into heated pricing debates, which too often deteriorate into hyperbolic claims that any interference with free-market pricing would destroy innovation. A more granular understanding of research and development could also shed light on the efficiency of the processes involved and spark debate about how society ought to appropriately compensate investment, outcomes, and risk and calibrate financial rewards to the degree of therapeutic advance offered.
Transparency is also key to another powerful idea endorsed by the panel: ensuring public return on public investment in medicine development. Drug development is a public–private enterprise, with the public investing in basic research and early-stage discovery through taxpayer funding of academic and public laboratories and then purchasing the medicines that private firms develop through insurance policies or out-of-pocket expenditures. In areas in which the market fails to offer adequate incentives for innovation — such as neglected diseases, emerging infectious diseases, or antimicrobial resistance — public funding and priority setting play an even greater role, subsidizing all stages of product development. For example, the U.S. government's Biomedical Advanced Research and Development Authority has funded private firms to develop medicines for use in potential outbreaks and has obtained approval from the Food and Drug Administration for 24 products since its founding in 2006. Transparency regarding public contributions to the research underlying a medicine could provide a foundation for tempering excessive pricing, either in advance through conditions imposed on public financing or after development through government regulation.
The report also calls for testing and implementing new business models of research and development that would build affordability into the product-development process by delinking research financing from end-product prices. Some such models have already been proven to work in not-for-profit drug-development efforts. For example, with $290 million from public funds and philanthropic contributions, the Drugs for Neglected Diseases Initiative (DNDi) put 26 candidate products into the development pipeline and brought 6 to market in 10 years; because the research costs have already been covered, DNDi's products can be sold for approximately the cost of production.4 Though there are important differences between drug development for neglected diseases and other therapeutic areas, this example offers proof of principle regarding better ways to manage public and private investments to channel research and development in the public interest.
Finally, the panel called for governments and companies to adhere to established agreements to protect access to medicines under international trade rules. For example, governments have the authority to decide when a private patent right can be set aside in the interest of public health — a right that has been reaffirmed in every relevant UN political declaration since 2001. Though the pharmaceutical industry has criticized the report as an attack on patents, the panel in fact recommended only that preexisting agreements be enforced; it did not recommend additional patent flexibilities beyond what has been agreed on for 15 years. Indeed, some panel members and civil-society organizations expressed disappointment that it did not call for a more dramatic overhaul of intellectual-property treaties.
Among the report's authors is the chief executive officer of GlaxoSmithKline (GSK), Andrew Witty, who has occasionally become a thorn in his industry's side by taking positions ahead of the curve. For example, he has called the $1 billion research-and-development price tag a myth reflecting inefficiencies rather than required costs; he expanded GSK's policy of licensing generic versions of patented medicines in some LMICs beyond HIV to include cancer; and he has endorsed new research-and-development models to combat antimicrobial resistance and pathogens of pandemic potential. His peers may wish to reexamine some of the business models advanced in the report, which could continue rewarding innovation while satisfying growing public demands for affordability and needs-driven innovation.
Given the charged politics of debates over access to medicines, I believe Secretary General Ban was courageous to convene this panel — though the report's fate in the UN system is uncertain, given that there is a new secretary general, a new U.S. president, and a new director general of the World Health Organization in 2017. Nevertheless, the panel's greatest impact may be realized not through intergovernmental talks, but by stimulating public debate over ways of reforming the research-and-development system to better serve the global public interest. The Netherlands' trade and health ministers recently echoed three panel recommendations, calling for transparency of pharmaceutical research-and-development costs, adequate public return on public investment, and testing of new business models.5
This report comes at a time when the public appetite for change is growing, the pharmaceutical industry's reputation is in the doldrums, and demand for a more equitable global trade system is building. It puts forth ideas that deserve a fair hearing in countries struggling to provide access to medicines for their people and in the boardrooms of companies with the vision to try new ways of delivering innovation. Business as usual is no longer an option.

Metronomics — an alternative P4 medicine

2016-07-21T06:48:58Z

In the last issue of Nature Reviews Clinical Oncology, the editor in Chief, Lisa Hutchinson has written an editorial on metronomics following the Metronomic@Mumbai meeting entitled : Metronomics — an alternative P4 medicine.. She proposes an alternative global version of the 4P oncology : Pragmatic, Practical, Proactive and(re)Purposed medicine.

The open access full text article is copied bellow but can also be accessed on the journal website by clicking here

In May 2016, I had the pleasure of attending the Metronomics@Mumbai conference. The advantages of metronomic scheduling of anticancer or repurposed drugs include a substantially lower treatment cost, the convenience of an oral agent, and a home-based care programme that requires minimal monitoring and supportive care compared with inpatient drug administration. Additional advantages for patients are lower toxicity and, in some cases, quite striking efficacy that exceeds that of maximum-tolerated-dose therapy. Amid the stark reality of our unsustainable global health-care systems, and articles published on an almost weekly basis in the literature about the exorbitant costs of cancer treatment, the organizers of this outstanding meeting felt it was pertinent to host this conference in a low-income or middle-income country, such as India.

The meeting kicked off with an explanation of the window-of-opportunity that some metronomic therapies provide, owing in part to their immunomodulatory and anti-inflammatory mechanisms of action. Drug repurposing in the perioperative period offers a number of unique opportunities to improve the outcome of patients with cancer, with changes as simple as using the right analgaesic during surgery to decrease post-surgical relapse. Exciting developments were presented on the promise of next-generation drug repurposing using high-throughput screening technology, as well as the timely identification of drug targets that are most suitable for drug-repurposing approaches. By harnessing 'omics' technologies and the use of knockdown experiments with small interfering RNA screens, efforts are already underway to decipher the best therapy combinations for patients.

Impressive results were discussed from a retrospective trial involving women in India with stage III or IV triple-negative breast cancer who received metronomic chemotherapy following disease relapse. Following standard cyclophosphamide, doxorubicin and 5-fluorouracil chemotherapy, patients were randomly assigned to observation or 12 weeks of maintenance with celecoxib, cyclophosphamide and cisplatin chemotherapy followed by 1 year of maintenance therapy consisting of oral daily metformin and cyclophosphamide along with weekly methotrexate. The maintenance therapy was shown to prevent relapse and significantly improve outcomes of women with this extremely difficult-to-treat cancer, and was associated with fewer toxicities than conventional regimens. Perhaps the most-striking data presented were the outcomes of a phase I trial conducted in the USA in which children with high-risk neuroblastoma were treated with difluoromethylornithine (DFMO) and etoposide. The combination was shown to be safe and well tolerated, and relapse was prevented. These children experienced an improved quality of life; moreover, extended and ongoing follow-up data demonstrate that some children are in remission. Despite these promising results, the company that provided the drug and funded the trial wanted to close the trial before the primary end point was met, as they considered the data collected were sufficient for the purposes of the trial. The parents of the children on the trial, however, decided to take control and set up their own company to produce the drug; they imported the active ingredients and worked with the FDA to get their drug approved and to continue the trial.

In a News & Views article in this issue of the journal, three of the presenters at this metronomics conference discuss fulfilling unmet needs beyond level A evidence in paediatric oncology, an area that is crying out for further progress and alternative approaches beyond our ill-defined 'standards of care'. The authors highlight that 80% of children with cancer live in low-income or middle-income countries, where the survival rate of patients with childhood cancers stagnates at around 20%. Thus, we are saving fewer than four out of 10 patients with childhood cancer, globally!

More than a decade ago, Leroy Hood coined the term 'P4 medicine' — that is, predictive, personalized, preventive, and participatory (P4) medicine. I would liken metronomic therapy with an alternative definition of P4 medicine — pragmatic, practical, proactive and (re)purposed medicine. We know that the permutations of trying to decipher the 'best' combinations of the existing and upcoming cancer drugs using our traditional trial and drug-development approaches is not only impossible in practical terms, but also prohibitive regarding cost and trial end-point measures. The cancer community has recognized the importance of capturing patient-reported outcomes and the need to pay more attention to patient toxicities. Thus, metronomics and drug repurposing is an excellent starting point to tackle the issues of cost, toxicity, practicality and efficacy — without the necessity of testing the efficacy and safety of all agents from scratch. In the new era of metronomic P4 medicine, what is there not to like?

Delivery of cancer care in rural India: Experiences of establishing a rural comprehensive cancer care facility

2015-06-25T11:34:24Z

In a recent article entitled Delivery of cancer care in rural India: Experiences of establishing a rural comprehensive cancer care facility published in the Indian J Med Paediatr Oncol , Pr Banavali from the Department of Medical Oncology, Tata Memorial Center, Mumbai, India reports an interesting experience of establishement of a a rural comprehensive cancer care facility in India.
According tp Pr Banavali, the establishment of A Model Rural Comprehensive Cancer Center should rely on 3 main principles/goals :
1) Creating health awareness about all cancers in general and specifically about oral, breast and cervical cancers;
2) Screening for precursors/early stages of cervix, breast and oral cancer among women, and oral cancer among men; and
3) Treatment of cases detected in these screening camps.

Of note, all the chemotherapy protocols used at BKLWH are developed using drugs listed on the WHO essential drug list and severral metronomic scheduling of anti-cancer therapies protocols were developed for patients with recurrent disease, which were found to be affordable and effective and were then later used in newly diagnosed cancer patients with advanced disease at presentation. Interestingly, the cost of drugs is low, but these protocols can be delivered with minimal infrastructure. Using this pilot data, some of these metronomic therapies are now being investigated in phase II/III trials at TMH.

In this article Pr Banavali aslo focusses on: Cancer Demographics in India, The Parody of Cancer Care in India, Access to Cancer Care in Rural Areas, Support Needed to Develop Rural Comprehensive Cancer Centers

You can assess the free full text here

Challenges for paediatric oncology in Africa

2013-04-10T07:20:03Z

A recent short article has been publisehd in the Lancet Oncology (Volume 14, Issue 4, Pages 279 - 281, April 2013) entitled Challenges for paediatric oncology in Africa

The authors Mhamed Harif , Fousseyni Traoré, Laila Hessissen, Claude Moreira, Jean-Jacques Atteby are all members of the GFAOP and 2 are member of MGHI

Tremendous progress has been made in cancer care for children in high-income countries, which has led to overall survival of 75—80%.1 However, 75—80% of children now live in parts of the world (low-income and most middle-income countries) where they have much less chance of being cured because of inadequate resources for treatment and care, and poor organisation.2, 3 In Africa, large areas of the continent have no available care for children with cancer. This situation reflects the difficulties faced in the building of complex and expensive cancer care programmes. Mortality in children younger than 5 years in Africa is more than 15 times higher than in Europe or North America because of infection and malnutrition.4 Political instability also has negative effects on the sustainability of health-related development programmes in the continent.
In this context, in April, 2000, physicians from France (led by Jean Lemerle) and Africa decided to work together in a joint effort to develop an infrastructure for paediatric cancer care in Africa. The resultant Groupe Franco—Africain d'Oncologie Pédiatrique (GFAOP; French—African Paediatric Oncology Group) planned to work together to adapt methods to diagnose and treat childhood cancer in Africa and to share their data in a prospective way. Six countries were initially involved: Algeria, Cameroon, Madagascar, Morocco, Senegal, and Tunisia.5 In north Africa, paediatric oncology services were already in place, but physicians in these services were asked to participate to share their experience and to put in place clinical research programmes. The first six countries were subsequently joined by Burkina Faso, Côte d'Ivoire, Mali, Mauritania, the Democratic Republic of the Congo, and Togo. Support was given to local teams to provide education, drugs, and medical supplies. Regular meetings, programme assessments, and educational programmes targeted nurses, laboratory technicians, pathologists, and paediatricians.
Patients with B-cell lymphoma and those with Wilms' tumour were the first to be enrolled. B-cell lymphoma is the most common childhood cancer in Africa and has been the subject of several GFAOP studies, which aimed either to reproduce the good results obtained in high-income countries or to test approaches designed for endemic Burkitt's lymphoma. Diagnosis of Burkitt's lymphoma is mainly based on cytology. The first series of patients were treated according to a regimen derived from the French LMB89 protocol.6 3-year overall survival from 306 enrolled patients was 61%. Notably, during these first few years, survival increased from 54% in the first year to 73% in the third year. Overall survival at 18 months was 75·2% in the north African countries, where treatment was more intensive, and 55·6% in the newly established units in the sub-Saharan countries. Besides diagnostic delay, many patients died in the initial phase of care because of metabolic disturbances and infections. Survival in the north African units was 56% before their host countries joined the GFAOP.7
The second GFAOP study into Burkitt's lymphoma was designed for sub-Saharan countries (Burkina Faso, Cameroon, Côte d'Ivoire, Mali, Madagascar, and Senegal). The primary objective was to reproduce the results reported by Hesseling and colleagues8 from Malawi, but with a less intensive regimen. Treatment consisted of 3-weekly cyclophosphamide courses with intrathecal methotrexate. A more intensive, second-line, regimen based on the LMB89 regimen6 was introduced for patients with an insufficient response during or at the end of cyclophosphamide monotherapy, or after relapse. 2-year overall survival for 178 enrolled patients (108 of whom needed to be given the second-line treatment) was 50·5%.9 Survival in patients with stage I—II disease was 75·0%. This approach showed that early rescue is a good strategy, particularly for stage I and II disease.
Wilms' tumour is a difficult cancer to treat in developing countries because of the need for different competences, including imaging, surgery, and pathology, together with a multidisciplinary approach. The GFAOP proposed a regimen based on SIOP 2001,10 with preoperative chemotherapy for all patients and postoperative treatment adapted on the basis of the extent of disease. 2-year event-free survival was 46·7% in the 32 patients from the sub-Saharan region and 86·6% in the 101 patients from north Africa during the first period (an improvement from 77·4% in the period before the GFAOP project).11, 12 The effect of radiotherapy is probably the main reason for this difference in outcome between north and sub-Saharan Africa.
The GFAOP programme has recently been extended to cover Hodgkin's lymphoma, acute lymphoblastic leukaemia, and retinoblastoma. The proposed regimen for Hodgkin's lymphoma uses chemotherapy (COPP/ABVD) alone, tailored according to disease stage. For standard-risk acute lymphoblastic leukaemia, the programme consists of three-drug induction, consolidation, intensification and maintenance, without high-dose methotrexate. A programme for non-metastatic retinoblastoma has been set up at the Bamako (Mali) unit and is being extended to other units.
The GFAOP experience shows that even in difficult economic and social contexts it is possible, as paediatric oncology teams are established and gain experience, to improve survival outcomes for many patients. The best approaches are based on local leadership and appropriate education programmes. The group has also successfully created clinical research programmes at several centres. In north African units, clinical research has been shown to be a good approach to improve the quality of care. In some countries, local and national authorities are aware of these achievements and so are more involved in the group's work. For example, in Bamako, a project to house the parents of paediatric patients with cancer is being implemented with the support of the national government and a local non-governmental organisation.
However, treated patients make up only a small proportion of children with cancer in Africa. Many children with cancer never access care, and many abandon treatment because of inadequate social support. Mortality from the toxic effects of treatment also remains high, and improvements in supportive care are needed.
The GFAOP now faces new challenges. These include the improvement of quality of care in already established units to reduce preventable morbidity and mortality, the setting up of satellite clinics to improve access to care and reduce rates of abandonment, and the opening of units in additional countries.
To achieve these objectives, the group is setting up several programmes, including projects to improve data collection by use of local data managers and the introduction of adapted patient information systems. To help to work towards the improvement of health-care provider qualifications, the GFAOP is setting up an African School of Pediatric Oncology in Marrakesh, Morocco. This school is developing programmes not only for physicians and nurses, but also for pathologists, surgeons, and technicians. To make progress in such ambitious projects, local and international support is needed.
All authors are board members of Groupe Franco—Africain d'Oncologie Pédiatrique; MH is president and LH is general secretary of the group. We declare that we have no conflicts of interest.

References
1 Gatta G, Childhood cancer survival trends in Europe: a EUROCARE Working Group study. J Clin Oncol 2005
2 Howard SC, Childhood cancer epidemiology in low-income countries. Cancer 2008
3 Ribeiro RC, Baseline status of paediatric oncology care in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study. Lancet Oncol 2008
4 World population prospects, the 2010 revision. UN Department of Economic and Social Affairs, Population Division (Population Estimates and Projections Section).
5 Lemerle J, Le traitement des cancers de l'enfant en Afrique—travaux du Groupe Franco—Africain d'Oncologie Pédiatrique. Med Trop (Mars) 2007
6 Harif M, Treatment of B-cell lymphoma with LMB modified protocols in Africa—report of the French—African Pediatric Oncology Group (GFAOP). Pediatr Blood Cancer 2008
7 Madani A, Traitement du lymphome de Burkitt de l'enfant par le protocole LMB89 à Casablanca. Bull Cancer 2005
8 Hesseling P, Intravenous high frequency cyclophosphamide plus intrathecal methotrexate for endemic Burkitt lymphoma—interim results. International Society of Paediatric Oncology, SIOP XXXVI Congress Meeting: abstracts. Pediatr Blood Cancer 2004
9 Traoré F, Cyclophosphamide monotherapy in children with Burkitt lymphoma: a study from the French—African Pediatric Oncology Group (GFAOP). Pediatr Blood Cancer 2011
10 Tournade MF, Optimal duration of preoperative therapy in unilateral and nonmetastatic Wilms' tumor in children older than 6 months: results of the Ninth International Society of Pediatric Oncology Wilms' Tumor Trial and Study. J Clin Oncol 2001
11 Moreira C, Treatment of nephroblastoma in Africa: results of the first French African Pediatric Oncology Group (GFAOP) study. Pediatr Blood Cancer 2012
12 Madani A, Treatment of Wilms tumor according to SIOP 9 protocol in Casablanca, Morocco. Pediatr Blood Cancer 2006

Treatment Abandonment is a Major Hurdle to Improving Survival in Childhood Cancer in the Developing World

2012-09-01T14:25:00Z

This is a new study published Mohammed Ramzan, Satya Prakash Yadav
and Anupam Sachdeva from the Pediatric Hematology Oncology and BMT Unit, Department of Pediatrics from the Institute of Child Health Sir Ganga Ram Hospital
in Delhi, India investigating abandonment of treatment in their center. A total of 234 out of 802 (29%) children diagnosed with cancer abandoned treatment. Refusal of treatment was noted in almost 50% (120/234) of those who abandoned therapy.
The main reasons reported by parents to explain abandonment were : the cost of treatment (60%), the distance of more than 100 km from hospital (22%), belief that cancer is incurable (22%) and girl child (9%). In this study abandonment of treatment occurred mainly during the first month.
This is very important since most articles from developing countries describe the outcome of patients who have completed therapy.

CANCER CONTROL OPPORTUNITIES IN LOW- AND MIDDLE-INCOME COUNTRIES

2012-02-19T10:01:36Z

CANCER CONTROL OPPORTUNITIES IN LOW- AND MIDDLE-INCOME COUNTRIES

by Frank A. Sloan and Hellen Gelband and the Board on Global Health has been published THE NATIONAL ACADEMIES PRESS Washington, D.C.
It provides a remarkable reveiw on this topics as well as a detailed of the situation in Malaysia and Tanzania.

The list of the chapters is copied bellow :

– Front Matter -
– Summary -
– 1 Introduction
– 2 Cancer Causes and Risk Factors and the Elements of Cancer Control
– 3 The Cancer Burden in Low- and Middle-Income Countries and How It Is Measured
– 4 Defining Resource-Level-Appropriate Cancer Control
– 5 Preventing Cancers (and Other Diseases) by Reducing Tobacco Use
– 6 Compelling Opportunities in Global Cancer Control
– 7 Palliative Care
– 8 Cancer Centers in Low- and Middle-Income Countries
– 9 Advocacy for Cancer Control
– 10 Expanding the Role of the Global Community in Cancer Control
– Appendix A Cancer Control in Malaysia and Tanzania
– Appendix B Acronyms and Abbreviations

the full text is availalbe on the National Academies press here

Repurposing Approved and Abandoned Drugs for the Treatment and Prevention of Cancer through Public-Private Partnership

2012-01-14T09:37:31Z

Repurposing Approved and Abandoned Drugs for the Treatment and Prevention of
Cancer through Public-Private Partnership

Cancer Research Commentary

Scott J. Weir, Louis J. DeGennaro, Christopher P. Austin, S

in press Cancer Research 2012

In this commentary, the authors report on the The Learning Collaborative experience.
Following a meeting gathering , leaders from industry, government, academia, and non-profit organizations which lead to the publication of a white paper : "The New Role of Academia in Drug Discovery and Development: New Thinking, New Competencies, New Results", the Learning Collaborative, was established with foccus on :
– Repurposing Drugs for the Benefit of Patients
– Building A New Academic Model
– Advances in Regulatory Science and Public Policy

While the target population is different, the conclusions of the paper is totally in line with the aims of MGHI :
"Non-traditional, dynamic partnerships, like The Learning Collaborative, allow non-profit
organizations to play a high impact role in advancing the development of new cancer drug
therapies and bringing these therapies rapidly to patients. The foundations of The Learning Collaborative model are a willingness to rely on partners for expertise, share freely, stay focused on the shared goal of translating discoveries from the lab to marketplace, and view deliverables as not only new treatments but also improvements in the processes by which those treatments are developed. The Learning Collaborative model allows the partner organizations to more effectively advance their missions to bring new therapies to the millions of patients suffering from rare cancers" .

Effect of corruption on medical care in low-income countries

2011-12-20T09:22:48Z

This is a very interesting editorial-like paper published recently in Pediatric Blood and Cancer about corruption and its impact on medical care in children with cancer living in low income countries. This topic is almost a taboo, or maybe neglected because we lack hard data. Anyhow as concluded by the authors : One cannot change what is not
acknowledged...

- Global Oncology

Pediatric oncology research in low income countries: Ethical concepts and challenges

2011-12-20T08:54:13Z

A Denburg, S Joffe, S Gupta, S Howard, R Ribeiro, F Antillon, R Vasquez, L Sung

Pediatric Blood & Cancer

Uneven strides in research and care have led to discrepancies in childhood cancer outcomes between high and low income countries (LICs). Collaborative research may help improve outcomes in LICs by generating knowledge for local scientific communities, augmenting knowledge translation, and fostering context-specific evaluation of treatment protocols. However, the risks of such research have received little attention. This paper investigates the relationship between pediatric oncology research in LICs and four core issues in the ethics literature: standard of care, trial benefits, ethics review, and informed consent. Our aims are to highlight the importance of this field and the need for further inquiry

Facing a “Slow-Motion Disaster” — The UN Meeting on Noncommunicable Diseases

2011-11-27T06:54:15Z

this is a recent editorial published in the New England Journal Of Medicien by Lisa Rosenbaum, M.D., and Daniela Lamas, M.D. following the the UN Meeting on Noncommunicable Diseases. Free full text can be found here.