SciDev.Net

This collection of features and commentaries, published by Nature, reflects the broad spectrum of activities and opinions of members and associates of TWAS, the academy of sciences for the developing world.

With more than three dozen articles written by prominent scientists working on research or policy issues in the South, the collection examines a range of topics in science-based international development — from the relevance of subjects like mathematics or physics, to the increasing roles of biotechnology and renewable energy.

The achievements made and challenges still facing developing countries in key areas like agriculture, health, climate change and energy are also discussed. And evidence from across the South is presented to show how strengthening science can help achieve economic goals and what more is needed to ensure that knowledge and development are shared by all.

This series of commentaries and research articles — published by The Lancet, the Peking University Health Sciences Centre and the China Medical Board — addresses China's major health challenges, strategies and future. It has been produced by a group of 63 scientists from 10 countries with Chinese scientists making up two-thirds of the authors.

The research papers give scientific evidence on key health issues including the emergence and control of both infectious and chronic non-infectious diseases in China as well as the performance of China's healthcare system.

Authors of the series' commentaries further discuss a range of topical issues affecting China's health system, including the state of biomedical science and technology (see 'Progress in Chinese biomedicine a massive challenge'), medical research ethics, the lessons learnt from China's schistosomiasis control programme and the challenges the country faces in controlling HIV/AIDS.

This article examines the rising rate of antibiotic resistance, and proposes action to reverse the trend. The authors call for leadership at international and national levels, a change in the behaviour of consumers and providers, and the development of antibacterial agents to match existing public health needs.

They suggest that international bodies such as the WHO should provide coordination and resources for generating key information on the burden of antibiotic resistance, and call for individual governments to set up multidisciplinary action programmes. They also examine the methods needed to better inform the public and discuss alternative approaches to developing new antibacterials, including product development partnerships and gap analyses.

The Millennium Development Goals (MDGs) practically define health efforts in the 21st century, but they virtually ignore non-communicable diseases such as mental health, say these authors. This is despite evidence that mental health disorders are among the most important cause of sickness and disability and even premature mortality. The authors argue that tackling mental health problems will be vital to achieving the MDGs, and three in particular — eradicating poverty, reducing child mortality, and improving maternal health.

Poverty and hunger are well-recognised risk factors for mental health, but mental health also makes it harder for people to escape the hunger trap. Mothers who are depressed during pregnancy and post natally, are more likely to have underweight babies; not only that, the illness means these mothers are more likely to stop breastfeeding and less likely to ensure their children are properly immunised than mothers without depression.

The authors advocate that strengthening basic health-care systems should be holistic. For example, developing countries need more and better-trained health workers but they should not only know how to deliver babies but also how to counsel new mothers. HIV/AIDS programmes, as another example, should ensure that individuals not only have good access to antiretrovirals but also to treatment for depression if they need it.

Schizophrenia is relatively rare — affecting 1% of the world's population — but is arguably one of the most severe mental illnesses. Diagnosing and treating it can be hard enough in developed countries; the challenges are magnified in developing nations with inadequate health systems; few trained staff; and pervasive social stigma. So how best to treat it? In this debate, three psychiatrists offer their different viewpoints.

Vikram Patel, at the London School of Hygiene and Tropical Medicine, says the shortage of mental health specialists means that the most effective way of spreading the expertise around might be for non-specialist health workers or community representatives to be trained to bear the brunt of providing first-line mental health services. Saeed Farooq, at Pakistan's Lady Reading Hospital, argues that the principles of the WHO's DOTS TB programme, in which patients are given an uninterrupted supply of medication taken under close supervision, could be used to treat schizophrenia. The rationale is that missing medication for schizophrenia, which can be common given the cognitive impairment associated with the illness, has serious consequences and can lead to much higher risks of relapse. R. Thara, director of the Schizophrenia Research Foundation, Chennai, India, advocates tackling stigma by offering proper treatment. In India at least, he says, the mystification of mental illness is intensified by a lack of awareness about schizophrenia and also by "magico-religious" beliefs. Effective treatment that shows the symptoms to be an illness rather than a religious curse is the best antidote to stigma, he says.

Antibiotics are used to prevent or treat disease or to encourage growth in animals intended for human consumption. Opinion is divided over the potential of the practice to cause health problems in people. This forum presents different perspectives from human and animal medicine experts.

The remarkable variation of views indicates the complexity of the debate. For some, there is no doubt that antibiotic use in animals causes resistance in people; for others, the link is present but unclear; and for the rest, not nearly enough is known to start taking action, and they suggest monitoring the situation. All agree, though, that whether in animals or people, antibiotics should be used with caution.

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A detailed discussion paper that presents a human rights approach to intellectual property rights. The paper was submitted to the UN Committee on Economic, Social and Cultural Rights for its discussion on "The right of everyone to benefit from the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author", which took place in Geneva in November 2000.

The paper starts with the premise that the manner in which creative works, cultural heritage, and scientific knowledge are turned into property has significant human rights implications. Various international human rights instruments have enumerated the right of an author, creator, and inventor to some form of recognition and benefit from their intellectual products — including the International Covenant on Economic, Social and Cultural Rights Article 15 (1) (c).

Recent trends underscore the need for a human rights approach to intellectual property; as various economic actors rush to stake claims over creative works and forms of knowledge — for example, through the provisions of the international agreement on Trade-Related Aspects of Intellectual Property Rights — human rights are being trampled. The author warns that unless human rights advocates provide an effective intellectual and organisational counterweight to economic interests, the intellectual property landscape will be reshaped in the years ahead without adequate consideration of the impact on human rights.