At Harvard, a week ago:
Recap: Wednesday's Health and Human Rights Discussion
Yesterday afternoon at the Loeb Theater, Harvard hosted a forum celebrating the tenth edition of their journal Health and Human Rights. This edition is the journal's first to be presented in open-access format, meaning that anyone can read it without paying the exorbitant fees associated with most journal articles. Bostonist was in the front row as Agnes Binagwaho, Gavin Yamey, Philip Alston, and Paul Farmer (profiled as "a man who would cure the world" by Tracy Kidder) discussed the past, present, and future of global health policy.
The most compelling aspect of the discussion dealt with the dilemmas faced by doctors worldwide, and particularly in areas like sub-Saharan Africa, in instituting the best practices for treating AIDS and other serious outbreaks. Most hospitals have extremely tight budgets, forcing them to rely on free (and sometimes factually incorrect) abstracts of published research, rather than the expensive full papers. This can cause trouble: Yamey noted that one South African hospital worsened its AIDS treatment program because of erroneous information contained in the abstract of a journal article. Yamey went on to say, "removing access barriers will... share the learning of the rich with the poor and the poor with the rich." This sentiment was echoed by Binagwaho, who heads up the effort to combat AIDS in Rwanda, and noted that increased Internet availability combined with open-access publication will enable rapid implementation of new treatment techniques at the community level.
Making the case for the right to health
Dr. Binagwaho reflected on the irony of research done in developing countries that is never available to the study subjects, and she applauded efforts like PLoS and HHR Journal for working to promote access to a wider audience. In addition, she stressed the need for intellectual exchange. She saw these discussions as "necessary to make the best decisions." Citing the example of GHDonline.org, she told of the value for herself and others in executive positions to bounce ideas off of each other (for example, should children of HIV-positive parents undergo mandatory testing?) and also the value gained by including field workers in the conversation. "People at the community level may not have the theories, but they have the knowledge," she said. Finally, she outlined that the sum of these efforts, of fighting for access to health, information, and education, is to eliminate poverty.
Dr. Yamey focused on the need to change the way we look at medical publications. He points out that information is so expensive to access that patients, and many doctors and researchers, can simply not afford to survey the literature and make fully informed decisions. "Only a tiny fraction of the intended audience can read a work. This paradigm is wrong -- medical research should be a global public good." The consequences of the current model are hazardous: often, doctors and patients are forced to rely on abstracts, which convey "dangerous half-truths." Also, because researchers in the global south often have less access to literature than their counterparts in the north, a dynamic of inequality is introduced in their interactions. The world would benefit from a "knowledge commons," which would better allow research and practice efforts to "build on the shoulders of giants." Dr. Yamey was instrumental in getting the journal online in an open access format, and he applauded the journal's new format.
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