Health for all in an unequal world: Obligations of global bioethics

The theme of the joint 14th World Congress of Bioethics and 7th National Bioethics Conference Congress “Health for all in an unequal world: Obligations of global bioethics” is of critical relevance in the present global context. Although the world is better off in terms of improved health status of people by many measures than before, there exist colossal gaps across and within populations. Much needs to be done to respond to the lack of access to healthcare, poor quality of living and working conditions, and deteriorating quality of overall environment which affects more adversely the already deprived. We take this opportunity to make a few observations about the current status of affairs on this front, and offer brief analytical insights into the complex origins of the global health scenario characterised by disparities. We revisit the original conception of bioethics and suggest that it is well placed to respond to the current global crisis of inexorably widening disparities in health and wealth, and that global bioethics has an obligation to engage with this crisis.

IJME Fifth National Bioethics Conference: a summary report

he Fifth National Bioethics Conference (NBC) was co-hosted by St John’s National Academy of Health Sciences (SJNAHS), Bangalore; Society for Community Health Research Awareness and Action (SOCHARA), Bangalore; and Forum for Medical Ethics Society (FMES), Mumbai, which publishes the Indian Journal of Medical Ethics (IJME). The conference was held at the St John’s campus, Bangalore from December 11 to 13, 2014. The theme of the Fifth NBC was “Integrity in medical care, public health, and health research”.

Is there an elephant in the room? Boundary violations in the doctor-patient relationship in India.

An anonymous postal survey on the awareness of the occurrence of nonsexual and sexual boundary violations (NSBV and SBV) in the doctor-patient relationship in India was conducted with psychiatrists and psychologists working in the state of Karnataka in India (n=51). Though this was not designed to be a prevalence study on violations, the results suggest that both NSBV and SBV do occur and, more importantly, respondents felt that this is an area which needs urgent attention in India. There was disagreement on whether some behaviours in certain situations could be construed as NSBV in the Indian culture. Though several respondents agreed that there was a need to develop guidelines on this issue in India, there was a perception that the problem was not in the availability of guidelines but in their implementation. The ethical implications of the study are discussed.

Psychiatric presentations of vitamin B 12 deficiency.

Vitamin B12 deficiency has been implicated in various psychiatric conditions for a long time. The association could be primary, secondary to the psychiatric disorder, or even just coincidental. However, left untreated, the deficiency can delay or preclude recovery. Hence early recognition is important, especially when the traditional manifestations of B12 deficiency like anaemia, macrocytosis or spinal cord symptoms are not prominent. Three cases are presented here where vitamin B12 deficiency and psychiatric symptomatology were coexistent, and the patients recovered only on a combination of B12 supplementation and psychiatric medication.

Waist circumference correlates better with body mass index than waist-to-hip ratio in Asian Indians.

BACKGROUND: Waist circumference has been reported to be a better index of android (abdominal) obesity than waist-to-hip ratio. It is likely that the cut-off values that denote medical risk in the Caucasian population cannot be extrapolated to Asian Indians. METHODS: This was a hospital-based, cross-sectional study. Anthropometric measurements were taken in 285 subjects (207 men, mean age 37 years, range 18-76 years; and 78 women, mean age 31.5 years, range 18-69 years). The subjects comprised patients under psychiatric care as well as normal individuals. The correlation of waist circumference, hip circumference and waist-to-hip ratio with body mass Index was studied. The prevalence of abdominal obesity using waist circumference was compared to the prevalence of abdominal obesity using waist-to-hip ratio. (Both the standard and the new recommended cut-offs for Asians were used.) RESULTS: Waist circumference correlated better with body mass index than waist-to-hip ratio (in men r = 0.821 and 0.341, and in women r = 0.729 and 0.113; p < or = 0.01 ). Forty-seven per cent of overweight men and 73% of overweight women had abdominal obesity as defined by the standard waist circumference cut-offs compared to none of the men and 47% of overweight women using the waist-to-hip ratio. CONCLUSION: Waist circumference correlates better with body mass index than waist-to-hip ratio. The prevalence of abdominal obesity using waist circumference is higher than that with waist-to-hip ratio. This is especially so in Asian Indians as the new recommendations of both body mass index and waist circumference cut-offs to detect subjects at medical risk are lower in them than in Caucasians.