Call for papers: Ethical considerations in the use of anti-retrovirals for HIV prevention

My favourite journal in my field of specialisation, Bioethics, on whose editorial board I also serve, has a spinn-off journal called Developing World Bioethics, that announces a coming special issue of potential interest to many people. This is a cross-post from Udo Schuklenk's (editor of Bioethics as well as Developing World Bioethics) Ethx Blog:

Ethical considerations in the use of anti-retrovirals for HIV prevention

Call for Papers

Evidence-based approaches to reducing sexual transmission of HIV has remained a major challenge in responding to the HIV pandemic.  The past 18 months has witnessed a substantial shift in this landscape.  Controlled trials have demonstrated that the treatment of individuals with HIV infection reduces the risk of viral transmission to uninfected sexual partners (treatment as prevention).  Additional evidence suggests the possibility of providing anti-retroviral medications to uninfected individuals may reduce the risk of acquiring HIV infection from sexual partners (PrEP— Pre-Exposure Prophylaxis).

In view of scarce resources, there will inevitably be a need to prioritize who will get anti-retroviral drugs; those who are sick, those who can transmit HIV, those at risk for acquiring HIV. Research that focuses on the balance between efficiency and equity will be involved.  Ethical frameworks for guiding decision-making at the clinical level as well as the macro social policy level will be essential.

Among the questions that will need to be discussed are:  

i.                    What rights claims can uninfected persons make for access to ARVs for prophylactic purposes when millions across the globe are dying from AIDS because they cannot access ARV treatment? 

ii.                   What moral claims can justify the provision of ARV therapy to those who do not yet clinically require treatment as a way of reducing the risks of HIV transmission?

iii.                  What normative issues are raised in making the determination that there is sufficient evidence to demonstrate the effectiveness of either PrEP or Treatment for Prevention? 

iv.                 How should the social and biological vulnerability of women to HIV infection inform discussion about the allocations of resources for either PrEP or treatment as prevention? 

v.                  If there is a risk that PrEP will increase the risk of drug resistance and compromise treatment options for those already infected, what ethical questions must be confronted? 

vi.                 What conceptions of procedural fairness and inclusiveness should shape decision making processes about these allocation decisions?

vii.                How should current research findings inform the ethics of trial design?

viii.               Given current evidence what moral issues involving the protection of research subjects should be considered in determining the extent of ancillary services and care that should be provided in prevention trials? 

This issue of Developing World Bioethics will be guest edited by Ronald Bayer (email: rb8@mail.cumc.columbia.edu) and Quarraisha Abdool Karim (email: abdoolq2@ukzn.ac.za), Mailman School of Public Health, Columbia University, New York, NY  10032  USA.

Deadline for submissions: 31 July 2012

Press release from Taylor & Francis on the New AJOB Management

Relating to my two posts yesterday on the controversy surrounding this (here and here): Today, via Twitter and Facebook, a press release from the publisher of the American Journal of Bioethics, scientific publishing giant Taylor & Francis, on the journal's new managerial arrangements has been distributed. Anyone can get it from here.

In short, T & F simply announces the new arrangement: Summer Johnson McGee and David Magnus as the new editor in chief team and states that Glenn McGee is "retiring", while advising the transfer to the new arrangements over a 2 months period (which is perfectly in order). Unsurprisingly, there is no comment whatsoever of the criticism that the new arrangement has attracted. There is, however, an attempt at an explanation of why Summer Johnson McGee is to be EiC in spite of her sharing the conflict of interest that explains Glenn McGee's resignation (due to their marriage): David Magnus demanded this arrangement for accepting himself stepping in as EiC. This explanation was commented on by John Lantos in yesterday's post. In short: if this is indeed the reason for the new arrangements it is, in extension, a worrying sign of poor judgement and undue focus on practicalities over integrity of both Magnus and Taylor & Francis.

Now, I can see the reason for wanting Summer Johnson McGee to go on with AJOB: she has been working with the journal (and it's sibling website and blog) in an executive capacity for a long time and probably know all the ropes better than most others. However, such practical reasons weigh lightly when balanced against the credibility, integrity and reputation of AJOB and it's spin-off journals. Not to belittle the competence and experience of either Glenn McGee or Summer Johnson McGee or David Magnus (should his condition for accepting to be EiC be as firm as it sounds), but these are things that can be passed on to other people where no embarrassing conflict of interest ties staining the reputation of AJOB will exist.

So I land once again in the conlusion I announced yesterday: AJOB is a fantastic achievement. But in light of the carreer choice made by Glenn McGee, to remain fantatstic it needs to completely severe all ties (except, of course, the recognition as founder and former management) - direct as well as indirect - to him – which, as things stand, includes also Summer Johnson McGee. As indicated by John Lantos, it is both surprising and rather disturbing that this is not obvious to David Magnus and the representatives of Taylor & Francis.

John Lantos resigns from the AJOB editorial board

As a direct result of the affair with regard to the American Journal of Bioethics that I discussed in my former post, John Lantos, Director of the Children's Mercy Bioethics Center and Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine, as well as Fellow of Clinical Medical Ethics at the University of Chicago, to which he belonged for over 20 years, just announced his resignation from the editorial board of AJOB via a post in the closed Facebook group Bioethics International. I've contacted John and he has given me permission to quote this post here, which I will do without further comment:

After thinking about AJOB since the story broke, here's where I stand:

As a long time supporter and admirer of the American Journal of Bioethics, a former member of the Editorial Board, and a friend of both current and former editors, it pains me to see what has happened. AJOB has been a great journal and I have been, until now, proud to be on its Editorial Board. But recent events make it clear that the journal has lost credibility in ways that tarnish not just the names of people associated with it but also the reputation of the entire field of bioethics.

To me, the key issues are not the ones of procedure that have gotten so much attention. Instead, they are issues of substance. They raise questions about the judgment of the editors and, more importantly, about the goals of the publisher. If, as we’ve been told, Taylor and Francis really asked Glenn McGee to stay on as Editor once he’d taken a job at Celltex, and if they really believed that the resulting conflicts-of-interest were manageable, one must wonder about both their judgment and their mission. Imagine that the Editor of the New England Journal took a job as Vice President at Merck, and the Mass Medical Society asked him to stay on as Editor, opining that the conflicts of interest would be manageable. One might rightly wonder, “What are these people smoking?”

An academic journal in any field, and especially in a field as value-laden as bioethics, must earn the trust of readers and writers alike. Authors need to know that reviews will be fair. Readers need to know that suggested revisions are not politically or financially motivated. The current arrangements offer no such assurance. We want to know what is really going on – and what will go on – and who will be making decisions -- when the journal decides what to publish on issues ranging from research ethics, stem cell controversies, conflicts of interest, relationships between industry and academia, innovative therapy, FDA regulation, patient deaths in clinical trials, research standards in other countries, cozy relationships between biotech companies and state governments, and a host of other issues that have direct financial implications for the new editor-in-chief and the ongoing “founding editor.” AJOB’s current policy for dealing with such conflicts is that editors “…will recuse themselves from any involvement in decisions where they have a financial or other conflicting interest.” In other words, “Shut up and trust us.” I am afraid I have lost trust.

I have, sadly, resigned from the AJOB Editorial Board. As long as the current leadership structure is in place, I will no longer submit papers to AJOB. I have withdrawn a paper that was in press and due out in March. I will discourage my colleagues from submitting papers to AJOB. I will not cite papers published in AJOB. In my opinion, the editors have failed to establish the degree of transparency that should be minimally acceptable for any journal and certainly for one charged to host a forum in which ethical evaluations are right at the center.