Ethical considerations for drug abuse epidemiological research

The mortality and morbidity caused by alcohol, tobacco and illicit drug misuse represents a significant public health burden (Ezzati et al., 2002). A key part of the public health response is the collection of epidemiological and social science data to define at-risk populations to identify opportunities for intervention and to evaluate the effectiveness of policies in preventing or treating drug misuse and drug-related harm. The systematic use of epidemiological and social science research methods to study illicit drug use is barely 40 years old in the United States and United Kingdom, which have pioneered this approach. Because of the sensitive nature of epidemiological research on illicit drug use a unique set of ethical challenges need to be explicitly addressed by the field. Although ethics guidelines have been proposed (Council for International Organizations of Medical Sciences, 1991), scholarship on the ethics of epidemiology is scant, and consensus on core values not yet achieved (Coughlin, 2000).

Ethics and health systems research in 'post'-conflict situations

Although considerable attention has been given to ethical issues related to clinical research in developing countries, in particular related to HIV therapy, there has been limited focus on health systems research, despite its increasing importance in the light of current trends in development assistance. This paper examines ethical issues related to health systems research in 'post'-conflict situations, addressing both generic issues for developing countries and those issues specific to 'post'-conflict societies, citing examples from the author's Cambodian experience. It argues that the destruction of health infrastructure results in a loss of structures and processes that would otherwise protect prospective research subjects who are part of vulnerable populations. It identifies the growth of health systems research as part of a trend towards sectoral and programmatic development assistance, the emergence of 'knowledge generation' as a form of research linked to development, and the potential for conflict where multilateral and bilateral donors are both primary funders and users of health systems research. It also examines the position of the health system researcher in relation to the sponsors of this research, and the health system being analysed.