Pathways to human experimentation, 1933-1945: Germany, Japan and the United States

The history of human experimentation in the twelve years between Hitler's rise to power and the end of the Second World War is notorious in the annals of the twen- tieth century. The horrific experiments conducted at Dachau, Auschwitz, Ravens- brueck, Birkenau, and other National Socialist concentration camps reflected an extreme indifference to human life and human suffering. Unfortunately, they do not reflect the extent and complexity of the human experiments undertaken in the years between 1933 and 1945. Following the prosecution of twenty-three high-ranking National Socialist physicians and medical administrators for war crimes and crimes against humanity in the Nuremberg Medical Trial (United States v. Karl Brandt et al.), scholars have rightly focused attention on the nightmarish researches con- ducted by a small group of investigators on concentration camp inmates. Less well known are alternative pathways that brought investigators to undertake human ex- perimentation in other laboratories, settings, and nations.

The ethics of paying drug users who participate in research: a review and practical recommendations

THE PAYMENT OF RESEARCH PARTICIPANTS raises ethical and empirical questions that have special importance in addictions research involving drug-dependent participants. Despite a now large literature on human subjects payment, what is still needed is practical guidance for investigators and ethics committees. This paper reviews the literature on: current payment practices and guidelines; defining features of undue and due incentives and fair reimbursement; and the significance of risks and harms that may arise from paying drug using participants. We conclude that research payments are ethically acceptable in most circumstances of addictions research, but should be closely scrutinized in situations where these may exacerbate existing harms or create additional risks for participants and investigators. General principles, key questions and procedural options are highlighted for an applied approach to ethical research payments. Future research directions are identified.

Participation in the RACS sentinel node biopsy versus axillary clearance trial

Background: The Royal Australasian College of Surgeons (RACS) SNAC trial is a randomized controlled trial of sentinel node biopsy (SNB) versus axillary clearance (AC). It opened in May 2001 and is recruiting rapidly with good acceptance by consumers. Methods: A study of eligibility and treatment choices was conducted between November 2001 and September 2002 for women presenting with early breast cancer to 10 centres participating in the trial. Results: More than half of the 622 women (54%) were ineligible for trial entry because they had large (> 3 cm) or multicentric cancers. Participation was offered to 92% of eligible women and was taken up by 63%. The commonest reason for not participating was the desire to choose treatment rather than have it randomly allocated. Despite this there is a great acceptance of clinical trials because very few women (4% of those eligible) gave 'lack of interest in clinical trials' as the reason for non-participation. Few women who declined trial participation chose to have SNB alone (4.5% of those eligible). Conclusion: Sentinel node biopsy may become the standard of care for managing small breast cancers, but a significant number of patients will still require or choose axillary dissection. Results from large randomized trials are needed to determine the relative benefits and harms of SNB compared with AC. Surgeons must carefully discuss options for management with their patients.

Handing over the keys : Contingency, power and resistance in the context of section 3LA of the Australian Crimes Act 1914

Using the work and ideas of French theorist Michel Foucault the writer examines s 3LA of the Crimes Act, which provides law enforcement officers with power to compel a person to reveal their private encryption keys and other personal information, and concludes that such a section creates fear, redirects flow of power between law enforcement agencies and citizens, and creates resistance.

The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia

Background: In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures. Methods: Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15 - 19 years. Results: There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15 - 19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications. Conclusion: A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.

Trends in morphine prescriptions, illicit morphine use and associated harms among regular injecting drug users in Australia

This paper examines population trends in morphine prescriptions in Australia, and contrasts them with findings from annual surveys with regular injecting drug users (IDU). Data on morphine prescriptions from 1995 to 2003 were obtained from the Drug Monitoring System (DRUMS) run by the Australian Government Department of Health and Ageing. Data collected from regular IDU as part of the Australian Illicit Drug Reporting System (IDRS) were analysed (2001-2004). The rate of morphine prescription per person aged 15-54 years increased by 89% across Australia between 1995 and 2003 (from 46.3 to 85.9 mg per person). Almost half (46%) of IDU surveyed in 2004 reported illicit morphine use, with the highest rates in jurisdictions where heroin was less available. Recent morphine injectors were significantly more likely to be male, unemployed, out of treatment and homeless in comparison to IDU who had not injected morphine. They were also more likely to have injected other pharmaceutical drugs and to report injection related problems. Among those who had injected morphine recently, the most commonly reported injecting harms were morphine dependence (38%), difficulty finding veins into which to inject (36%) and scarring or bruising (27%). Morphine use and injection is a common practice among regular IDU in Australia. In some cases, morphine may be a substitute for illicit heroin; in others, it may be being used to treat heroin dependence where other pharmacotherapies, such as methadone and buprenorphine, are perceived as being unavailable or undesirable by IDU. Morphine injection appears to be associated with polydrug use, and with it, a range of problems related to drug injection. Further research is required to monitor and reduce morphine diversion and related harms by such polydrug injectors.

Drug use patterns and mental health of regular amphetamine users during a reported 'heroin drought'

Aims The present study extends the findings of a pilot study conducted among regular amphetamine users in Newcastle, NSW, in 1998. It compares key features between current participants in a state capital city (Brisbane) and a regional city (Newcastle) and between the 1998 and current Newcastle sample. Design Cross-sectional survey. Setting Brisbane and Newcastle, Australia. Participants The survey was conducted among 214 regular amphetamine users within the context of a randomized controlled trial of brief interventions for amphetamine use. Measurements Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. Findings The main findings were as follows: (i) the rate of mental health problems was high among regular amphetamine users and these problems commonly emerged after commencement of regular amphetamine use; (ii) there were regional differences in drug use with greater accessibility to a wider range of drugs in a state capital city and greater levels of injecting risk-taking behaviour outside the capital city environment; and (iii) there was a significant increase in level of amphetamine use and percentage of alcohol users, a trend for a higher level of amphetamine dependence and a significant reduction in the percentage of people using heroin and benzodiazepines among the 2002 Newcastle cohort compared to the 1998 cohort. Conclusions Further longitudinal research is needed to elucidate transitions from one drug type to another and from recreational to injecting and regular use and the relationship between drug use and mental health in prospective studies among users. Implications Intervention research should evaluate the effectiveness of interventions aimed at: preventing transition to injecting and regular use of amphetamines; toward reducing levels of depression among amphetamine users and interventions among people with severe psychopathology and personality disorders; and toward reducing the prevalence of tobacco dependence among amphetamine users.

Effects of reduction in heroin supply on injecting drug use: analysis of data from needle and syringe programmes

n early 2001 there was a dramatic decline in the availability of heroin in New South Wales (NSW), Australia, where previously heroin had been readily available at a low price and high purity.1 The decline was confirmed by Australia's strategic early warning system, which revealed a reduction in heroin supply across Australia and a considerable increase in price,2 particularly from January to April 2001. This "heroin shortage" provided a natural experiment in which to examine the effect of substantial changes in price and availability on injecting drug use and its associated harms in Australia's largest heroin market,2 a setting in which harm reduction strategies were widely used. Publicly funded needle and syringe programmes were introduced to Australia in 1987, and methadone maintenance programmes, which were established in the 1970s, were significantly expanded in 1985 and again in 1999.

Transnational organised crime and the International Criminal Court developments and debates

Limitation to jurisdiction of International Criminal Court (ICC) - proposal to strengthen the universal criminalisation of transnational organised crimes by enabling them to be prosecuted through an international authority - debate on whether existing offences under the ICC Statute encompass certain transnational organised crimes - whether the Statute should be expanded to include crimes that have been recognised in international treaties.

Effects of litter and fine root composition on their decomposition in a Rhodic Paleustalf under different land uses

Plant litter and fine roots are important in maintaining soil organic carbon (C) levels as well as for nutrient cycling. The decomposition of surface-placed litter and fine roots of wheat ( Triticum aestivum ), lucerne ( Medicago sativa ), buffel grass ( Cenchrus ciliaris ), and mulga ( Acacia aneura ), placed at 10-cm and 30-cm depths, was studied in the field in a Rhodic Paleustalf. After 2 years, = 60% of mulga roots and twigs remained undecomposed. The rate of decomposition varied from 4.2 year -1 for wheat roots to 0.22 year -1 for mulga twigs, which was significantly correlated with the lignin concentration of both tops and roots. Aryl+O-aryl C concentration, as measured by 13 C nuclear magnetic resonance spectroscopy, was also significantly correlated with the decomposition parameters, although with a lower R 2 value than the lignin concentration. Thus, lignin concentration provides a good predictor of litter and fine root decomposition in the field.

Whither the responsibility to protect? Humanitarian intervention and the 2005 World Summit

At the 2005 World Summit, the world's leaders committed themselves to the "responsibility to protect", recognizing both that all states have a responsibility to protect their citizens from genocide, war crimes, ethnic cleansing and crimes against humanity and that the UN should help states to discharge this responsibility using either peaceful means or enforcement action. This declaration ostensibly marks an important milestone in the relationship between sovereignty and human rights but its critics argue that it will make little difference in practice to the world's most threatened people. The purpose of this article is to ask how consensus was reached on the responsibility to protect, given continuing hostility to humanitarian intervention expressed by many (if not most) of the world's states and whether the consensus will contribute to avoiding future Kosovos (cases where the Security Council is deadlocked in the face of a humanitarian crises) and future Rwandas (cases where states lack the political will to intervene). It suggests that four key factors contributed to the consensus: pressure from proponents of the International Commission on Intervention and State Sovereignty, its adoption by Kofi Annan and the UN's High Level Panel, an emerging consensus in the African Union, and the American position. Whilst these four factors contributed to consensus, each altered the meaning of the responsibility to protect in important ways, creating a doctrine that many states can sign up to but that does little to prevent future Kosovos and Rwandas and may actually inhibit attempts to build a consensus around intervention in future cases.