Center for History and Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, New York, USA.
Department of Clinical Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Int J Tuberc Lung Dis. 2011 Jun;15 Suppl 2:25-29. doi: 10.5588/ijtld.10.0618.
The global burden of tuberculosis (TB) demands that research be undertaken. The vulnerability of the populations most at risk for TB demands that such research be subject to ethical review to protect their rights and interests. In this brief article we cannot review the vast and important literature bearing on the ethics of clinical and epidemiological research and public health surveillance. Instead, we have focused on three questions that have been at the center of discussion and debate and which have special relevance for TB. First, we examine a question that has special bearing when wealthy nations or international organizations carry out research in poor countries: what does justice require in the post trial period? Second, we examine the question of how the principles of consent and confidentiality may require modification in record-based epidemiological research. Third, we look at the challenges posed by public health surveillance, which in many cases requires case reporting by clinicians to public health agencies. By way of conclusion, we take note of the centrality of enhancing the institutional capacities for ethical review of research in poor nations.
全球结核病（TB）负担要求开展研究。最易感染结核病的人群的脆弱性要求对这类研究进行伦理审查，以保护他们的权益。在这篇简短的文章中，我们无法对与临床和流行病学研究及公共卫生监测的伦理有关的大量重要文献进行综述。相反，我们集中讨论了三个问题，这些问题一直是讨论和辩论的中心，并且对结核病具有特殊意义。首先，我们研究了一个在富裕国家或国际组织在贫穷国家开展研究时具有特殊意义的问题：在试验后期间，正义需要什么？其次，我们研究了同意和保密原则如何可能需要在基于记录的流行病学研究中进行修改的问题。第三，我们研究了公共卫生监测带来的挑战，在许多情况下，公共卫生监测需要临床医生向公共卫生机构报告病例。最后，我们注意到加强贫困国家研究伦理审查机构能力的重要性。
