Microbicides 2004 Microbicides 200428-31 March 2004, Hilton London MetropoleThe conference42 million men, women and children worldwide were living with HIV by the end of December 2002 (source: UNAIDS), including five million newly-infected during that year alone. Another 45 million people will become infected between 2002 and 2010, unless the current transmission rates can be vastly reduced. Of the 42 million, 29.4 million live in sub-Saharan Africa and 58% of them are women. Not only are women more susceptible to HIV infection, many are powerless to insist on the use of condoms or other methods of protecting themselves. In this context, and with the knowledge that an effective HIV vaccine is unlikely to be available for several years, the need for an effective topical microbicide grows ever more urgent. 2004 should prove to be a landmark year in the field of microbicide development as the first Phase III trials of novel products are due to start – the next step along the road to making a microbicide available to the millions worldwide in desperate need of protection.The aims of the Microbicides 2004 conference are to:Report novel or innovative work in the microbicides fieldProvide updates on recent microbicides research, divided into three tracks: basic science, clinical science, and behavioural science (including public health and the microbicide marketplace)Provide a forum for the discussion of new developments in microbicide research including ethical, clinical, behavioural and methodological issuesPresent opportunities for knowledge-sharing between microbicide researchers, public-health workers and advocacy organisations.There will be an opening ceremony on the evening of Sunday 28 March at which politicians, policy makers and the international media are expected. The conference will run for a full three days, each of which will contain:Scientific overviews and presentations with plenary sessions, invited lecturers and presentations of original researchWorkshops to review issues unique to microbicides such as trial design and outcome measures, and ethical issues in the clinical trials of microbicidesPoster sessions. Focus on LondonFollowing the successful Microbicides conferences in Washington in 2000 and Antwerp in 2002, March 2004 sees the focus move to London.The venue is the Hilton Metropole Hotel, two minutes by taxi from Paddington station and the Heathrow Express, with a journey time from the airport of 15 minutes. The hotel is in walking distance of Hyde Park and London’s main shopping streets, and close to Imperial College. Accommodation will be available at the venue and other hotels in the vicinity.London in March offers a variety of diversions for out-of-conference relaxation, including sight-seeing and shopping; the arts and the theatre; and pubs, clubs and restaurants to suit every taste. Conference staff will be on hand to help delegates plan their spare time.To book your place or find out more information, e-mail info@microbicides2004.org.uk or telephone the Event Office on +44 (0) 20 7720 4411
Oral: invited speaker Oral: Track A Oral: Track B Oral: Track C Poster: Track A Poster: Track B Poster: Track C Abstract only Authors

SC-01 JUSTICE AND THE STANDARD OF CARE

Emanuel, Ezekiel J
Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda Maryland

Justice is essential to determining the standard of care for clinical research. As part of research, people cannot be denied medical services that they are entitled to, except in specific cases. This entitlement determines the kind of interventions that must be included as standard of care in research. However, what people are entitled to cannot simply be based on what services they actually receive, because this could result from injustice. Determining what they are entitled to is based upon considerations of distributive justice. Conflicts of the standard of care can be traced to conflicts in conceptions of justice.

London’s Global Egalitarianism claims that “international medical research [itself] is not morally permissible until…a more equal distribution of global resources” occurs. Thus standard of care is not even an issue, because any clinical research is currently unethical. This seems untenable for empirical reasons about the source of inequality, witness India and China, and because it would only worsen the 90-10 divide, focusing all research on diseases of the rich.

Rawls’s Law of the People’s contends that great wealth is not required for a just flourishing society, only a hospitable political culture matters, witness Kerala; most societies in the world are not so poor that they cannot become just. Thus, the duty of foreign assistance is limited to helping establish a just society; since this does not require substantial wealth, aid beyond eliminating grinding poverty is not required. Rawls’s view of justice suggests that people are entitled to what they are currently receiving, and the appropriate standard of care would be the current care people are receiving in the host country.

At the opposite pole is a radical equality view that holds that all people, regardless of country, are entitled to about the same well-being. Justice requires people to transfer their wealth as long as it can increase the well-being of others more than it decreases their own. This is a Singer type version of utilitarianism. It would mean people everywhere should be entitled to the best care available anywhere and would endorse the Declaration of Helsinki’s “best proven method” anywhere in the world view.

Finally, limited cosmopolitanism holds that we are required to create institutions that give other individuals the opportunities for a flourishing life; there is no demand for equality of well-being or resources. We need not develop a full theory of justice, but focus on justice in health alone. The well known relationship of increases in life span compared to health spending has an asymptote at $500 per person per year, provides guidance on what is necessary in health given people and opportunity to flourish. That is, the health care people are entitled to in an international order that complies with the limited cosmopolitan view of justice is the services they would get for $500 per person per year. In 1997, long course AZT cost $800 per person and would not have been the standard of care. Today, triple ARV therapy costs under $300 per year making it standard of care. This limited cosmopolitan conception of justice provides a way to both justify and operationalize the notion of highest attainable and sustainable standard of care.

Ezekiel J. Emanuel, M.D., Ph.D.
Department of Clinical Bioethics, Building 10 Room 1C118, NIH, Bethesda, Maryland 20892-1156
(Telephone) (301) 496-2429 (Fax) (301) 496-0760 (E-mail) eemanuel@nih.gov