The ethical review of medical research: a social movement to protect the interests of research subjects

This paper is based upon observations made in the United States regarding the operation of the Institutional Review Boards. Institutional Review Boards are an essential part of the American system for the ethical review of human subjects research and it is argued that their importance is due in part to the American approach to the protection of minority groups. It is important to evaluate the effectiveness of the Institutional Review Boards since a similar model is being proposed by the National Health & Medical Research Council as part of the ethical review of medical research projects conducted in Australia.     

Speech at the UN International Conference on Population,Mexico City,August, 1984

In seeking a solution to its population problem, China, as a developing socialist country, has been making unremitting efforts to develop economy while controlling the rapid growth. The objective is to control rapid population growth so that population growth may be in keeping with socioeconomic development and commensurate with utilization of natural resources and environmental protection. In the past decade, and particularly since 1979, China has made much progress in developing economy and gained remarkable successes in controlling population growth. The natural population growth rate dropped to 1.15% in 1983, from 2.089% in 1973. Living standards have improved with a gradual annual increase of per capita income. All this proves that the policy of promoting family planning to control population growth along with planned economic development is correct. In China family planning is a basic state policy. The government has advocated the practice of "1 couple, 1 child" since 1979. This does not mean that 1 couple could have 1 child only in every case. The government provides guidance for the implementation of family planning programs in the light of specific conditions such as economic developments, cultural background, population structure, and the wishes of the people in different localities. The requirements are more flexible in rural than in urban areas and more so among the people of national minorities than among the people of the Han Nationality. In rural areas, couples who have actual difficulties and want to have 2 children may have a 2nd birth with planned spacing. In carrying out its family planning program, China has consistently adhered to the principle of integrating state guidance with the masses' voluntariness. The government has always emphasized the importance of encouraging the people's own initiatives, through publicity and education, which is the key link in implementing the family planning program.     

The use of a model in long term planning—A case history

Long term planning in companies can range from the partial simplistic approach to a structured time-consuming ritual. Either extreme can bring planning into disrepute, and both reflect the lack of the proper tools of the trade. Models, by themselves, are no panacea, but properly conceived, constructed, and developed they can transform the planning process. The key to effective and practical models is use, and this can be achieved through direct management involvement on the model's development, and by making sure the model is basically simple and flexible. This article describes how such a model was constructed using a modular approach, and how it was used effectively in long term planning.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.     

Toward an assessment of the social role of rural midwives and its implication for the family planning program: an Iranian case study

An axiom of family planning programming is the importance of culturally-appropriate communicators and motivators. Traditional midwives seem ideal for this task but few studies have been done to verify this assumption by analyzing the midwife's social role as perceived by the community. 325 married women and 81 unmarried girls from a "model village" near Shiraz were interviewed by female undergraduates. 82.5% of the women are of childbearing age; 66% married before 14 years; 33% use contraception, mostly the pill, but most want large families because they expect high child mortality rates. Most of the older women are able to assist in childbirth but none, except the village's one recognized midwife, who is considered to have divine backing, will do so except in an emergency. The midwife's activities cause her to be held in low esteem by the community because 1) she has contact with a woman's sexual parts and this fact is public; 2) she has contact with vaginal excretia which are, in Islam, polluting; and 3) she is paid for her services, which labels her as a woman "without shame". The midwife is, however, widely used since women and their husbands fear the trip to the hospital and treatment by a male doctor much more than a midwife-supervised birth. The midwife in the study village had been there only 2 years and feels that she is not fully trusted. She is not consulted on birth control at all, because women expect the pill to be dispensed by doctors and consider other methods as a matter strictly between husband and wife. The midwife's role seems to complement that of the government health authorities rather than compete. The midwife's low status and circumscribed sphere of activity, the weak respect in which her advice is held and the pattern of having only 1 recognized midwife in a village at a time make the midwife a poor agent for family planning services. Her effectiveness as an agent of social change could be improved by training her in hygienic practices of childbirth and by redefining her role-relationship with the community. Studies should be done to identify the areas where traditional birth attendants are the best family planning communicators and those where that role is best left to others.