Critical reflections on evidence, ethics and effectiveness in the management of tuberculosis: public health and global perspectives.
BACKGROUND
Tuberculosis is a major cause of morbidity and mortality globally. Recent scholarly attention to public health ethics provides an opportunity to analyze several ethical issues raised by the global tuberculosis pandemic.


CONCLUSIONS
Recently articulated frameworks for public health ethics emphasize the importance of effectiveness in the justification of public health action. This paper critically reviews the relationship between these frameworks and the published evidence of effectiveness of tuberculosis interventions, with a specific focus on the controversies engendered by the endorsement of programs of service delivery that emphasize direct observation of therapy. The role of global economic inequities in perpetuating the tuberculosis pandemic is also discussed.


CONCLUSIONS
Tuberculosis is a complex but well understood disease that raises important ethical challenges for emerging frameworks in public health ethics. The exact role of effectiveness as a criterion for judging the ethics of interventions needs greater discussion and analysis. Emerging frameworks are silent about the economic conditions contributing to the global burden of illness associated with tuberculosis and this requires remediation.
Verma
Geetika
G
Department of Psychiatry, University of Toronto, Toronto, M5T 1R8 Canada.
Upshur
Ross E G
RE
Rea
Elizabeth
E
Benatar
Solomon R
SR
D032763:Behavior Control / Q000941:ethics; D003068:Coercion; D003140:Communicable Disease Control / Q000379:methods; D003469:Culture; D003906:Developing Countries; D023801:Directly Observed Therapy / Q000941:ethics / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006806:Human Rights; D006801:Humans; D010349:Patient Compliance; D026684:Personal Autonomy; D011634:Public Health / Q000941:ethics*; D011790:Quarantine / Q000941:ethics; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy