Artemisinin-class combination therapy for malaria-unresolved ethical and technical issues.
Artemisinin-class Combination Therapy (ACT) remains the most plausible means by which the ambitious goal of halving malaria mortality by the year 2010 may be achieved. Convincing evidence of ACT efficacy in treating uncomplicated malaria now exists. ACT appears safe but most safety studies have been weak methodologically. Thus there is an acute need for sensitive ongoing pharmacovigilance. Limited availability of ACT in those countries most likely to benefit from its public health use, has resulted in allegations of 'medical malpractice' against the World Health Organization and Global Fund for AIDS, TB and malaria. The ethical principles of autonomy, sanctity of life, beneficence and justice are pertinent to the adoption of ACT as first-line therapy of uncomplicated malaria by endemic countries.
Durrheim
David N
DN
School of Public Health and Tropical Medicine, James Cook University, Townsville 4811, Australia.