Philosophy, ethics, and humanities in medicine : PEHM
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Philos Ethics Humanit Med · May 2011
Telemedicine in primary health: the virtual doctor project Zambia.
This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. ⋯ We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront.
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Philos Ethics Humanit Med · May 2011
CommentShould we treat depression with drugs or psychological interventions? A reply to Ioannidis.
We reply to the Ioannidis's paper "Effectiveness of antidepressants; an evidence based myth constructed from a thousand controlled trials." We disagree that antidepressants have no greater efficacy than placebo. We present the efficacy from hundreds of trials in terms of the percentage of patients with a substantial clinical response (a 50% improvement or more symptomatic reduction). This meta-analysis finds that 42-70% of depressed patients improve with drug and 21%-39% improve with placebo. ⋯ Indeed better evidence might prove it was more efficacious that originally found. We find no empirical or ethical reason why psychiatrists should not try to help depressed patients with drugs and/or with psychotherapeutic/behavioral treatments given evidence of efficacy even though our treatment knowledge has limitations. The immense suffering of patients with major depression leads to ethical, moral, professional and legal obligations to treat patients with the best available tools at our disposal, while diligently and actively monitoring for adverse effects and actively revising treatment components as necessary.