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We examine the ethical, social and regulatory barriers that may hamper research on therapeutic potential of certain controversial controlled substances like marijuana, heroin or ketamine. Hazards for individuals and society, and their potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of certain substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may hinder research on their considerable therapeutic potential. We review the surprisingly sparse literature and address the particular ethical concerns of undue inducement, informed consent, risk to participants, researchers and institutions, justice and liberty germane to the research with illicit and addictive substances. We debate the disparate research stakeholder perspectives and why they are likely to be infected with bias. We propose an empirical research agenda to provide a more evidentiary basis for ethical reasoning.

The risk of sepsis is low. The best probiotic to optimize outcomes has not yet been identified. Potential benefit for CD4 count, recurrence or management of bacterial vaginosis and diarrhea. Uncertain effect on translocation, BV treatment.

This paper analyzes data collected through focus groups of patients at an outpatient AIDS clinic at a New York medical center. Seven focus groups were conducted with 42 HIV+ patients, and verbatim transcripts of focus group sessions were analyzed through a combination of ethnographic and content analysis. We examined patients' reports of interactions with and attitudes toward their providers and attempted to define what elements in the provider-patient relationship are necessary to enable patients to become more integrally involved in the management of their illness. Participants' statements emerged as consistent with three themes: (a) dynamics of provider-to-patient communication; (b) dynamics of patient-to-provider communication; and (c) dynamics of collaboration. Each of these themes is discussed in terms of its implications for creating patient-provider relationships based on mutual-participation, and requisites for effecting meaningful patient-provider partnerships are outlined.

BackgroundApproximately 28.5 million people living with HIV are eligible for treatment (CD4<500), but currently have no access to antiretroviral therapy. Reduced serum level of micronutrients is common in HIV disease. Micronutrient supplementation (MNS) may mitigate disease progression and mortality.ObjectivesWe synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease.MethodsWe searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs.Principal FindingsFrom 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞).ConclusionsMNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV.