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Tropical medicine: a brittle tool of the new imperialism (p 1087)
March 31, 2004This week's Lancet editorial is strongly critical of the way that tropical medicine remains structured on outdated colonial lines and calls for the discipline to 'resist contemporary imperialistic forces that hide under the folded veils of counterterrorism and corporate colonialism'. THE LANCET charges tropical medicine with rewriting its history to suggest that it is 'an emblem of social enlightenment, individual sacrifice, and scientific altruism', whereas it has instead 'accepted prevailing policies of colonialism, militarism, and violence'. Tropical medicine has been living through a 'century of shame'.
The editorial reflects on the contemporary problems that tropical medicine has to face, predominantly in Africa: human displacement, an emerging epidemic of non-communicable disease, collapsing health systems, the desperate need for palliative care as the tidal wave of HIV-AIDS continues, and the denial of access to vital medicines. The ability of globalisation to resolve these problems has been thwarted by unparalleled global mismanagement-namely, by undemocratic supranational agencies and undemocratic transnational corporations.
'Second, there must be a commitment to listen to local voices. At last, for example, the Global Fund to Fight AIDS, Tuberculosis, and Malaria is launching a "partnership forum" three years after opening its doors to announce yet another opaque system of rich-world patronage. Third, physicians should protest against policies that hurt efforts to improve the health of the poor, such as the discriminatory US trade embargo on science editing (see p 1160). And finally, research must be put at the heart of policy development. While we accept experimental approaches to determine the effectiveness of clinical practices (see p 1093), we too often allow ideology to govern matters of political practice.'
The editorial concludes: 'Tropical medicine is indeed changing. The intersecting lines of disease and public health are being radically redrawn. Globalisation has made us all more aware-and horrified-at the disturbing mix of indifference and intervention that is being perpetrated in all our names. Doctors must not let the starry robes of democracy conceal the flagrantly immoral project of naked imperialism now before us. We must not allow the righteous excuse of strengthening state security to sugar the poison of state violence. Tropical medicine's future remains rooted in the lives, communities, conditions, and diseases of the tropics. But its context is explicitly and urgently political, economic, and social. Is 21st century tropical medicine prepared for these, its most critical, predicaments?'
Lancet
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