International Fellowship Program Vol.2


A year-end report from Peter Doshi, visiting researcher, MIT

From April, 2008 to December, 2009, I was a visiting researcher in the Center for Biomedical Ethics and Law at the University of Tokyo (CBEL). My home department is with the Program in History, Anthropology, and Science, Technology and Society at the Massachusetts Institute of Technology in the United States where I am a fourth year Ph.D. candidate studying the science and politics of public health policy.

My year and a half affiliation with CBEL was enormously helpful in allowing me to further my research on infectious disease epidemiology and policy, including carrying out fieldwork as an intern in the Japanese Ministry of Health, Labour, and Welfare and the National Institute of Infectious Diseases in Tokyo. But more than anything else, my time at the University of Tokyo allowed me to research and write, culminating in five publications.

In one article I co-authored with Professor Akira Akabayashi of CBEL, we offer an overview of Japanese Childhood Vaccination Policy. This article, due to be published later this year in the Cambridge Quarterly of Healthcare Ethics, offers a broad outline of Japanese vaccine policy and its history, and compares this policy to that in the United States. We focus on the question of how Japan has achieved what seems elusive in many other countries: high vaccination rates (an important goal of public health officials) under a completely voluntary system (a central concern of public health ethics).

In “Calibrated response to emerging infections,” (BMJ 2009;339:b3471) I discuss the sociology of epidemiological understandings of epidemics using the 2009 influenza pandemic as a case study. I argue that advances in laboratory technology have led to reactions to newly emerging infectious diseases out of proportion with the morbidity and mortality threat of the disease itself.

Subsequent to this research, I worked on a rapid and urgent Cochrane review update of the evidence base for neuraminidase inhibitors (the most famous of which is Tamiflu, a popular antiviral medication for influenza). This research had particular relevance in the context of the 2009 influenza pandemic, and was commissioned by both the UK and Australian governments. Our research (BMJ 2009;339:b5106) was part of a larger investigation carried out by the Cochrane Collaboration, the British medical journal BMJ, and the UK television program Channel 4 News. Our team found that the manufacturer of this drug has been making claims about the effectiveness of its drug that were not verifiable using open sources. There claims were rather based on unpublished data that we were unsuccessful in accessing. Given that governments spent billions of dollars stockpiling this drug over the last few years, our research raises questions about public health policies which invest in interventions for which the evidence base is not open to independent scrutiny but rather taken on trust. In addition to the Cochrane review, I wrote an analysis article (BMJ 2009;339:b5164) which explains the background of the story and discusses the possible implications to public health policy.

In an unrelated letter now accepted for publication, I wrote to the Journal of Infectious Diseases that the definition of an influenza pandemic must include some connotation of severity. This letter is in response to an historical review article by the director of the National Institute of Allergy and Infectious Diseases and colleagues which suggested that a pandemic might best be understood as an epidemic with large geographical spread. The problem with this definition, I point out, is that it implies that influenza is a pandemic each and every year, as are many illnesses such as the common cold. If the distinction between “pandemic influenza” and “seasonal influenza” is lost, I argue, what further public policy rationale exists for treating one disease any different than the other?

My year at CBEL was extremely helpful in allowing me to pursue my research and writing. Being affiliated with the University of Tokyo opened many doors that may otherwise have been closed. But what I really enjoyed was the very friendly and supportive community of scholars with broad training and research interests that make up CBEL. This interdisciplinary environment helped me think about my own research in different ways and exposed me to a wide range of literature and scholarship on issues pertinent to my studies, making for a very fun and productive year in Japan.

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