South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde最新文献

{"title":"It is time to heed Solomon Benatar's call to disrupt the global research ethics paradigm.","authors":"J V Lavery, R E G Upshur, P A Singer, E M Meslin","doi":"10.7196/SAMJ.2026.v116i6b.4040","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6b.4040","url":null,"abstract":"<p><p>The history of research in low- and middle-income countries is rife with practices that have extracted the time, energy, data, biological samples and, in many cases, the health and lives of those who participated, often justified by beliefs about their racial, cultural and civilisational inferiority. As global health research expanded in the late 20th century, this history raised substantial ethical concerns, including exploitation, double standards and the broader social, economic and political contexts in which international research occurs. Although research has contributed to reductions in mortality, morbidity and poverty, its benefits continue to accrue disproportionately to the wealthiest countries, even as access to the fruits of science has been recognised as a human right. In 1999, Prof. Solomon Benatar challenged the Global Forum for Bioethics in Research to confront research as an 'extractive enterprise' and to acknowledge the need for 'a paradigm shift in thinking and action', grounded in interdependence, duties, social justice and the promotion of human flourishing. The prevailing global paradigm, shaped largely by the US Common Rule regulations, emphasises institutional accountability, standardised procedures and a protectionist focus on individual research participants through regulatory compliance. Despite its influence, it remains unclear whether this model has advanced Prof. Benatar's vision of a research enterprise that fosters inclusiveness and promotes the broader societal value of research. We outline possible shifts toward a more proactive, creative, inclusive, context-sensitive and innovative model that embraces empirical testing and global learning, with an emphasis on creating social value. These shifts reflect Prof. Benatar's lifelong commitment to moral imagination, his call to reject extractive practices and his vision of a global research enterprise that enhances human flourishing, especially for the world's most disadvantaged populations.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e4040"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The changing landscape of diagnosing HIV-associated tuberculosis.","authors":"G Maartens","doi":"10.7196/SAMJ.2026.v116i6b.3965","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6b.3965","url":null,"abstract":"<p><p>Tuberculosis is the most common cause of hospitalisation and death globally among people with HIV (PWH), even in the antiretroviral therapy era. Diagnosis of tuberculosis is challenging in PWH as bacillary load is lower in sputum and a high proportion have extrapulmonary or disseminated tuberculosis. The clinical features of tuberculosis in PWH are nonspecific and there is a wide differential diagnosis of other opportunistic infections. Tuberculosis progresses rapidly in people with advanced HIV disease, necessitating rapid diagnosis. In this narrative review, key changes are described in the diagnosis of HIV-associated tuberculosis in adults from 1990 until the present. Smear microscopy was the only rapid diagnostic test for tuberculosis until 2011, but its sensitivity is lower in PWH. Algorithms for diagnosing smear-negative tuberculosis had poor diagnostic accuracy, resulting in both underdiagnosis, which increased tuberculosis deaths, and overdiagnosis, leading to missed or delayed diagnosis of the opportunistic infections causing the symptoms. The evidence base for screening for HIV-associated tuberculosis is strong among ambulatory PWH, but screening algorithms have lower sensitivity in people on antiretroviral therapy. The development of novel rapid diagnostic tests (nucleic acid amplification tests and urine lipoarabinomannan lateral flow assay) for tuberculosis and the advent of antiretroviral therapy have dramatically changed the landscape of diagnosing HIV- associated tuberculosis, resulting in reductions in both tuberculosis incidence and deaths. Diagnostic challenges persist as none of the currently available rapid diagnostic tests have sensitivities that are ideal, and only one test (urine lipoarabinomannan detection) is both affordable and simple to perform at the point of care. Therefore, there is still a need for the development of novel, accurate and affordable point-of-care tests to improve the rapid diagnosis of HIV-associated tuberculosis.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e3965"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The University of Cape Town Department of Medicine from 1980 to 2025: 45 years of growth, transformation and rising to challenges.","authors":"G Meintjes, N Ntusi, V Burch, J Seggie, M Ntsekhe, M Setshedi","doi":"10.7196/SAMJ.2026.v116i6b.4729","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6b.4729","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e4729"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health sector reforms in South Africa: Evaluating financing models for universal health coverage in the post-apartheid era.","authors":"S Cleary, M Haji, G C Solanki","doi":"10.7196/SAMJ.2026.v116i6b.4039","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6b.4039","url":null,"abstract":"<p><p>From the Gluckman Commission's call for a universal, equitable health system, through the racial exclusion of apartheid, to the reform agenda of the post-apartheid period, South Africa's journey toward expanding universal health coverage (UHC) has been marked by historical inequities and bold reform visions. With current health sector reform initiatives challenged by polarising debates and legal contestation, this paper aims to compare and contrast reform options to encourage engagement and debate that advances UHC. An adapted UHC analytical framework is applied to four alternative health financing models that have either been implemented or considered in the post-apartheid period: the current public sector (National Health Service (NHS) model), the current private sector (voluntary health insurance), and two key alternatives, namely National Health Insurance (NHI) and Social Health Insurance (SHI). This analysis suggests that, while NHI offers the most comprehensive vision for UHC, its success depends on overcoming significant governance and fiscal constraints. SHI offers a more incremental and financially sustainable pathway by expanding formal sector coverage and enabling regulated risk pooling. However, a key finding is that no financing model, however well designed, will succeed without addressing underlying governance failures in the public health system. Drawing on lessons from the post-apartheid period, this paper argues for a phased hybrid approach that advances financing reforms alongside investment in governance capacity as the most feasible pathway to enable progress toward UHC.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e4039"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The primacy of care.","authors":"A Kleinman","doi":"10.7196/SAMJ.2026.v115i6b.3705","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v115i6b.3705","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e3705"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Notes on the political economy of planetary health - with reflections on prospects for the 'symbiocene' and the 'post-modern princess'.","authors":"I Bakker, S Gill","doi":"10.7196/SAMJ.2026.v116i6b.3718","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6b.3718","url":null,"abstract":"<p><p>This short reflection draws upon political economy and historical and social perspectives to help make sense of the crises, forces and influences that have shaped global and planetary health and may do so in the foreseeable future. Our contribution reflects on the existing world order and its structures of political economy, with their 'morbid symptoms', or on 'what is'. We then consider not only what planetary health 'might be', but also what it 'ought to be' for progressive, socially just and ecologically sustainable change to promote improvement in the health of people and our planet. To address the question of what might promote such transformations we introduce two concepts: the 'symbiocene' and the 'post-modern princess'. These concepts may help us to theorise new forms of political agency orientated to ethically advancing that future scenario.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e3718"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's new in TB diagnosis? A spotlight on active case-finding.","authors":"A J Scott, T Perumal, S Oelofse, A Esmail, K Dheda","doi":"10.7196/SAMJ.2026.v116i6b.4036","DOIUrl":"10.7196/SAMJ.2026.v116i6b.4036","url":null,"abstract":"<p><p>Tuberculosis (TB) remains the deadliest infectious disease globally, with gaps in case detection hindering its control. Active case-finding (ACF) comprises active screening of at-risk populations, including asymptomatic individuals, who constitute over half of TB prevalence in high-burden areas and who may contribute to community-based transmission. Common ACF models in community settings include door- to-door screening or mobile, vehicle-based screening using chest X-ray and/or molecular testing modalities. Other forms include healthcare facility-based screening and mass screening in congregate settings. The World Health Organization recommends ACF for communities with a TB prevalence of ≥0.5%, and its implementation is most effective in TB 'hot spots'. ACF can also be focused on specific at-risk groups such as household contacts and people living with HIV. Despite resource and logistical challenges, community-based ACF trials have demonstrated significant reductions in TB prevalence with repeated rounds of screening. In practice, however, community-based ACF is rarely undertaken by TB programmes in endemic countries, owing to limited funding ('willingness to pay') and a lack of context-specific, evidence-based operational guidance on ACF implementation. Therefore, the real-world effect of ACF will likely depend on implementation intensity, the use of scalable and accurate screening and diagnostic tools, and engagement with communities and health systems.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e4036"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data science and AI in medicine and global health: The need for inter-philosophies dialogue, cross-cultural ethics and ecocentricity.","authors":"N S Munung, G B Tangwa","doi":"10.7196/SAMJ.2026.v116i6b.3662","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6b.3662","url":null,"abstract":"<p><p>Advances in data science and medical artificial intelligence (AI) raise complex philosophical and ethical quandaries about what it means to know a person or a community through data and what kinds of people and societies we are becoming in this era of predictive data science. Drawing on four lightly fictional but reality-informed case studies in mental health, radiology, genomics and environmental public health, we reflect on how AI technologies, largely built on Western biomedical traditions, may conflict with relational, spiritual and Indigenous understandings of health and wellbeing. This may manifest as epistemic friction, algorithmic fatalism and diminished trust in patient-clinician relationships. Besides familiar concerns regarding bias and transparency, this paper advances the discourse on the ethics of medical AI and data science in healthcare by shifting the analysis from epistemology (how AI systems know, classify and predict) to ontology (the study of the nature of being, as reconfigured by data and AI). We argue that AI systems may inflict significant ontological harm by reconfiguring identity, moral agency and imagined futures and advocate for a renewed medical humanism driven by inter- philosophies dialogue, cross-cultural ethics and ecocentric approaches to care. From Bamenda, Cameroon, to Mthatha, South Africa and Toronto, Canada, the future of medical AI must be defined by the moral and philosophical traditions that people already live by. African, Indigenous, Islamic, Buddhist, Confucian and marginalised Western worldviews should not be treated as peripheral critiques, but as constitutive resources for building inclusive, human-centred health technologies. We conclude that bioethics should be recognised as a core infrastructure in global health, on equal footing with data science, medicine, biomedical research and health innovation.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e3662"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A holistic healer.","authors":"H Adam, K Moodley","doi":"10.7196/SAMJ.2026.v116i6b.4041","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6b.4041","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e4041"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professor Solomon Benatar's legacy in transforming bioethics in global health research.","authors":"Q Abdool Karim, J Mohan","doi":"10.7196/SAMJ.2026.v116i6b.3843","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6b.3843","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6b","pages":"e3843"},"PeriodicalIF":1.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}