ICF illustration library.

549Bulletin of the World Health Organization | July 2004, 82 (7) Books & Electronic Media Reproductive health and human rights: integrating medicine, ethics and law Authors: Rebecca J. Cook, Bernard M. Dickens, Mahmoud F. Fathalla Publisher: Clarendon Press, Oxford; 2003 ISBN: 0 19 924132-5; hardback; 582 pages; price UK£ 60 0 19 924133-3; paperback; 582 pages; price UK£ 19.99 An adolescent woman requests a contra- ceptive method from a health provider in a country where access for under-aged users is restricted; a couple denounces an involuntary sterilization to a local non- governmental organization; a woman requests a legal abortion in a context where termination of pregnancy is highly stigmatized and access to safe services is denied her. These are just examples of terribly unfortunate but common features in developing countries, where women, particularly poor women, lack the necessary power to successfully fight for their needs and rights. A meaningful and appropriate response to these complex situations requires a comprehensive approach. As acknowledged by the authors of Repro- ductive health and human rights: integrat- ing medicine, ethics and law, no single discipline or perspective will resolve the many dilemmas involved in protecting reproductive and sexual health. Health providers, advocates and public officials struggling with real cases on a daily basis are not always able to adopt such an in- clusive view, largely because previously available publications dealt separately with sexual and reproductive health, rather than focusing on their links and interactions. This monograph is therefore an important addition to the scarce literature at the interface between medicine, ethics, human rights, and law, and represents a unique reference source that seeks to fulfil this unmet need. The book’s three parts comple- ment each other. Part I, theoretical and conceptual, provides the reader with 1 Population Council, Regional Office for Latin America and the Caribbean, Panzacola No. 62 – 102, Col. Villa Coyacan, Mexico City, Mexico (email: alanger@popcouncil.org.mx). all the necessary tools to understand the challenging issues that form Part II, such as female genital cutting; use of sexual and reproductive health services by adolescent girls; medically assisted reproduction; involuntary female steril- ization; counselling and care for women who are HIV-positive; and requests for pregnancy termination. The variety of examples discussed makes the book appealing to a global readership. Part III provides a historical and empirical framework for the previous sections: essential reproductive health data from around the world obtained from the most reliable international sources; a list of human rights treaties and UN conference documents with references to sexual and reproductive health; and bibliographic details of key relevant papers that have appeared over the last 50 years. The authors’ main objective is am- bitious: to make readers understand that “reproductive and sexual ill-health does not occur in a vacuum, but is condi- tioned by cultures, laws and values.” This is fully achieved thanks to the authors’ encyclopaedic knowledge and interna- tional perspective. Although obvious to some, this perspective may be new for many readers who don’t have access to views from disciplines other than their own or have knowledge of distant geographic areas and diverse cultural set- tings. A further objective is to stimulate readers to develop their own analyses and approaches based on local circumstances. Part II is instrumental in achieving this goal. Each of its fifteen chapters analyses the medical, ethical, legal and human rights aspects of a separate issue; provides solid recommendations for use at the clinical and health-care system levels; and describes the social actions needed to ad- dress the underlying problem involved. Relevant and concrete recommendations for improving the quality of care received by individuals with reproductive and sexual health problems are also given. This approach may, however, be limited in its usefulness: attempts to change prevalent practices, even when strong scientific evidence is available, have proven to be extremely difficult to realize. The authors of this book are dis- tinguished specialists with the highest credentials in sexual and reproductive health (Mahmoud F. Fathalla), repro- ductive and sexual health law (Rebecca J. Cook), and medicine and ethics (Bernard M. Dickens). They worked on this common endeavor for four years, during which time they were able to go beyond the limits of their disciplines and merge their complementary areas of expertise to produce a brilliant and unique book. The intended readership includes health providers, lawyers, researcher workers, ethical analysts, health adminis- trators, members of grassroots organiza- tions, and legislative aides. The book’s interdisciplinary approach, contents, and good balance between theory, concepts, concrete examples and recommenda- tions will make it appealing and relevant to this broad audience. Additionally, it is written in a language that is relatively accessible and reader-friendly. Neverthe- less, the complexity of some of the issues it discusses, its size and wealth of detail, may constitute a barrier for lay people and even for some professionals in developing countries. The fact that it is written in English may also be barrier to some readers in developing countries. The publication of this book is opportune because this is a particularly challenging time for the sexual and reproductive health and rights move- ment. After gaining momentum during the 1990s, this movement has been dramatically affected by a conservative backlash and a financial recession that have undermined multilateral and bilat- eral international aid programmes and the support provided by many private foundations. This monograph highlights the crucial importance and complexity of sexual and reproductive health and rights, which are currently under attack and at risk of being excluded from international and national agendas. O Ana Langer1 550 Bulletin of the World Health Organization | July 2004, 82 (7) Books & Electronic Media ICF illustration library The ICF illustration library is an illus- trated website version of the WHO International Classification of Func- tioning, Disability and Health (ICF). It provides a simple and understandable way of navigating the structure and construction of ICF. The web site shows Japanese (http://www.tokyo.image-lab. or.jp/icf/ill/) and English (http://www. tokyo.image-lab.or.jp/icf/ill/english/) versions of the library. Access to both versions is free, and the web pages enable the user to view the classification via a hierarchical structure with accompanying codes, text and illustrations. The site’s design permits other languages to be added simply to the library. Upon opening the web site, the user is presented with a screen showing the top level structure of ICF: Body Functions; Body Structures; Activities and Participation; Environmental Factors. Clicking on any one of these head- ings leads to a display of the associated chapters. The key feature of the library is its use of illustrations at all levels to support the text. If a concept can be further classified by a more detailed ICF code, a “MORE” button is displayed; by clicking on it, the user is taken to the next deeper code layer. The route by which the user has arrived at a particular code is displayed on screen, allowing easy access to any part of the hierarchy, thus making the web pages very easy to navigate. Fig. 1 shows the image of a page of the ICF illustration library, with the right- hand expanded set of images showing the page obtained when a user presses the “MORE” button shown below d410. Development of the illustrative library was based on experience gained in devising a functional assessment tool 551Bulletin of the World Health Organization | July 2004, 82 (7) Books & Electronic Media 2 Senior Consultant and Analytical and Statistical Services Manager, NHS Information Authority, King’s Court, The Broadway, Winchester SO23 9BE, England (email: stephen.sutch@nhsia.nhs.uk). 3 Department of Philosophy, University of the Philippines, Diliman, Quezon City, 1104 Philippines (email:decastro@skyinet.net). for the elderly in Japan. The illustrations, which were drawn by a professional artist under supervision, are marked by their simplicity and provide a good graphical description of the classification concepts and codes. The illustrations are copy- righted by Dr Tai Takahashi (Interna- tional University of Health and Welfare, Japan) but the creators are keen to allow the non-commercial use of their work. The textual information taken from ICF is comprehensive and includes the full descriptions of the codes as well as notes on inclusions and exclusions. The pages on the site can be poten- tially used as a training aid to under- standing the structure and composition of ICF, as well as an online aid to using and interpreting the ICF classification system. Use of the illustrations in addi- tion to the text may also result in a more standardized interpretation of the clas- sification and thus ensure consistency. Although the library has been specifi- cally designed for dealing with elderly patients, its design would also lend itself to being adapted for other patients groups and used in other cultural settings. O Steve Sutch2 Ethical and regulatory aspects of clinical research: readings and commentary Editors: Ezekiel J. Emanuel, Robert A. Crouch, John D. Arras, Jonathan D. Moreno, & Christine Grady Publisher: Johns Hopkins University Press, Baltimore, MD, USA; 2004 ISBN: 0-8018-7813-6; paperback; 528 pages; price US$ 39.95 It was quite propitious that this book arrived for review just as we were prepar- ing to conduct another training course in research ethics at the University of the Philippines for health researchers and members of Ethics Review Com- mittees in the Asia–Pacific region. The book begins with a history of human subjects research and then covers various aspects of clinical trial process, including: designing the trial, recruiting partici- pants, ensuring informed consent, and studying special populations. Conflicts Bulletin board: have your say Readers now have the opportunity to comment on recently published articles that have appeared in the Bulletin, in the form of an informal letter to the editor. These comments will then be published on the Bulletin’s web site, after quick editorial review, under our new “Bulletin board” section and a selection will be chosen to appear in the print version of the journal. Please visit our web site at http://www.who.int/bulletin/en/ to access the latest articles and email your contributions to: bulletin@who.int. of interest and scientific misconduct are also covered. Examining the contents of the book in terms of reviewing our curriculum and putting together assigned reading material for the participants in the course, we thought that many of the chapters easily deserved to be required reading — not only for the particular course module that we were about to give but for subsequent modules that were to follow. The book’s contents easily fit the requirement for a single volume that contains most of the materials that one would have wanted — providing an introduction, current international guidelines, theoretical analyses, as well as excellent selections on specialized issues and the most recent controversies. Most of the readings that have been chosen for the book can lay claim to being classics. They represent sophisti- cated thinking on various topics. Also they chronicle the advances in ethical theory that have come about in response to the controversy-ridden strides that have been made in biomedical research over the past half century. However, there can be drawbacks to elegance and sophistication in thought if the objective in mind is the practical application of information. Classical writings do not necessarily constitute the best materials for educating people who have differ- ent levels of scholarly commitment and practical involvement in research and review of research ethics. For example, participants in our training courses have occasionally told us that they are more interested in being given specific rules or guidelines that they can refer to in making decisions to approve — or to conduct — proposed biomedical research projects. Scholarly discussion tends to confuse them and to leave them still hoping for clear guidelines regard- ing particular decisions that have to be made. Some of the participants in our courses may tend to have such feelings upon reading Ethical and regulatory aspects of clinical research. Such feelings cannot, however, be ascribed to the book itself. Perhaps it should be the responsi- bility of regulatory bodies to show how materials such as those in monographs such as this relate directly to the work of ethics reviewers and researchers, and to particular positions that they may take with respect to certain issues. The book is clearly primarily in- tended for an American audience, which is understandable, since the editors are American academics. Also, the indi- vidual contributors are from developed country institutions. One wonders whether this reflects a bias in favour of authors who could be appreciated by an American readership; a dearth of relevant material written by scholars from other parts of the world; a lack of appreciation for perspectives expounded by developing country authors; or, as we hope, a simple oversight that the editors will attempt to rectify in a subsequent edition. Nevertheless, the compendium of articles in this book is, on the whole, relevant internationally, with some qualification. O Leonardo D. de Castro3