Contracts,Norms, and Political Economy: Sub-Saharan State Credibility and the Microeconomic Foundations of Developmental Taxation

The article focuses on the microeconomic foundations and effects of the fragile tax base in Sub-Saharan Africa, which have been insufficiently taken into account by the international financial institutions. Two vicious circles are analysed. The first addresses the political economy of states: their inability to redistribute revenues reinforces a lack of credibility, leading to a reluctance by the majority of the population to pay taxes. Instead, there is ongoing reliance on private interpersonal transfers. This is compounded by the way markets interlock, creating negative effects in terms of efficiency. This vicious circle is related to a second one, which stems from the nature of the social contracts that link citizens to the state, and which are rarely of the individualistic-voluntary type characteristic of developed states. States, therefore, are often not part of the reciprocity chain, which explains the failure of some reforms in Africa.     

A nation's genes for a cure to cancer: evolving ethical, social and legal issues regarding population genetic databases

The advent of the human genome sequence has focused research on understanding underlying genetic links to complex diseases such as cancer, asthma and heart disease. In the past few years, individual countries, such as Iceland, Estonia, Singapore and the United Kingdom, have created national databases of their citizens' DNA for comparative research. Most recently, an international consortium including Nigeria, Japan, China and the United States launched a $100 million project called the International HapMap to map the human genome according to haplotypes, blocks of DNA that contain genetic variation. Such population genetic databases present challenging ethical, social and legal issues, yet regulation of genetic information has developed sporadically, from region to region, without a consistent international standard. Without a clear understanding of the consequences of genetic research in terms of individual and community-wide discrimination and stigmatization, genetic databases raise concerns about the protection of genetic information. This Note provides a survey of the evolving landscape of population genetic databases as a legislative and public policy tool for national and international regulators. It compares different approaches to regulating the collection and use of population genetic databases in order to understand what areas of consensus are formulating a foundation for an international standard. As the first population genetics project that will span multiple countries for the collection of DNA, the International HapMap has the potential to become an influential standard for the protection of population genetic information. This Note highlights issues among the national databases and the HapMap project that raise ethical, social and legal concerns for the future and recommends further protections for both individual donors and community interests.     

The doctor-patient relationship as the business case for quality: doing well by doing right

The idea that healthcare quality in America has lagged behind optimal levels has been a central national policy issue since at least 1998. Reform efforts, however, have failed to acknowledge the critical and unique role physicians play in making quality initiatives real. This Article argues physicians are at the core of any effort to propel quality forward in a significant way and, therefore, must be taken into account directly and without apology. The Article examines the quality-accountability context present in this country. It addresses why the physician nexus on these issues is vital for real change to take place and sets forth a clear statement of what is essential to support the doctor-patient relationship in any quality agenda. Finally, it reiterates the author's previously proposed five principles for quality, as well as her unified field theory of quality, all of which are designed to advance quality in a very different way.