http://hdl.handle.net/10608/4852 Sun, 12 Apr 2026 15:53:56 GMT 2026-04-12T15:53:56Z http://www.ipubli.inserm.fr:80/bitstream/id/69726/ http://hdl.handle.net/10608/4852 http://hdl.handle.net/10608/5145 L’éthique de la recherche et l’usage du placebo : un état de la question au Canada Keating, Bernard Parmi les questions discutées en éthique de la recherche, il en est une qui resurgit de façon récurrente, c’est celle de l’usage du placebo. Cette question était au cœur des discussions précédant l’adoption de la dernière révision de la Déclaration d’Helsinki, en octobre 2000 à Édimbourg. Élaborée par l’Association médicale mondiale, la Déclaration d’Helsinki a pour objectif de fournir des recommandations destinées à guider les médecins et autres participants dans leurs recherches sur l’être humain.; The question of the use of the placebo is one of the most controversial in the field of the ethics of research today. The use of the placebo remains the standard practice of biomedical research in spite of the fact that various revisions of the Helsinki Declaration have sought to limit its use. In Canada, the Tri-council policy statement: Ethical conduct for research involving humans adopted a very restrictive position with respect to the use of placebos, precisely defining the situations in which its use would meet the demands of ethical research. The positions taken by the various ethical decision-making bodies are, however, hardly shared by regulatory bodies such as the Food and drug administration (FDA), the Council for international organization of medical sciences (CIOMS) or the European agency for the evaluation of medicinal products (EMEA). This divergence of opinions reveals two quite different conceptions of what constitutes the ethical. In the case of decision-making bodies in the ethical field, it is clearly medicine’s Hippocratic Oath which explains their reluctance to use placebos. The first responsibility of the doctor is to «do no harm» to his or her patient. This duty is inherent to the medical profession and as such is not grounded in the view of medicine as a contract for care. In the case of regulatory bodies, it is the vision of «medicine as contract» which is in view; and it is this notion that justifies the use of placebos once free and informed consent has been obtained. It is also worth noting that these regulatory bodies make frequent use of arguments based on utilitarian ends. In an unprecedented move, the World medical association published in October 2001 a clarification note about the use of placebos. An analysis of this text raises the question about its real meaning: clarification or concession ? Thu, 01 Jan 2004 00:00:00 GMT http://hdl.handle.net/10608/5145 2004-01-01T00:00:00Z http://hdl.handle.net/10608/5144 Thérapie génique du déficit immunitaire combiné sévère lié à l’X : Efficacité et complications Fischer, Alain; Hacein-Bey-Abina, Salima; Cavazzana-Calvo, Marina Thu, 01 Jan 2004 00:00:00 GMT http://hdl.handle.net/10608/5144 2004-01-01T00:00:00Z http://hdl.handle.net/10608/5143 Le choléra et la naissance de la santé publique dans le Japon de Meiji : 1. Modernité, choléra et pensée hygiénique Chemouilli, Philippe En 1868, le Japon rétablit un régime impérial et se dote progressivement des structures d’un État moderne. Relativement préservé des épidémies comme le choléra en raison d’une longue période de fermeture, le pays doit faire face à des flambées de choléra et d’autres maladies épidémiques qui troublent l’ordre public. Dans cet article, nous analysons les circonstances qui ont conduit à la mise en place d’un système moderne d’hygiène et les difficultés rencontrées dans le contexte du Japon de Meiji. Nous étudions en particulier les principaux modèles et tentons de replacer les choix qui ont été faits dans le contexte international de l’époque. Il est en effet bien établi que l’accent a été mis sur les maladies infectieuses aiguës qui troublaient l’ordre social plutôt que sur la lutte contre des maladies plus chroniques ou l’amélioration des conditions de vie. Nous souhaitons illustrer dans le contexte du Japon la tension permanente qui a existé dans tous les pays entre la nécessité de mesures coercitives et l’idée de bien-être et d’un droit des individus à la santé; We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji governement set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show, that in Japan as well as in Western nations, public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health. Thu, 01 Jan 2004 00:00:00 GMT http://hdl.handle.net/10608/5143 2004-01-01T00:00:00Z http://hdl.handle.net/10608/5142 La couverture maladie universelle : l’apport de la protection complémentaire Le Laidier, Sylvie Thu, 01 Jan 2004 00:00:00 GMT http://hdl.handle.net/10608/5142 2004-01-01T00:00:00Z