The government has marketed India as a site for international clinical trials. Two essays in this issue express concern about this enthusiasm. An editorial writer warns of the danger to participants in the absence of proper monitoring and regulation of trials. Besides, the writer of a selected summary declares, recruitment incentives encourage unethical practices.

The recent Hepatitis B epidemic in Gujarat showed up failures in multiple systems. An editorial emphasises the need for a multi-pronged response: regulating medical practice, monitoring the handling and disposing of biomedical waste, and generating awareness. The Medical Council of India is “plagued by inefficiency, arbitrariness and lack of transparency,” according to a commentary writer who backs up his stories of corruption and misconduct with documents.

The existence of multiple medical systems should provide “healthy alternatives”, but a researcher in traditional medicines learns that “the valuable socio-cultural and medical services provided by the Indian traditional medical systems… are eclipsed by this moral dilemma of unqualified, unregulated medical practitioners, sought out by unsuspecting, misguided patients.”

Researchers interviewed medical practitioners about why they conducted pre-surgical HIV screening. They conclude that an approach that “balances patients’ needs with an appreciation of practitioners’ perspectives may result in more workable solutions for field-level ethical dilemmas”.

Newborn screening is expanding in India. A paper uses a public health ethics framework for developing a policy on newborn screening.

How should societies resolve the shortage in organs for transplant? A writer suggests that “presumed consent” might work. Two commentary writers, one from Pakistan and one from India, express their reservations. With this issue we bid goodbye to Ann Sommerville who, as member of the International Editorial Advisory Board, made an invaluable contribution to IJME’s growth. We welcome Julian Sheather on the IEAB and look forward to an enriching association.

Cover: K Ananthan, Needles, syringes and medicine vials among hospital waste. Photograph courtesy The Hindu.