Unintended consequences of sanctions against IranBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4650 (Published 23 July 2013) Cite this as: BMJ 2013;347:f4650
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The public health effect of economic sanctions on Iran needs more attention
Adopting smart sanctions on medical equipments, pharmaceutical and agricultural products could threaten the public health situation obviously [1, 2]. But even the general trade sanctions on none medical goods can equally be harmful for public health. For example the US sanctions against Iranian airlines, reduced the safety of air travel for millions of people through bans on selling aircraft and its repair parts.
Moreover in oil-based single product economies like Iran, sanctions expected to affect public health more significantly. In such countries, reduction of oil sailing as result of sanctions can lead to reduction of government capacity to financing health care system that can lead to higher percentage of households exposed to catastrophic health expenditures. For example annually 2.8% of Iranian households are exposed to catastrophic health expenditures that is three time higher than the goal of 1% in Iranian fourth five year developmental plan. Also the situation seems to be worsen in west of Iran. Only in Kermanshah at 2008, 21.4% of households sold their property and 47.6% were in debt to get access to health care. Such situation can reduce household’s financial access to health care to extent that they ignore some necessary health care services. So even when sanctions designed in such a way that the medical products are exempt from sanctions list, still can have significant effect on access to health care services.
PhD student in Health Economics, Tarbiat Modares University, Tehran, Iran.
1. Mohammadi, D., US-led economic sanctions strangle Iran's drug supply. The Lancet, 2013. 381(9863): p. 279.
2. Baradaran-Seyed, Z. and R. Majdzadeh, Economic sanctions strangle Iranians' health, not just drug supply. The Lancet, 2013. 381(9878): p. 1626.
3. Moghadam, M.N., et al., Iranian household financial protection against catastrophic health care expenditures. Iranian journal of public health, 2012. 41(9): p. 62.
4. Karami, M., F. Najafi, and B. Karami Matin, Catastrophic health expenditures in Kermanshah, west of Iran: magnitude and distribution. Journal of research in health sciences, 2009. 9(2): p. 36-40.
Competing interests: No competing interests
US sanctions against publication of articles from Iran is not new . In believe neither handling a manuscript by a journal nor its publication should be considered a violation of the sanction. In a full-blown sanction, we expect to see an outright ban on the flow of goods and technical information from outside into Iran, whereas, working on a manuscript to make it more readable is in fact a service to the readers , and publishing scientific articles from Iranian researchers is indeed outflow of information from (not into) Iran; and thus, should not be considered a violation of the sanction. Instead, this action might be interpreted as a form of apartheid in science publishing . This action might also be construed as a breach of the first amendment of the US Constitution, freedom of speech.
Although I believe science has no boarder, and many international organisations such as the World Association of Medical Editors (WAME), in its policy statement on “Geopolitical Intrusion on Editorial Decisions” (available from: http://www.wame.org/resources/policies#geopolitical), assert that “editorial decisions should not be affected by the origins of the manuscript, including the nationality, ethnicity, political beliefs, race, or religion of the authors”, we should not expect people (and of course journal editors) not to abide the rules of their own countries. In the meantime, we should work together to correct unreasonable rules, to make a better world.
1. Habibzadeh F. Extension of US trade embargoes to science editing. Lancet 2004;363(9415):1160.
2. Habibzadeh F. Is there an apartheid in science publishing? Lancet 2013;382(9889):310.
Competing interests: The authors are Iranian researchers and journal editors.
Medical sciences in Iran have improved very rapidly during last decades. In 2006, Butler reported that Iran after Turkey stood in the second position among Islamic countries according to the number of published papers. 1 In Iran, there are 44 medical schools which are public and therefore, affiliated with government owned universities. The medical school applicants in Iran need to pass a very competitive entrance exam, named Konkoor. Ranking by this exam, only the best and most intelligent applicants in the country are able to enter the medical schools in Iran. As a result, most of the research studies in Iran are being performed by these students and professors in public universities.
As a medical doctor who graduated from Tehran University of Medical Sciences (First ranked medical school in Iran) with more than 7 years of experience in basic-science and clinical research, I believe that the medical research in Iran, including the ones that are being done in the government owned universities, have no aim but improving the medical knowledge and contributing to the health of all the human beings to have a better lives, no matter where they live.
Iran is a country with people from different cultures, economical levels, and religions and even different races and ethnicity; this fact applies to the medical schools too. However, all the medical students and professors are only focused on helping the patients and human beings, while respecting each other’s differences and committing to medical ethics.
I totally agree with adding this paragraph to the code of conduct of The Committee on Publication Ethics (COPE), which says “Editorial decisions should not be affected by the origins of the manuscript, including the nationality, ethnicity, political beliefs, race, or religion of the authors. Decisions to edit and publish should not be determined by the policies of governments or other agencies outside the journal itself.” And I believe as the doctors, we all need to apply this paragraph in our daily lives while contacting with different patients, staffs, and persons.
As mentioned in the first paragraph of this article, the latest changes to US sanctions on Iran, designed to discourage the country from developing nuclear weapons. Now the question is how boycotting Iranian medical research and articles by journal editors can have any effects on the politics and politicians’ decisions while the aim of all these studies have nothing to do with the politics and are solely for improving the medical knowledge worldwide?
As a medical doctor, graduated from Iran, I want to appreciate and acknowledge the decision of outstanding and prestigious journals such as BMJ, Lancet, NEJM and JAMA on having no restrictions on publishing articles from Iranian authors. This decision shows their commitment to the science and ethics. I am sure all of these efforts to support medical science production from Iran, will lead to improve the medical knowledge and peace all over the world.
Mina Zarei M.D.
1. Butler D. Islam and Science: the data gap. Nature. 2006 Nov 2;444(7115):26-7.
Competing interests: No competing interests