[World News] 150 experts say Olympics must be moved/postponed because of Zika

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150 experts say Olympics must be moved or postponed because of Zika
from The Washington Post



More than 100 prominent physicians, bioethicists and scientists from around the world posted a letter Friday urging WHO Director-General Margaret Chan to exert pressure on Olympic authorities to move the Olympics from Rio de Janeiro or delay the games because of public health concerns over the Zika virus.

Brazil, which is hosting the Olympics and the Paralympics, is at the epicenter of the rapidly evolving mosquito-borne epidemic.

The letter is signed by 150 individuals from more than a dozen countries, including Brazil, Japan, Israel, Russia, Sweden, South Africa and the United States. It calls on the WHO to convene an independent group to advise it and the International Olympic Committee, and for authorities to reconsider the decision to hold the Games in Rio.

"We are doing it to ask for an open, transparent discussion of the risks of holding the Olympics as planned in Brazil," said Arthur Caplan, a bioethicist at New York University and one of the letter's four authors, in an email explaining the reasoning behind the letter.

The group of scientists is not seeking "general assurance" from the WHO, Caplan said. Instead, they want "a frank discussion among independent experts," he said.

"If Rio is going to happen, the world deserves a full discussion of why and at what potential risks and liabilities," Caplan said.

The other authors are Lee Igel, an associate professor at New York Univesity; Amir Attaran, a biologist and law professor at the University of Ottawa; and Christopher Gaffney, a senior research fellow at the University of Zurich who studies the impact of major sporting events on urban populations.

Each author has published articles in recent weeks and months calling for the games to be postponed because of Zika.

In the open letter posted Friday on Twitter and Facebook, the authors said evidence shows that Brazil's Zika strain has more serious medical consequences than researchers previously knew, that Rio de Janeiro is one of the hardest hit areas of the epidemic, and that Rio's mosquito-killing efforts are not meeting expectations.

Zika infections during pregnancy can cause serious fetal brain abnormalities, including microcephaly, which is characterized by abnormally small heads and severe developmental problems. The virus has also been linked to neurological disorders in adults. Zika is primarily transmitted through mosquitoes but can also spread through sexual contact.

In the most recent letter, the authors say that Rio's public health system is so "severely weakened" as to make a last-minute push against the mosquito that transmits Zika impossible. Citing government data, the letter notes the increasing number of cases of dengue, a related virus spread by the same mosquitoes, that is considered a proxy for Zika.

In the specific neighborhood of the Olympic Park, Barra da Tijuca, there have been more dengue cases in the first quarter of 2016 than in all of 2015, the letter said.

"It is therefore imperative that WHO conducts a fresh, evidence-based assessment of Zika and the Games, and its recommendations for travelers," the letter said. "Given the public health and ethical consequences, not doing so is irresponsible."

The IOC insists that the Games will go forward as planned. Earlier this month, the WHO urged athletes and travelers planning to attend the competitions to take measures to protect against infection, but it did not call for the Olympics, which start Aug. 5, or the Paralympics, which begin Sept. 7, to be canceled or postponed.

U.S. Olympic Committee officials have said the decision to attend the Games is up to individual athletes.

The authors say the estimated 500,000 foreign tourists from all over the world who are expected to attend the Games represent an unnecessary risk because they could potentially get infected and return home to places where the virus can become endemic.

"Should that happen to poor, as-yet unaffected places (e.g., most of South Asia and Africa) the suffering can be great," the authors wrote. "It is unethical to run the risk, just for Games that could proceed anyway, if postponed and/or moved."

U.S. health officials disagree with that assessment.

In an interview this week, Tom Frieden, the director of the Centers for Disease Control and Prevention, said: "We don't see from a public health standpoint any reason to cancel the Olympics."

"There's been some claims that if the Olympics happen, it's going to disseminate the virus everywhere, it's going to amplify it," Frieden said. "Well, we looked at the numbers. The Olympics account for less than one quarter of 1 percent of all travel to Zika-affected areas."

Frieden has said the risk to Olympians is "very, very low." About 100 athletes, coaches and staff of the U.S. Olympic delegation are already being monitored for the virus as they begin to go to Brazil; up to 1,000 are expected to be monitored as the Olympics and Paralympics begin.

He said it was "unfortunate" that Major League Baseball recently decided to scrap a two-game series in Puerto Rico and move it to Miami amid concerns over the Zika virus.

CDC and health officials across the globe have advised women who are pregnant to avoid traveling to regions where Zika is prevalent, and they have advised women who are trying to become pregnant, and their male partners, to use condoms or abstain from sex during their stay for months after and after returning home.

The CDC is also conducting a risk assessment for each of the approximately 180 countries with athlete delegations. More than 10,500 athletes are expected at the Olympics and about 4,350 are likely to be at the Paralympics. Analysts are looking at the expected number of athletes and travelers likely to go to Brazil, the susceptibility of those countries to epidemic diseases, and the potential for how added travel might accelerate the spread of Zika.

But in Friday's letter, the authors say the many uncertainties about Zika "currently make it impossible for mathematical models to predict the epidemic's course accurately."


Here's a full list of the 150 people who signed the letter, in alphabetical order, and represent individuals, not their institutions:

1. Prof. Akira Akabayashi, Department of Biomedical Ethics, School of Public Health, The University of Tokyo Faculty of Medicine, Tokyo, Japan
2. Prof. Paul S. Appelbaum, Director, Division of Law, Ethics & Psychiatry, Department of Psychiatry, Columbia University, New York, USA
3. Prof. Kwame Anthony Appiah, Department of Philosophy, NYU Law, New York University, New York, USA
4. Prof. Thalia Arawi, Founding Director, Salim El-Hoss Bioethics & Professionalism Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
5. Prof. Amir Attaran, School of Epidemiology, Public Health and Community Medicine and Faculty of Law, University of Ottawa, Canada
6. Ms. Stephanie Augustine, Researcher, Department of Maternal Fetal Medicine, North Shore University Hospital, Manhasset, USA
7. Prof. Robert Baker, Bioethics Program of Clarkson University & The Icahn School of Medicine at Mount Sinai, Schenectady, USA
8. Dr. Alison Bateman-House, Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, USA
9. Prof. Frances Batzer, Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, USA
10. Prof. Angelica M. Baylon, External Relations Director, Maritime Academy of Asia, Kamaya Point, Philippines
11. Prof. Solly Benatar, Founding Director, University of Cape Town Bioethics Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa 12. Prof. Cecilia Benoit, Centre for Addictions Research of British Columbia, Department of Sociology, University of Victoria, Victoria, Canada
13. Mr. Edward J. Bergman, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
14. Prof. Kenneth Berkowitz, Department of Population Health and Department of Medicine, School of Medicine, New York University, New York, USA
15. Prof. Ivy Lynn Bourgeault, Canadian Institutes of Health Research Chair in Gender, Work and Health Human Resources Telfer School of Management, University of Ottawa, Ottawa, Canada
16. Prof. Marie A. Bragg, Department of Population Health, New York University School of Medicine, New York, USA
17. Dr Berit Bringedal, Senior Researcher, Institute for Studies of the Medical Profession, Oslo, Norway
18. Prof. Amy Brown, Maria Fareri Children's Hospital at Westchester Medical Center, Department of Pediatrics, New York Medical College, Valhalla, USA
19. Prof. Arthur L. Caplan, Division of Medical Ethics, New York University Langone Medical Center, New York, USA
20. Dr. Rhyddhi Chakraborty, Researcher, Philosophical Bioethics, Global Public Health and Social Justice, American University of Sovereign Nations, USA.
21. Prof. Theeraphap Chareonviriyaphap, Department of Entomology, Kasetsart University, Bangkok, Thailand
22. Prof. Cheryl Cline, Office of Bioethics, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada.
23. Dr. Catherine Constable, Instructor, Department of Medicine, New York University Langone Medical Center, New York, USA
24. Prof. Glenn Cohen, Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics, Harvard Law School, Cambridge, USA
25. Prof. Patrick Derr, Chair, Department of Philosophy, Clark University, Worcester, USA
26. Prof. Débora Diniz, Faculty of Law, Universidade de Brasília, and Bioethics Program, FIOCRUZ, Brasília and Rio de Janeiro, Brazil
27. Prof. Ames Dhai, Director, Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
28. Dr. Hasan Erbay, MD. PhD., Department of Medical Ethics and History of Medicine, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey.
29. Prof. Eric Feldman, Health Policy and Medical Ethics, University of Pennsylvania Law School, Philadelphia, USA
30. Dr. Holly Fernandez-Lynch, Executive Director, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, Harvard University, USA
31. Prof. Chris Feudtner, Department of Pediatrics and Department of Medical Ethics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
32. Dr. Christopher Gaffney, Department of Geography, University of Zürich, Zürich, Switzerland
33. Prof. William Gardner, Children's Hospital of Eastern Ontario Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Canada
34. Prof. Robert P. George, McCormick Professor of Jurisprudence, Princeton University, Princeton, USA
35. Prof. Grover Gilmore, Dean, Applied Social Sciences, Case Western Reserve University, Cleveland, USA
36. Prof. Moti Gorin, Director, Jann Benson Ethics Center, Colorado State University, USA
37. Prof. Linda Granowetter, Department of Pediatrics, New York University Langone Medical Center, New York, USA
38. Prof. Abhik Gupta, Ph.D., Professor and Dean, School of Environmental Sciences, Assam (Central) University, Silchar, India.
39. Prof. Sally Guttmacher, College of Global Public Health, New York University, New York, USA
40. Prof. Negin Hajizadeh, Department of Medicine, Hofstra Northwell School of Medicine, Hofstra University, Hempstead, USA.
41. Mr. George Halvorson, Chief Executive (Retired) Kaiser Permanente, and Chair, InterGroup Understanding, Sausalito, USA
42. Prof. Deborah S. Hamm, Department of Psychiatry, Columbia University Medical Center, New York, USA
43. Prof. Alice Herb, Division of Humanities in Medicine at State University of New York, Downstate Medical Center, New York, USA
44. Prof. Søren Holm, Centre for Social Ethics and Policy, School of Law, University of Manchester, UK.
45. Prof. Lee H. Igel, Tisch Institute for Sports Management, Media, and Business, New York University, New York, USA
46. Prof. Judy Illes, Canada Research Chair in Neuroethics, Department of Medicine, University of British Columbia, Vancouver, Canada
47. Dr. Mahmood-uz- Jahan, M.D., PhD., Director, Bangladesh Medical Research Council, Dhaka, Bangladesh
48. Prof. Dale Jamieson, Chair, Department of Environmental Studies, New York University, New York, USA
49. Prof. Yeremias Jena, M. Phil., M.Sc, Professor of Medical Ethics at Atma Jaya School of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
50. Prof. Steven Joffe, Vice-Chair, Department of Medical Ethics and Health Policy, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
51. Prof. Ken Johnson, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada
52. Prof. Nora Jones, Associate Director, Center for Bioethics, Urban Health, and Polic, Lewis Katz School of Medicine, Temple University, Philadelphia, USA
53. Prof. Therese Jones, Associate Director, Center for Bioethics and Humanities, Director, Arts and Humanities in Healthcare Program, University of Colorado Anschutz Medical Campus, Denver, USA
54. Prof. Matthias A. Karajannis, Division of Pediatric Hematology/Oncology, New York University Langone Medical Center, New York, USA
55. Prof. Douglas I. Katz, Department of Neurology, Boston University School of Medicine, Braintree, USA
56. Prof. Ralph V. Katz, Professor of Epidemiology, Fellow of the American College of Epidemiology F.A.C.E.), and Founding Chair, Department of Epidemiology and Health Promotion, New York University, New York, USA
57. Ms. Lisa Kearns, Research Associate, Division of Medical Ethics, New York University Langone Medical Center, New York, USA
58. Prof. Aaron Seth Kesselheim, Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, USA
59. Dr. Abbas Kharabi, University of Malaya, Kuala Lumpur, Malaysia
60. Dr. Robert Klitzman, Professor of Psychiatry, Director, Masters of Bioethics Program Columbia University, New York, USA
61. Prof. Craig Klugman, Chair, Department of Health Sciences, DePaul University, Chicago, USA
62. Prof. Adam Kolber, Center for Health, Science, and Public Policy, Brooklyn Law School, Brooklyn, USA
63. Prof. Craig Konnoth, Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania Law School, Philadelphia, USA
64. Prof. Ralph A. Korpman, School of Medicine, Loma Linda University School of Medicine, Loma Linda, USA
65. Dr. Ronald L. Krall, Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, USA
66. Prof. Sheldon Krimsky, Department of Urban and Environmental Policy & Planning, Department of Health and Community Medicine, Tufts University, Boston, USA
67. Prof. John Lantos, Director of Pediatric Bioethics, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, USA
68. Prof. John Last, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
69. Prof. Stephen Latham, Director, Interdisciplinary Center for Bioethics, Yale University, New Haven, USA
70. Dr. Thuy Le, Oxford University Clinical Research Unit, Oxford University, Ho Chi Minh City, Vietnam
71. Prof. Arthur Leader, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
72. Mr. Leonard leBlanc, Research Fellow, Eubios Ethics Institute, Japan.
73. Prof. Trudo Lemmens, Scholl Chair in Health Law and Policy, Faculty of Law, University of Toronto, Toronto, Canada
74. Prof. Betty Wolder Levin, School of Public Health and Health Policy, City University of New York, New York, USA
75. Prof. Bruce Levin, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
76. Prof. Ariane Lewis, Department of Neurology and Department of Neurosurgery, New York University Langone Medical Center, New York, USA
77. Dr. Ana Lita, Director, Global Bioethics Initiative, New York, USA
78. Prof. Julian Little, Director, School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
79. Prof. Sergio Litewka, Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, USA
80. Prof. Alex John London, Director, Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, USA
81. Prof. Darryl Macer, Ph.D., Hon.D. President, American University of Sovereign Nations, Arizona, USA; Director, Eubios Ethics Institute, Christchurch, New Zealand
82. Prof. Tim Mackey, Director, Global Health Policy Institute, Department of Anaesthesology and Public Health, University of California at San Diego, San Diego, USA
83. Prof. Ruth Macklin, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, USA.
84. Prof. Cheryl Macpherson, Bioethics Department, St George's University School of Medicine, True Blue, Grenada
85. Prof. Brian Martin, Director, Graduate Program in Public Health, Eastern Virginia Medical School, Old Dominion University, Norfolk, USA
86. Prof. Thomas Mayo, Southern Methodist University Dedman School of Law, University of Texas Southwestern Medical School, Dallas, USA
87. Mr. Michael Mawadri, Emergency Coordinator with Action for Development (AFOD) in South Sudan, South Sudan
88. Prof. James McCartney (Reverend, Order of St. Augustine), Department of Philosophy, Villanova University, Villanova, USA
89. Prof. John Merz, Department of Medical Ethics & Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
90. Mr. Alan Milstein, Sports Attorney, Sherman, Silverstein, Kohl, Rose & Podolsky, Moorestown, USA
91. Prof. Christine Mitchell, Executive Director, Center for Bioethics, Harvard Medical School, Boston, USA
92. Prof. Jonathan D. Moreno, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
93. Prof. Dr. Martin Müller, Department of Geography, University of Zürich, Zurich, Switzerland
94. Prof. Carin Muhr, Department of Medical Science, Uppsala University, Uppsala, Sweden.
95. Prof. Anna Nolan, Department of Environmental Medicine , Department of Medicine, New York University Langone Medical Center, New York, USA
96. Prof. Stjepan Oreskovic, Andrija Stampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
97. Prof. Brendan Parent, Division of Medical Ethics and Co-Director NYU Sports and Society Program, New York University, New York, USA
98. Prof. Shamina Parvin Lasker, Head of Department of Anatomy, Samorita Medical College; Secretary General, Bangladesh Bioethics Society, Dhaka, Bangladesh.
99. Prof. Pasquale Patrizio, Division of Reproductive Endocrinology & Infertility, Yale School of Medicine, New Haven, Connecticut, USA
100. Prof. Sean Philpott-Jones, Department of Bioethics, Clarkson University, Schenectady, NY
101. Dr. Carolyn Plunkett, Division of Medical Ethics, New York University Langone Medical Center, New York, USA
102. Prof. Stephen G. Post, Department of Family, Population & Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, USA
103. Prof. Kathleen Powderly, Director, John Conley Division of Medical Ethics and Humanities, SUNY Downstate Medical Center, Brooklyn, USA
104. Prof. Duncan Purves, Environmental Studies and Bioethics, New York University, New York, USA
105. Prof. Vojin Rakic, Founding Director, Center for the Study of Bioethics, Head of the European Division of the UNESCO Chair in Bioethics, University of Belgrade, Serbia
106. Prof. Vardit Ravitsky, School of Public Health, Université de Montréal, Montreal, Canada
107. Prof. Avad Raz, Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
108. Prof Kathleen Reeves, Director, Center for Bioethics, Urban Health, and Policy, Lewis Katz School of Medicine, Temple University, Philadelphia, USA
109. Prof. Donald R. Roberts, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, USA
110. Dr. Philip Rubin, Principal Assistant Director (Retired), Office of Science and Technology Policy (OSTP), Executive Office of the President of the United States, New Haven, USA
111. Prof William Ruddick, Founding Director, Center for Bioethics, New York University, New York, USA
112. Prof. Maya Sabatello, Department of Psychiatry, Columbia University, New York, USA
113. Dr. Mojgan Saleuhipour, Faculty of Biomedicine, South Baylo University, CA, USA
114. Prof. Judit Sandor, Director of the Center for Ethics and Law in Biomedicine, Central European University, Budapest, Hungary
115. Prof. Pamela L. Sankar, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
116. Prof. Arthur Schaefer, Founding Director, Centre for Professional and Applied Ethics, University of Manitoba, Canada
117. Prof. Udo Schuklenk, Ontario Research Chair in Bioethics, Department of Philosophy, Queen's University, Kingston, Canada
118. Prof. Evan Selinger, Department of Philosophy, Rochester Institute of Technology, Rochester, USA
119. Dr. M. Selvanayagam, Professor, Dean of Research and President of India Association of Bioethics, India
120. Prof. Seema K. Shah, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
121. Prof. William S. Silvers, University of Colorado Denver School of Medicine, Denver, USA
122. Prof. Peter Singer, University Center for Human Values, Princeton University, Princeton, USA; and School of Historical and Philosophical Studies, University of Melbourne, Melbourne, Australia.
123. Prof. Maria Fiatarone Singh, Chair of Exercise and Sport Science, Faculty of Health Sciences, Sydney Medical School, University of Sydney, Australia
124. Prof. Daniel Skinner, Assistant Professor of Health Policy, Department of Social Medicine, Ohio University, Dublin, USA
125. Raquel R. Smith, Ph.D., Prof. Of Clinical Psychology, American University of Sovereign Nations, Arizona, USA; Community Emergency Response Team (FEMA) Instructor and Manager
126. Prof. Robert Smith?, Department of Mathematics and Faculty of Medicine, University of Ottawa, Ottawa, Canada
127. Prof. Jeremy Snyder, Faculty of Health Science, Simon Fraser University, Burnaby, Canada
128. Prof. Robert W. Snyder, Esq. Attorney at Law, Professor of Healthcare Management and Finance, American University of Sovereign Nations School of Medicine, USA.
129. Prof. Martin Strosberg, Bioethics Program of Clarkson University & The Icahn School of Medicine at Mount Sinai, Schenectady, USA
130. Prof. Eileen Sullivan-Marx, Dean, School of Nursing, New York University, New York, USA
131. Prof. Edwin van Teijlingen, Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
132. Prof. Henk ten Have, Director, Center for Healthcare Ethics, Duquesne University, Pittsburgh, USA
133. Ms. Ananya Tritipthumrongchok, General Manager, International Peace and Development Ethics Centre, Kaeng Krachan, Thailand.
134. Prof. Duunjian Tsai, M.D., PhD., Professor, Taipei Medical University, Taiwan.
135. Prof. Connie Ulrich, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, USA
136. Prof. Erick Valdés, Universisad del Desarrollo, Chile
137. Prof. Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University, Washington DC, USA
138. Prof. J. David Velleman, Professor of Philosophy and Bioethics, New York University, New York, USA
139. Dr. Ford Vox, Brain Injury Medicine, Shepherd Center, Atlanta, USA
140. Dr. Gary I. Wadler, Past Chairman, World Anti-Doping Agency (WADA) Prohibited List Committee, Recipient of the International Olympic Committee's President's Prize in 1993, Manhasset, USA.
141. Mr. Wendell Wallach, Lecturer, Yale Interdisciplinary Center for Bioethics, New Haven, USA
142. Prof. Vivian Welch, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
143. Prof. Bruce Wilcox, Faculty of Public Health, Mahidol University, Bangkok, Thailand
144. Prof. Benjamin Wilfond, Director, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, USA
145. Prof. Loren Wissner Greene, Department of Population Health and Bioethics, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, USA
146. Prof. Wendy L. Wobeser, Division of Infectious Diseases, Queen's University, Kingston, Canada
147. Prof. Paul Root Wolpe, Asa Griggs Candler Professor of Bioethics and Director, Center for Ethics, Emory University, Atlanta, USA
148. Prof. Sanni Yaya, School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada.
149. Prof. Boris Yudin, Department of Humanitarian Expertise and Bioethics, Institute of Philosophy, Russian Academy of Sciences, Moscow, Russia
150. Dr. Diana Zuckerman, President, National Center for Health Research, Washington DC, USA