Thursday, March 12, 2009

Wanted: A Social Network for Global Health News

Towards building a social network for real global health news on the cheap.

The promise: the Web allows anyone to have a voice.

The reality: the Web is actually narrowing the bounds of conversation. We’re recreating in the digital world the same categories and divisions that exist in the real world—only stronger. (See James Evans' recent analysis in Science for supporting evidence in scientific publishing online. On a related note, check out this study about "the winner's curse.")

Case in point: global health news coverage. This topic always falls between the cracks in the mainstream press—somewhere between “world news” and “health news.” Those offline categories are simply getting stronger in the online world. News categories are not yet miscellaneous enough, as David Weinberger describes.

In my experience, most global health news is actually promotional, not journalistic in nature.

A possible solution and the reason for this message: organizing the folks who are already writing about global health news online for free. Note: this is not going to pay anybody’s bills but since we are doing it anyway (as a way of keeping online notes for a book, learning, self-promotion, etc.), why not make it as powerful as it can be?

Some background: the fact that we were able to cover global health news at all was a happy result of the inefficiencies in the advertising model that financed most of the news business until very recently. Yes, most of the health advertising in TIME Magazine, for example, came from pharmaceutical companies but the firewall between edit and the publishing side, my own interests and those of several colleagues plus the fact that drug companies were okay with the fact that their ads reached both people who wanted their medications as well as those who did not, allowed us to write about global health and other less obviously remunerative articles. Keyword-based advertising has changed all that but that’s a topic for another post. (See Ethan Zuckerman for a really clear introduction to the value of advertising inefficiency, especially the part about how Bloomingdales underwrites the New York Time's Africa coverage)

After spending a lot of time thinking about this and talking to lots of people, I’m starting to accept that foundations are NOT going to pay for global health news coverage. And there probably is not a very good business model for it either. Oh yes, certain sections will get peeled off—anything having to do with mobile phones, pharmaceuticals or risk management. Plenty of opportunities for targeted advertising, subscriptions or commercial contracts there.

But the same market failures that have hobbled the development of new TB drugs over the past 50 years also affect the production and coverage of in-depth global health news.

Note, I am not talking about creating an educational service—like Kaiser’s Nor am I envisioning a PR newswire for global health—like (which was developed by a PR company for the Global Health Council).

Both are necessary but not sufficient to what I would like to see, which is an independent editorial voice in global health news.

The news industry as we know it is undergoing radical transformation. It is too busy focusing on survival to care what happens to global health news. The Knight Foundation and others are focusing on local community news and investigative journalism. The foundations that fund global health are taking some baby steps—like the Gates Foundation funding NPR, PRI and the Jim Lehrer show—but they won’t do something bigger, I think, because they don’t want to give up control of the message.

So that leaves the people who are doing it for little or no money, out of passion or as an adjunct to other paying projects. (Heaven help us.)

Meanwhile, how do we get the values, the best of what we aspire to as journalists, as global citizens, baked into whatever the new systems are? I'm going to try buttonholing as many of my fellow participants at the meeting of the Association of Health Care Journalists in Seattle April 16-19 about this as I can. This is not something anyone can do on their own. But is there a critical mass willing to try? That's what I would like to know.

I welcome your thoughts.

Related posts:
Sharing and Global Health Blogging
Update on the Global Health Blogging Experiment
Community Organizing Meets Global Health Blogging
Looking for Context in Global Health Reporting

Friday, March 6, 2009

Can You Improve Wikipedia's Entry on Global Health?

After 27 months, Wikipedia's entry on "global health" is finally starting to take shape. I look at this as yet another lesson on the need to wait for (or build) a critical mass.

Not all conversations on the Web happen so fast and include so many partners that it makes your head spin. Some are so long and laborious that you might think the participants were Treebeard and the rest of Tolkien's Ents. Case in point: the 27-month long conversation behind Wikipedia's entry on "global health."

Back in June of 2005, a volunteer Wikipedia editor who went by the name "Drgregmartin" wrote a short entry on Wikipedia about "global health." A few months later, I came along and did a little copy-editing, added some historical context and a few external links.

By the fall of 2006, this short, not-great entry had morphed into something completely overgrown and unreadable. A number of anonymous users from several universities clearly decided to do a little self-promotion while others added several giant tangents or pet peeves. Eventually, the entry got flagged as "needing clean up."

So far, I have described the natural history of countless Wikipedia entries. An earnest soul writes a short piece, others discover it and soon so many editors have a hand in it that it morphs into something that is far worse than whatever it started off as. In the best circumstances, this chaotic phase settles down and editing becomes much more stable--and the writing and the rigor improve.

Trying to be a good Wikipedian, I started a conversation on the global_health talk page about how to fix the entry and get to the next, more stable phase of Wiki writing. My proposal was met with deafening silence.

Meanwhile, the entry was getting longer and less readable. I contemplated fixing things myself but figured I would be out-revised by the self-promoters. Every once in a while I would come back to check on things. The entry kept getting woolier and woolier. I chalked it up as a reality-check on how Wikipedia works: popular articles are more likely to be better.

But, every now and then, someone would add a comment on the talk page. In more than two years, there have in fact been seven responses--all fairly substantial. And here's the most intriguing thing: they actually can be read as a conversation with genuine give and take.

Gradually, a Wikipedian by the name of Useknowledge came along and edited the entry back to a form that is more manageable.

It is still not perfect, but it is an improvement over the original post. The next step, as someone who may be Evelyne de Leeuw from Australia wrote, is to try to make the focus more health-oriented and less disease-oriented.

So, what do you think? Will a community arise organically to do this or is going to take concerted effort by a few people to create that community?

Some of the more utopian aspects of the web have enchanted many of us into giving credence to an "if you build it, they will come" mindset.

For me, the history of the "global health" entry on Wikipedia so far shows the limitations of that ideal (especially since already there is a new, more sophisticated round of self-promotion happening with external links to a number of academic centers). But I was heartened by the improvements that did happen. I suspect, however, that I may need the lifespan of an Ent to see the full flowering of the global health entry.

Or you could prove me wrong by taking a crack at

Thursday, March 5, 2009

Links: Hidden Good News, Plumpy'Nut, Malaria

Nigerian sisters tell of African good news odyssey
The BBC reports that "Nigerian sisters, Chioma and Oluchi Ogwuegbu, have got fed up with all the bad news out of Africa. So much so that they've embarked on a journey right across Africa to try to draw attention to the good news which doesn't get reported." Go to the Ogwuegbu sisters' website at

Paul Farmer mocks Nutriset patent on Plumpy'Nut
Ha! Farmer told me the same story a year and a half ago. It's the anecdote that got me looking into intellectual property rights and ready-to-use therapeutic foods (RUTFs). According to the Charlotte Observer's account of a recent Farmer talk, "when Partners in Health built a factory and began making its own peanut butter product, Farmer said he got "cease and desist” letters from the makers of Plumpy'nut. “It sounds crazy to argue over peanut butter,” he said. “But patenting some things goes a little too far.” " See my previous Plumpy'Nut posts for more background.

WHO cracks down on new malaria resistance reports that the World Health Organization "has confirmed resistance to the malaria drug artemisinin at the Thai-Cambodia border, prompting urgent action."

Tuesday, March 3, 2009

Jim Kim Goes to Dartmouth

Like others in the global health community, I was surprised to learn Jim Kim is going to be the new president of Dartmouth College. But now an email exchange Jim and I had back in January makes more sense. I was reading it as his thinking through the pros and cons of taking a position in the Obama Administration, if asked. I should have read it as an indication that he was even considering leaving Harvard at all.

Kim clearly sees this as a chance to broaden the reach and influence of the global health movement. He told Tamar Lewin of the New York Times, ". . . what I want to do is train an army of leaders to engage with the problems of the world, who will believe the possibilities are limitless, that there’s nothing they can’t do. Being the president of an Ivy League university is an amazing opportunity.” Kim reiterated that view in his first address to Dartmouth.

But as Alanna Shaikh points out, there is a lot about being a college president that has nothing to do with energizing global movements--especially in an era of global financial turmoil and falling endowments.

Speculation alert: You also have to wonder if the Harvard School of Public Health had become too crowded for Kim--now that it has a new dean, Julio Frenck, the very impressive former health minister of Mexico and a onetime candidate to head the World Health Organization. Was the deanship a position Kim had wanted for himself?

Wonder now what will become of Kim's partnership with Michael Porter at the Harvard Business School. Kim was very enthusiastic about applying some of the tools that business has developed to the challenges of implementation in global health.

Nothing yet about the new appointment on the Partners in Health website. Had to smile at the way Lewin described Kim's career as having been "entwined" with that of Paul Farmer. It has been an incredibly productive partnership with twinges of sibling rivalry at times.

Anyway, it will be interesting to see whether Jim Kim turns the presidency of Dartmouth into a bully pulpit for global health.