More on the Plumpy'Nut controversy in India. Cipla, a company more famous for its generic versions of AIDS drugs, makes pre-packaged food supplements for export to Africa, according to claims no market in India. I find this hard to believe and hope "More on Cipla, Plumpy'Nut and India."
The Indian government has told Unicef to stop using Plumpy'Nut for the treatment of severe acute malnutrition in that country over concerns about importing and becoming dependent on "foreign food." This is a separate issue from the patent controversy that I have blogged about in the past.
The Indian government questions whether RUTFs (ready-to-use therapeutic food) are better than hot-cooked food, as reported by the Times of India.
On that score, the government's concerns about efficacy seem overblown. Plumpy'Nut is a fortified peanut paste that has a good track record as a ready-to-use therapeutic food in several African countries. And hot cooked meals aren't going to provide the concentrated calorie and nutrient power needed in an emergency situation.
But the larger issue--of having to depend on commercial food imports should not be dismissed lightly. Yes, there's a strong whiff of protectionism but that's understandable in light of the growing crisis in the world's supply of staples. (See Lester Brown's article in Scientific American, or for an even more provocative view, this piece by Deborah Fahy Bryceson in the Monthly Review.)
The solution to the Indian impasse, as reported in the Times Online, may be to use locally produced RUTF. Two Indian companies are starting to get into the business of doing just that.
Two carefully researched reports in the Lancet argue that the world is not getting its money's worth in global health.
The first, from the World Health Organization, says that a focus on making improvements in individual diseases--like AIDS--has come at the expense of comprehensive programs that offer treatment for all the most pressing health problems.
The other, from Institute for Health Metrics and Evaluation in Seattle, documents a quadrupling of funds for global health since 1990 but shows that some of the poorest countries with the highest disease burdens have actually received less help than somewhat healthier and wealthier countries. In addition, the IHME paper documents the shift in power and influence from government and public agencies to private foundations--like the Gates Foundation, which funded the study--and individuals.
Both research articles--and the accompanying comments and editorials--are well worth reading at length and at leisure (which I plan to do this weekend). I do not know if these articles will spur any changes in direction or action on the ground but I have a feeling we will be hearing about these pieces for some time to come.
Several of the blog posts I have read so far about these studies are rehashes of the press releases that accompanied them. Given the nuances of the arguments and the complexity of the data, it may take a while for more thoughtful reviews to appear.
Maria Cheng's article for the Associated Press is a good, if basic, introduction to the papers. Kaiser Health News says they will post an aggregation soon--and here it is.
Sandi Doughton of the Seattle Times lifts the lid a bit on one of the more exclusive clubs in global health--the Health-8 or H8--meeting this week in Seattle.
Her report documents one more step in the ongoing privatization of global health as power and influence drain away from public groups--like the World Health Organization--to private foundations and non-profit organizations.
Given the reactions in Doughton's article, folks don't seem too concerned about the lack of transparency. After all, it's not like Hilary Clinton having secret talks about health care during her husband's administration or Dick Cheney chatting about energy policy with petroleum execs--right?
Related Post:
Who are the Health 8 (or H8)?
Here is another example of why we need more independent reporting on global health and development. A study from the Public Library of Science found that many global health initiatives are still effectively siloed efforts that focus on single diseases or institutions and do not, despite claims to the contrary, support overall health systems.
And yet, as I have seen in my own travels through Malawi, Lesotho, South Africa and Zambia, improving health systems is precisely what is needed in many poor countries and impoverished areas. "Health system strengthening" has become the new catchphrase but, according to the PLOS report and the lived experience of many in the global health field, there has been no real change in action to support this goal.
One positive trend: the researchers note that while their funding came from the Institute of Tropical Medicine, Antwerp, "the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." This slightly more detailed conflict-of-interest statement should be adopted more widely when reporting or writing about global health.
Related post:
Who Pays for Global Health News and Why?
Reuters reports that three girls' schools in Afghanistan have now been the targets of improvised gas attacks. Five girls fell into comas for a short while after the most recent attack, which occurred on Tuesday, while 100 others were hospitalized. Apparently, throwing acid at some girls, wasn't enough to convince many of their sisters to stop their education.
The news of the attacks has kept hundreds of girls from showing up at school, according to the Associated Press.
Still unclear: what kind of gas was used. Blood samples have been sent for testing. There is also a chance that a gas leak--as opposed to a premeditated attack was involved at the third school.
Also disturbing, the attacks are happening in Kapisa province, a region east of Kabul that has been relatively open and supportive of girls' education.
Related news:
Katie Couric had a piece on the CBS News about the assassination of a women's rights activist in Afghanistan and the passage of a new law that (may be changed) that would allow marriage as a defense against rape.
Is there a way to combine human and technological intelligence to figure out what is going on in a tiny section of Sri Lanka, which suffered heavy bombardment this past weekend? Can you, dear reader, help collect that information?
The American Association for the Advancement of Science has published satellite imagery which suggests heavy shelling and mass movement of people. (hat tip @mwmcelroy who works at the AAAS.)
According to the Associated Press (as quoted in the New York Times), "a government doctor said at least 378 civilians — and perhaps as many as 1,000 — had been killed and more than 1,100 wounded on Saturday and Sunday during intensive shelling of the combat zone on Sri Lanka’s northeastern coast, a boggy sliver of beachfront where Sri Lankan troops have surrounded Tamil separatist fighters." (Click here for the full AP report, which details three rounds of shelling on the hospital.)
Journalists report not being allowed into the area to report on what is going on.
This seems like quite a test case for folks who promote the benefits of crisis-mapping.
Crisis-mapping is an emerging technology that uses SMS or mobile texting plus other crowd-sourced pieces of information to map a crisis, while it is happening. The idea is to give folks on the ground as well as those far away some idea of what is going on and which areas are particularly dangerous in real-time. Click here for a video introduction to crisis-mapping from Patrick Meier, whose dissertation features a lot about crisis-mapping and who has been traveling the globe recently introducing folks to it.
I am asking my larger Twitter and blogging community for help in gathering resources. Will share the results here.
What's missing from the latest news about the World Health Organization, DDT and malaria? Context! Context! Context! Namely, if DDT had been used from the time of its invention only for public health purposes--for indoor residential spraying against mosquitoes in areas hard-hit by malaria--it would probably never have developed its toxic reputation.
The fact that agricultural interests--particularly cotton farmers--adopted wholesale DDT spraying is what killed birds and poisoned entire ecological systems.
There is a special case to be made for judicious, environmentally-protective DDT spraying of residential homes--particularly in hard-hit African countries. South Africa has shown how to do this and still protect the environment. (I wrote about this in TIME Magazine five years ago. Please also note, it was the combination of DDT and treatment with an anti-malarial drug that turned the tide.)
The World Health Organization seemed to have acknowledged that point back in 2006.
Now comes word that they hope once again to achieve a total ban on DDT, thanks to pilot programs that have used other anti-mosquito pesticides and means in Mexico and Central America. Please note: malaria is much worse, much more prevalent in central and southern Africa so what works in Mexico may have little effect in malarial zones of Africa.
As for increased resistance of mosquitoes to DDT, the point is actually not to kill the mosquitoes but to keep them from biting. And DDT is actually a better mosquito repellent than anything else--exactly what you want, according to a 2007 study in Nature Medicine.
I suppose all public health programs have an element of politics but I find it very frustrating to read news reports that pretend that all decisions with respect to DDT are made solely on a scientific basis.
Related posts:
Can Malaria Be Eradicated?
Human Health Effects of DDT
Is it me—or has there been more uninformed reporting than usual over the past few days about the developing outbreak of human swine flu? Could it be the wholesale exodus of experienced health reporters from many newspapers and magazines is having an effect on the quality of coverage? Flu is not a topic that general assignment reporters can easily get up to speed on overnight.
I have read news reports cautioning people not to get near pigs for fear of contracting swine flu.
Not true. The new human swine flu is transmitted from person to person. So you minimize your risk of getting it by keeping your distance from other people, washing hands, reminding folks to cover their nose and mouth when they sneeze.
A number of news articles ominously report that the new human swine flu is H1N1—the same subtype as was responsible for the 1918 pandemic. The implication—that a terrifying type of flu has come back after more than 90 years.
Yes, the 1918 flu was caused by an H1N1 strain. But the H1N1 subtype is now very common. Indeed, it has caused many seasonal flu outbreaks over the past 90 years. The current vaccine even includes a strain of H1N1, first identified in Brisbane in 2007.
So if the new flu is H1N1 and H1N1 subtypes have been around for years, why are health officials so worried? Because the arrangement of genetic components of the new flu have never been seen before—whether in pigs or people. And they are different enough from the recent strains that the body’s immune system may not be able to mount a quickly effective response.
Many news sites are also reporting as fact that the flu is killing more people under the age of 60 than the usual seasonal flu. We don’t actually know this for sure.
Yes, there have been lots of reports of middle-aged people dying from the flu in Mexico. That’s worrisome because it’s the same pattern of fatalities that was seen in the 1918 pandemic. But that is only part of the story. There are other possible explanations for the pattern of middle-aged deaths: maybe those were the folks who went to the hospital first. Maybe health officials haven’t paid as close attention to deaths among the elderly because they are so much more common. It could still be a true cluster of middle-aged deaths but we probably won’t know that for at least another couple of weeks.
Lots of headlines are also proclaiming that countries are racing to “prevent the pandemic.” Sorry, that horse is out of the barn. This flu has already been confirmed in Mexico, the U.S., Canada and cases are suspected in New Zealand, Israel and Western Europe. If there is going to be a pandemic, there will be a pandemic. That will depend on how virulent the virus is—something that we don’t know yet.
What people can do is mitigate the damage. Sort of like a hurricane. You can’t stop it from coming ashore but you can try to protect as many people as possible from drowning.
In addition to newsfeeds at the Centers for Disease Control and the World Health Organization, here are some of the folks I have come to trust for information on the current flu outbreak:
Anything written by Helen Branswell, Canadian medical reporter. Her coverage of flu and the potential for pandemic flu over the past several years has been stellar. She is also @diseasegeek on Twitter.
Tara Smith at Aetiology. Tara is an assistant professor of epidemiology, whose research focuses on pathogens that jump from animals to humans. Very readable and very smart.
The Reveres at Effect Measure. Anonymous, opinionated but well-informed, from public health professionals.
Crof at H5N1. Crof has been a smart aggregator about avian flu and potential pandemic news for years but is now including human swine flu.
The pandemic flu section of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.
Good, if technical overview on swineflu, also at CIDRAP.
And here are some web resources to understand flu and potential flu pandemics better. I’m chasing down links to some other tools and will add them as I learn them.
One-stop access to US government information on pandemic flu
The Nieman Reports special issue on preparing to cover pandemic flu
Association of Health Care Journalists ($60 per year). Members have access on the website to excellent content created specifically for journalists covering flu. (Update: AHCJ has now made its flu resources freely available.)
The basic science section of the Flu Wiki
WHO's excellent guide to risk communications in a pandemic
General overview on pandemic flu, with history, by US government's Health and Human Services.
Related blog post: Swine Flu: Stocking Up On Soup, Just In Case
(Updated April 30, 2009)
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 celebrateafrica.net
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
Scidev.net reports that the World Health Organization "has confirmed resistance to the malaria drug artemisinin at the Thai-Cambodia border, prompting urgent action."
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.
Two important news items that should be getting more attention. The first is on a "midnight rule" change from the former Bush Administration that is just coming to light. The other is on a unique partnership between a journalistic outfit and a global development organization.
Well, this is bad news
Maryn McKenna tells us "the FDA has quietly reversed a decision it took last summer, and will allow cephalosporins, a human medicine, to be used without restriction in food animals." McKenna takes the time to put the news in context and add some of her own reporting--good journalistic habits. About that headline . . .
Media and Development
Excellent post from Larry Hollon at Perspectives about an "agreement between the African Medical and Research Foundation (AMREF) and the Guardian, the London-based daily newspaper, to document a development program in Katine, Uganda." I was most struck by Larry's concise summary of the high expectations and journalistic conflicts that accompany such projects.
Filipino tests positive for Ebola
From Reuters in Manila: "At least one person has tested positive for the Ebola-Reston virus in the Philippines, where the disease has broken out in pigs at two farms north of the capital, the government said on Friday."
Are Working Toilets A Good Anti-Corruption Indicator?
From the BBC's Mark Doyle: Reading official reports about corruption can be so boring. Doyle's lighthearted look at whether working toilets indicate progress against corruption in Sierra Leone.
The Challenge of Iodized Salt
From Alanna Shaikh, who just moved to Uzbekistan Tajikistan: A quick look at why it is so hard to make iodized salt universally available.
While the rest of the world was focused on the peaceful transition of power in the U.S., Iranian AIDS doctors Kamiar and Arash Alaei learned on January 20 that they had been sentenced to three years and six years, respectively, in prison, according to Physicians for Human Rights.
The Alaei brothers' case is one of several recently in which professionals and religious minorities have been falsely accused of fomenting revolution. Lawyer and Nobel Laureate Shirin Ebadi's Human Rights Defenders Center was raided and shut down by police in December (Los Angeles Times). Her former secretary was arrested earlier this month in a roundup of six B'hai women (B'hai News).
(Update: The LA Times says Sylvia Hartounian, 33, a reproductive medicine specialist, was sentenced along with the Alaei brothers.)
Radio Free Europe has a good summary article that ties all these moves to internal Iranian politics--trying to sow fear among the Iranian electorate ahead of presidential elections in June.
The Washington Post quotes an unnamed Iranian official as saying the brothers' treatment is part of a "full-fledged intelligence war" between the U.S. and Iran. "A soft revolution has been programmed against our country and carried out in some instances, but it was suffocated in the cradle," the Iranian official was quoted as saying.
Further update (1/29/2009): For deep context, listen to Jeb Sharp's excellent podcast on Public Radio International's "The World" about the long-term damage to US-Iranian relations caused by the 1953 coup engineered by the CIA.
Related posts:
Jailed Iranian Docs
Jailed AIDS Docs Tried in Secret
Sentences Expected for Iranian AIDS Docs
The decision to censor Gene Robinson's prayer at yesterday's pre-inaugural concert in Washington, D.C. meant HBO's television audience also did not hear his call to do more about "women [who are] raped because they want an education" and the "thousands [who] die daily from malnutrition, malaria and AIDS." Interestingly, the openly-gay bishop also reminded folks of something that many conservatives have been saying lately, too--sometimes more crudely than other times--that Obama is not the Messiah.
AfterElton.com reports that HBO says it was only following the Inaugural Committee's wishes not to air the pre-concert show.
Christianity Today posted a video of Robinson's prayer on Youtube. (Episcopalcafe has text of the prayer.)
My two cents: I believe all prayers are heard by God. Whether or not the rest of us pay attention is another story.
Opposition to the possible nomination of Sanjay Gupta as Surgeon General is building.
"CNN journalist lacks independent voice to be surgeon general," says Peter Canellos today in the Boston Globe. Representative John Conyers of Michigan is pushing a different candidate, Dr. Herb Smitherman, a public health advocate from Detroit.
I still find it hard to believe Gupta will take the position. He will have a much smaller staff and much tinier budget than he is used to at CNN. Sanjay looks good on television because he is talented but he also has some very capable producers helping him.
If the Surgeon General were just a health educator, then Gupta, who I like very much (for one thing, he never gave me grief when I edited his columns at TIME), would be a surprising but logical step. But there are also policy issues. The SG is supposed to lead the 6,000-person U.S. Public Health Service Commissioned Corps. (Per comments on one of my earlier posts, morale there seems very low.) There is also talk Gupta will play a role in the Office of Health Reform (Washington Post), perhaps as salesman for whatever national health care reform the Obama Administration offers?
I would also like to know a lot more about Gupta's relationship to the pharmaceutical industry. This is a question I would ask of any doctor or health journalist who is being considered for government office--and Gupta is both.
We all know that advertising and corporate sponsorship make mainstream media possible. That is why you need to look at the firewalls between the sponsors/advertisers and editorial side in any specialized field, but especially in health, to make sure they are solid.
This is especially true when there is a single sponsor for a television program or print column. Anyone who cared to flip through the pages of TIME Magazine from a few years ago would see that Gupta's column always ran next to ads from Pfizer. The New Republic has written about the pharmaceutical industry's sponsorship of CNN's AccentHealth.
In addition, the practice of accepting speaking fees from pharmaceutical companies is very controversial, to say the least, among health journalists. I have written about why I do not do it. Just last November, we learned that psychiatrist Fred Goodwin, host of NPR's Infinite Mind, received more than a million dollars in consulting fees from drug companies (New York Times). That little conflict of interest left a huge black eye on NPR.
So, I would also like to know a lot more about the speaking fees that Gupta has received over the years from pharmaceutical companies.
This is more than I had planned to write about Sanjay Gupta as Surgeon General. But this is something new for health journalism--a health journalist being tapped for a high government position.
The revolving door between government and politics is a lot more common for my colleagues in political journalism--where the potential conflicts there have been looked at in greater depth.
If Gupta and the Obama Administration are serious about the Surgeon General's position, then we need to examine this possible nomination more closely.
Related posts:
AIDS Docs, Gupta, Measles
Questions About Gupta for Surgeon General
Update: See also Gary Schwitzer's extensive critique of Gupta's journalism. Schwitzer used to be head of the medical news unit at CNN.
I missed this study from Pediatrics over the New Year's holiday. Researchers say "third hand smoke," which is smoking residue that lingers in people's hair or clothing, can damage the health of babies. A new survey shows that most people are unaware of the danger. So, even stepping outside to smoke does NOT protect infants from third-hand smoke. (Discover Magazine)
Obviously, no one in this day and age should be smoking--whether it is cigarettes, pipes, cigars. And yet, I have a question. Is third-hand smoking less harmful than second-hand smoking? Given the addictive nature of smoking, we don't want current smokers to just throw up their hands and decide to come into the room and smoke near the baby because they are "damned if they do and damned if they don't."
Read an abstract of the Pediatrics' study on attitudes about second-hand and third-hand smoke here.
Two internationally known AIDS doctors were tried in secret in Iran on Dec. 31, 2008, according to reports received by Physicians for Human Rights. Drs. Arash and Kamiar Alaei were arrested back in June, apparently on suspicion of traveling to international AIDS conferences as a cover for spreading revolution in Iran.
Their plight has not received anywhere near as much attention as that of Iranian-American academic Haleh Esfandiari, who was detained under similar charges in 2007 before being released after 110 days in prison.
The U.S. State department released a statement (updated link here: apparently with the change from Bush to Obama Administrations, all the press releases were archived to a different place in the ether) about the Alaei brothers' situation in Iran on Tuesday, Dec. 23. In the statement, the State department also condemned the closing of the Center for the Defense of Human Rights, which was founded by Iranian lawyer and Nobel Peace Prize winner Shirin Ebadi.
Here's an excerpt from the latest press release from Physicians for Human Rights:
The doctors have been held in Tehran's notorious Evin prison since late June 2008. They were indicted in December on charges of communicating with an "enemy government" according to their attorney, Masoud Shafie.Related post: Jailed Iranian AIDS DocsOn December 31, the Iranian prosecutor tried the brothers in Tehran's Revolutionary Court on these charges, and also informed the court of additional, secret charges which the brothers' attorney had no opportunity to refute, because the prosecutor did not disclose either the charges or the evidence on which they are based.
Back in November when I saw that New York City had turned to computerized mapping software in its renewed fight against rodents, I knew I wasn't going to be satisfied with just a quick blog post. I had to learn more.
After 19 hours of work, including a wonderful but very cold expedition to the Bronx to see Bobby Corrigan and Mike Mills at work, I produced a written piece on rat mapping for Time.com and did the voiceover for the video, which was shot and edited by Ed Robbins.
It's kind of fun to compare the two projects. Text is great for information--and there's plenty of it in my text piece. Audio is ideal for emotion and I recorded several versions of the voiceover--some that sounded a lot more menacing than the one the editors ultimately used. And the video did a much better job of giving you a sense of Bobby's and Mike's personalities than my written piece did.
The written piece was picked up by CNN earlier this month and was one of the most popular pieces on Time.com for a while.
But enough with the media commentary: more importantly, the rat map has helped drive the number of rat problems in the Bronx down 40% in the past year.
Below is a screengrab from NYC's rat map of the abandoned house (upper left corner) where Bobby and Mike introduced Ed and me to their work. (You may need to click on the photo to see the detail.) The official rat map interface is a bit clunky but it yields an utterly fascinating view of New York City.
Seasonal flu. Health experts announce that this year nearly all H1N1 viruses are resistant to oseltamivir (sold as Tamiflu) and responsive to adamantane, amantadine and rimantadine. The opposite is true for H3N2 viruses. (Toronto Sun)
Abortion. Blogger roundup about abortion and women's rights from Brazil (Global Voices Online)
Science Commons. Google shutters its science data service before it is even launched (Wired)
TB. How evolution and human migration make controlling drug-resistant tuberculosis even harder than you think (PLoS Biology)
