Friday, June 29, 2007

Flu Pandemics: When Will the Next One Strike? Take the Poll!

Although bird flu has dropped off the popular press's radar for quite a while now, cases of H5N1 infection in birds and people keep popping up with distressing regularity. So when do you think the next flu pandemic--whether caused by H5N1 or another subtype--will strike? In the next 5 years? 5 to 10 years? 10 to 50 years? Never? Vote for your favorite answer at right. (One vote per IP address.) I'll take the poll down the first week of August and post the answers then.

(Can't see the poll? Let me know at cgormanhealth[AT]gmail[DOT]com)

Friday, June 22, 2007

How Does A Computer Define Global Health News?

I still have a lot to learn about tags, feeds, pipes and customized search engines. I've used all these tools to try to organize news and information about global health. But I haven't yet hit on the best combination to keep me up to date without a lot of time spent trolling the Internet on my part.

My latest frustration: I can't get a single RSS or Atom feed that automatically updates for global health news. Yahoo News will give me various health feeds or world news feeds but nothing that combines the two. I've been experimenting with pipes at Yahoo to combine and filter feeds but am not terribly impressed with the results for global health.

Part of the problem seems to be that it's difficult to create general categories for the blend of articles about economics, health, human rights, environment and policy that makes up global health. The keyword approach (AIDS, G8, HIV, malaria, maternal mortality, sanitation, sustainable development, tuberculosis, vaccine, water, women's rights . . . ) seems way too inelegant.

So, I'm relegated to using my own 'noggin plus Google Reader to share news items that I find interesting on my Global Health Mini-blog at right. It's easy but it's still rather manual.

In the meantime, I've also updated my Technorati Profile to claim this blog as well.

Thursday, June 21, 2007

TB Money, Guinea Worm, TB Textbook

House Approves $50 Million to Fight TB overseas (AP)
But is any of it new money or is it all scavenged from other public health budgets that can scarce afford the cuts?

The Tail End of Guinea Worm (New England Journal of Medicine)
How to eradicate a parasite without drugs or a vaccine. (Article available in full)

TB Textbook Pulished Online
Everything you ever wanted to know about diagnosing and treating tuberculosis.

Wednesday, June 20, 2007

Windmills on My Mind

I hope to meet Ethan Zuckerman, who has been a driving force behind bridge blogging and Global Voices, when I start my Nieman year at Cambridge. In the meantime, I've been lurking on Zuckerman's personal blog--soaking up his coverage of the TED Global meeting earlier this month in Arusha.

While the pointed--and seemingly endless--debate over the value of development aid between Bono and Uganda journalist Andrew Mwenda electrified the e-pundits, Zuckerman has zeroed in on the ingenuity of William Kamkwamba, a young man in Malawi who built a windmill out of discarded items on his family's farm to run a radio and a few other items.

Kamkwamba is surely a young man worth watching--and we may all get a chance to do just that by reading his posts on William Kamkwamba's Malawi Windmill blog.

But it also has me wondering whether wind has been overlooked in the race to find appropriate electrical generation technology for very poor countries? Today's standard-issue solutions favor hydroelectric and coal plants. Visionaries in the northern hemisphere tout solar panels--most of which have to be engineered elsewhere.

And what about the wind? Can windmills really be a cottage industry, with all parts made locally, thereby boosting local economies? Something to think about.

Tuesday, June 19, 2007

Liberals or Conservatives: Who Likes Financial Incentives More?

Funny how using financial incentives to better the health of poor people is a conservative idea that gets attacked by liberals when we're talking about programs in Latin America. But when the subject is paying poor people in the U.S. to go to health clinics or attend school, the idea is a terrible liberal program that's attacked by conservatives.

Or at least that's the way I read The New York Post's skeptical view on the matter. Interestingly, the headline in the actual paper reads "Free Cash" as opposed to the online version, which was "Pay the Poor Plan; 3G to Pass 5 Tests."

Thursday, June 7, 2007

The World Beyond the Silos

Some good discussion over at Tara Smith's Aetiology in response to a few of the points I brought up about global health news coverage at the annual meeting of the Global Health Council last week. As a reminder, you can read the whole speech here.

See also Karen Ventii's Science to Life for more on how science has shaped global health.

Tuesday, June 5, 2007

Congress Gets New Bill on TB Funding

Responding to the Andrew Speaker case, Senators Sherrod Brown, Kay Bailey Hutchinson and Ted Kennedy are set to introduce a new bill to the U.S. Congress asking for increased TB funding at 11 A.M. this morning.

Highlights from Global Health Council Meeting

With this post, I'll have an even dozen from last week's annual meeting of the Global Health Coalition.

I was impressed by the commitment and passion of the attendees, as well as the attempts to get some discussions going across silos. And yet, and yet, I saw once again how fragmented so many efforts seem to be.

For example, Friday morning's discussion on child survival managed to include mothers and women's rights (that doesn't always happen) but left out malaria--one of the biggest killers of children.

Some of my favorite moments:

Hearing Dr. Gebre of Ethiopia, who honored and remembered her sisters--now since deceased--for making it possible for her to go to school and to survive. Click on the following link to read the full text of Dr. Grebe's speech.

The dumbstruck look Lucy Chesire gave me when I asked whether the TB community really needed activists like the AIDS activists of old? I imagined her wondering, "Who is this clueless American reporter who asks such obvious questions? Can't she see how urgent the need is?"

The funny disconnect between Wednesday morning's panel, which cautioned against paying health-care workers more money, with another panel, that afternoon, that promoted the use of financial incentives--for health staffers as well as patients--to reach public health targets.

And of course, she said modestly, my own talk on global health news coverage.

Blog entries of note from other attendees:

Using Mobile Devices to Aid Global Health
" . . . a rather innovative way to use technology to serve more patients with fewer staff." (Forum One's Andrew Cohen on Influence)

Social Marketing at the GHC conference
"The first thing to know about the GHC meeting: it is the gathering for the international health 'industry' " (PSI's Craig Lefebrve on Social Marketing)

Safe Motherhood After 20 Years
" "Why rights?" some have asked. "Why not just stick to health?" It's quite simple: If something is not a right, then it's simply a commodity, and entirely acceptable for some to get it—usually the rich and well-connected—and others not." (GHC's own Nils Daulaire on RH Reality Check)

Monday, June 4, 2007

Bill Frist's New Venture, Smoking, Female Condoms

News you might have missed . . .

It worked for another Bill. Former Sen. Bill Frist says he's going to make global health--particularly the health and well-being of children and their mothers in the poorest parts of the world--the focus of his life's work. According to an interview in the Tennessean, Frist is teaming up with Save the Children on the mother-and-child survival effort and with Bono on a project to interject more discussion of global health in the 2008 U.S. Presidential race. Given Frist's previous track record on the Terry Schiavo case and other health matters, could that signal even greater politicization of child-survival efforts, as Larry Hollon of Perspectives fears?

Smokeout in the Balkans. Bloggers react to the new public smoking ban in Albania and ponder whether Serbia is next. (Hat tip to Global Voices Online)

Bye Bye Condoms. The Ugandan AIDS Commission (UAC) halts distribution of female condoms for two years, saying women found them difficult and even painful to use at times. Or is it that women still don't have much of a say in their sexual relations with men? James Kigozi, a spokesperson for the UAC told The Monitor of Kampala, "Research shows that one of the reasons why the female condoms were not popular is that women are not empowered in society and therefore their husbands and boyfriends were forcing them to remove them after they had inserted them." (The Monitor)

Saturday, June 2, 2007

Christine Gorman's Global Health Talk

I gave a talk on May 31, 2007 at the annual meeting of the Global Health Council about covering global health: who's reporting, who's listening and what stories are we missing? Several people asked for a copy of my remarks. So, scroll down if you want to see my notes (with a couple of links thrown in). I can't promise that I gave the speech verbatim as you see it here, but it was pretty close.

Covering Global Health News

Thank you, Laura and members of the Global Health Coalition.

In the next ten minutes I hope to do three things: celebrate some highpoints, share a few concerns I have about global health news coverage and issue a challenget

The challenge is to those of you in the room who don’t consider yourselves to be journalists.

Could I get a show of hands of all the non-journalists in the room?

Okay. Consider yourselves warned. I’m going to make a challenge to you at the end.

First up on our whirlwind tour is AIDS. Journalists have written and produced so many words and images about AIDS over the past two decades that it has led to some of our best as well as some of worst work. Twenty years ago, I was told by a top editor at TIME that we could not use the phrase “full-blown” to describe anything having to do with AIDS in our family-friendly magazine because it sounded perilously close to “blow-job,” which, I guess, is what he imagined all those previously invisible gay men must have been doing to create this epidemic in the first place.

Nowadays, we don’t have to talk about HIV in whispers and innuendo—at least on the official level and to varying degrees throughout society, whether in North America, Europe or in most developing countries.

Of course in the U.S., we’ve gone in the 1980s from NOT talking about AIDS in the to the 1990s in which we talked quite a LOT about AIDS in the US while ignoring the rest of the world to the past seven years or so in which we’ve talked quite a lot about AIDS in the rest of the world while ignoring it in the U.S. So the circle turns.

Trailing AIDS in number but not necessarily in quality, we have a range of stories about malaria, tuberculosis and polio, with a smattering of offerings on diarrheal diseases, genital mutilation and rape—any one of which quickly disappears under the occasional flood of bird flu news.

These single-issue stories are the easiest ones for us journalists, driven by ever-shorter deadlines, to understand and produce. A single illness, a single vaccination campaign, a single celebrity or event gives us focus and provides the inherent structure for the story.

While I’m at it, I’ve heard a little grumbling over the past couple of days about how AIDS sucks all the oxygen—and the grant money—out of the room. Let me just say that if there hadn’t been so much coverage on AIDS over the past few years, I doubt there’d be as much interest in malaria, tuberculosis, guinea worm, etc. as there is now. AIDS has opened the eyes of many in the First World to the health problems of the Third World.

Okay, so journalists are not so good at writing the stories that cut across lines, across diseases, across silos. Sound familiar?

But back to journalists. Let’s be honest. Stories that cut across silos are tought to write. And, they’re tougher stories to sell to our editors, the gatekeepers of what gets published in the traditional media.

Still, there are a few stories that get at some of this interplay:

• Ciara Curtin’s piece in Scientific American last December about the link between new highway construction in Ecuador and the spread of diarrheal pathogens. In fact, there’s a whole genre of highway and health stories. Highways and emerging diseases. Truck routes and HIV.

• Celia Dugger’s front page article in the New York Times that looked at the difficulties of QUOTE getting an unwieldy collection of international organizations and charities to work together effectively UNQUOTE to use everything from vitamin A supplements to bed nets to measles and polio vaccines all at the same time to combat common preventable diseases in children.

• Various reports in the Ugandan press probing corruption in the ministry of health and beyond for misuse of GAVI funds.

We need more of these—a lot more of these stories that cut across categories.

What other themes are we missing?

Here are my top three:

1. The foundational roles that clean drinking water and basic sewage treatment play in promoting health.

2. The growing threat of all the drug-resistant microbes combined—staph, strep, tuberculosis—and our own role in making matters worse.

3. The preference for pills over people—doctors, nurse, health community workers—when it comes to funding basic healthcare infrastructure.

After that, if I could just name a couple of others—although there are many more:

The extent to which international agencies and non-government organizations actually cripple the public sector by luring the few doctors and nurses out of public hospitals and clinics.

Any real critical analysis of the Gates Foundation’s effect—both positive and negative—on global health efforts. It has certainly grabbed a lot of people’s attention. And done a lot of good. But does it have too much power? Is it scaring off other donors? Shoving aside effective, more home-grown or low-tech efforts?

Any stories about successes. Any stories in which success is credited to local organizations and leaders and not just the benevolence or foresight of international agencies and non-government organizations.

Which brings me to WHO is being left out of stories on global health.

Next time you read a news article on a global health issue or look at the accompanying images or the standalone video, ask yourself who are the actors and do-ers in the story and who are the recipients, the acted upon? Chances are the people who are fighting the good fight are from the richest countries of the world. And everyone else is either grateful, passive or ignorant. Come on. Does this really reflect reality on the ground?

My hope is that as more journalists in the poorest parts of the world write more extensively about health issues and their work becomes more widely available, we’ll hear more about these homegrown heroes of global health. And that there will be more give and take about what’s really need and who’s really benefiting from all these worthy programs.

Finally, about that challenge to those of you who don’t consider yourselves journalists. You may not have noticed but the field of journalism—at least as practiced in North America and Europe—is itself going through tremendous upheaval right now. There are lots of reasons for this but most of them trace back to the Internet and the evolving digital revolution that makes it possible to dispense with the middleman-or-middlewoman from any social, commercial or political interaction. Just look at what’s happened with real estate, automobile sales and financial services.

As for journalism, what it means is that there are fewer beat reporters, people who are given the time and resources to specialize in a particular topic. There are fewer book reviewers, fewer environment reporters, fewer film critics, fewer health reporters and certainly fewer journalists who can report exclusively on global health issues.

That’s the bad news.

The good news is that you have an opportunity now, as never before, to get your story out—and I don’t mean simply by posting all your press releases on the Internet, although that’s a start. And I certainly don’t mean by e-mailing ME your press releases.

Blast e-mail is dead, killed—much like antibiotics—by indiscriminate overuse. The noise to signal ratio has gotten so high in the flood of emails that journalists receive that most of them—at least the smart ones—are ignoring blast e-mails and relegating more and more of them to their spam filters.

What’s taking their place? Filtered RSS feeds, web alerts and the creative use of search engines. I don’t have time to go into all the details here but suffice it to say that RSS stands for really simple syndication. It’s a great way of creating a sort of web-friendly ticker tape of news, email posts or alerts that interested individuals can subscribe to, search and even filter for keywords as they drill down in the search for timely news and information. If you’re interested in getting the word out about your program, your ideas, your policy proposals and values, you need to know about RSS.

You probably also want to consider applying for some of the free ads is making available to non-profit groups whose missions QUOTE range from animal welfare to literacy, from supporting homeless children to promoting HIV education UNQUOTE.

I can’t tell you how much the journalists who are left are scouring web pages, reading RSS feeds and checking search engines in their quest for new stories and new angles for ongoing stories.

I call this search-engine journalism and what it means is that you don’t have to bring your story to individual journalists so much as you used to, figuring out who to contact and when. Instead, interested journalists will find you—and, guess what, they won’t all be from the New York Times. They may not even look like regular journalists. My regular reading includes such blogs as Aetiology, Effect Measure, Larry Hollon’s Perspectives and Global Voices Online. You can find the urls for these blogs, as well as a copy of my remarks on my website

So my challenge to you—while you’re waiting for the traditional media to catch up—is to write your own articles and produce your own slide shows, video and other multi-media—leavened with a touch of Daily Show humor if you’re serious about reaching a wider audience. You should actively contribute to the rich interplay of ideas that is happening on the web. You may be surprised to learn just how often the media follow, as well as lead.

Thank you very much.

Friday, June 1, 2007

More questions on Timing of Speaker's TB Diagnosis

Update: Mike Stobbe has sketched out some of the early dates in Andrew Speaker's odyssey with tuberculosis in a June 4 report from the Associated Press. It still doesn't give a sense of how long it takes to diagnose tuberculosis, in any form, in the first place.

What did Andrew Speaker's doctors know and when did they know it? That's what I keep asking myself as more details filter out about why an Atlanta lawyer with a dangerous form of tuberculosis felt it necessary to elude federal health authorities earlier this May.

Something Dr. Ken Castro of the CDC said at today's TB session at the annual meeting of the Global Health Council underscored the point. Castro was speaking via a video hookup from Atlanta. "It was only after he [Speaker] left and was in Europe that we learned he had XDR-TB," Castro told the gathering of public health and development staffers, activists and business people.

Now, here's the curious thing: Dr. Castro went on to say that it took 18 days for the first culture to be positive (which proved the lawyer had TB). "Then it was several more days, months to learn the drug sensitivity," Castro said.

Was that a simple slip of the tongue or did it really take months to learn Speaker's TB was highly drug resistant? Was he getting treatment in that time?

In any event, the delay shows why a rapid diagnostic test is needed for TB in all its forms. If a rapid test had been available, doctors would have known before Speaker left for his wedding that he had extensively drug-resistant TB and likely would have been able to keep him from going.

From Rock Hudson to Andrew Speaker

Lots of consternation at this morning's panel on drug-resistant tuberculosis that Andrew Speaker's name was published in connection with his case of extensively drug-resistant tuberculosis. The docors and public health experts attending the panel expressed concern that Speaker, who successfully eluded health authorities in order to get back to the U.S., might get turned into some kind of super TB villain.

Shades of the early days of the AIDS epidemic, when there was talk of publicly identifying folks who were infected so that the rest of the community could protect itself, whatever that meant.

In fact, if history is any guide, the sensation over Speaker's case will subside as people adjust to the new situation.

In fact, Andrew Speaker, who is not your typical TB patient--because he is white and certainly not poor, may do for tuberculosis what the actor Rock Hudson did for AIDS years ago. He may help more and more Americans realize that "TB anywhere is TB everywhere."

Where Are Dr. Grebe's Sisters?

Only someone with a heart made of stone could be unimpressed by the people and groups who were honored at last night's banquet dinner at the annual meeting of the Global Health Council. What I most want to remember from the evening is the impassioned speech for women and against female genital cutting by Dr. Bogaletch Gebre of Ethiopia.

Dr. Grebe founded an NGO called the Kembatti Mentti Gezzimma or Kembatti Women's Self-Help Center in Ethiopia in 1997 as a way to empower women and help them and their brothers, fathers, uncles change the cultural practice of scraping or cutting away the clitoris of young girls.

In accepting the 2007 Jonathan Mann Award for Health and Human Rights, Dr. Grebe honored her own mother, who she said was her mentor, and her sisters, "who carried my burden" so that she could continue her schooling and become an epidemiologist. In a strong voice that cracked at times with the power of deep-felt emotion, she then relayed that all her sisters, the ones who had pulled together to give her a chance, had since passed away.

It made you think how many other voices have been silenced before their time because of the fatal effects of extreme poverty, because of the continuing second-and-third class status of women in so many countries.