Wednesday, December 31, 2008

Top 5 Blog Posts for 2008

My top five 2008 blog posts, based on unique page views:

1. Demand for Plumpy'Nut Outstrips Supply

2. At Work with Malawi's Nurses

3. Who Are the Health Eight (or H8)?

4. Al Gore: Clean Coal is a Lie

5. Agnes Binagwaho on Brain Drain

When I look at the analytics graphs for these posts, I am struck once again by the ways in which the Web captures ephemeral posts and makes them permanent.

The Plumpy'Nut post received the greatest number of unique page views. In fact, even my posts from 2007 on the controversy surrounding the patent for this nutritional supplement, which helps to save the lives of starving kids, still get a lot of hits. Intriguingly, views of the the post on the demand for Plumpy'nut peaked in July, two months after the post first appeared.

I'm glad to see "At Work with Malawi's Nurses" continues to be popular since it describes the focus of my Nieman Fellowship field project and has occupied a lot of my psychic energy over the past year. It's still chugging along at 58% of its peak back in March.

"Who are the Health Eight (or H8)?" about eight big players in the global health field continues to amaze me. It has had two peaks since it first appeared in April (the second, taller than the first, coincided with the July meeting of the G8 on health in Tokyo) and is currently on its third big upward slope, which seems likely to beat the other two.

My very simple reporting of Al Gore's speech at the Clinton Global Initiative in September, in which he called the concept of "clean coal" a lie, got attention from both the left and right zones of the blogosphere. It is on a second surge, possibly related to the coal ash spill in Tennessee earlier this month.

And the Agnes Binagwaho post, in which she speaks movingly of her own temptation to quit practicing medicine in Rwanda, has the most intriguing web analytics profile--a couple of peaks and valleys that also grow in popularity and that I think mirror the different speeches she has given on university campuses in the U.S.

Tuesday, December 30, 2008

ProPublica and Conflicts-of-Interest

Hmmm. In a lengthy piece that was otherwise mostly about Herb and Marion Sandler, the New York Times reported last week that Paul Steiger, the editor-in-chief of ProPublica, contacted Lorne Michaels at NBC to protest an utterly tasteless, wickedly funny and potentially libelous skit on Saturday Night Light. The skit depicted the Sandlers, who are the major funders of ProPublica, as corrupt peddlers of predatory mortgages and "people who should be shot."

Okay, so SNL clearly went too far with the "people who should be shot" bit. But the New York Times piece by Michael Moss and Geraldine Fabrikant does make you wonder if maybe the Sandlers should go to jail.

At any rate, NBC pulled the full video from its site and substituted a redacted version that leaves out the Sandler segment entirely--not just the offensive "should be shot" title--but the whole thing. The conservative blogosphere had a field day with this when the flap first occurred in October. But Steiger's role, as far as I can tell, did not come out until last week.

And that's the part that interests me the most at the moment. I'm also teaching a class next May and June on journalistic judgment, although it's about science, health and environment reporting.

Every form of journalism has to deal with conflicts of interest--no matter where the money comes from to pay for it. There is nothing about being a nonprofit organization that earns you a free pass.

This was very clear to me last spring while I was researching and developing a business plan for launching a global health news service. And yet, I was surprised at how much pushback I got on this issue.

This is not rocket science. I am sure that ProPublica has a conflict-of-interest policy for its individual news staff. They should also come up with a policy for its coverage and comments about the Sandlers. Then, they should post their conflict of interest policies on their web site (that section on "privacy policy and other terms" looks about right) and move on.

Ditto for news organizations that take Gates Foundation money to cover global health.

Oh yeah, and as more advocacy groups engage in journalism, they are going to have to come up with their own policies on conflicts of interest.

As for my own potential conflicts: I am a freelancer and former TIME Magazine writer who is passionate about global health and would like to be paid for what she writes. (Believe me, AdSense is not the way to make money in this business.)

Although advertising paid for my salary at TIME, my contacts with the business side were severely limited. In addition, I do not directly own any pharmaceutical or biotech stock. I do not take consulting fees from same. My Nieman Fellowship was paid for by the Gates Foundation but they had no say in my Malawi project.

Writing it down like that is a good reminder.

Monday, December 29, 2008

Video: Mapping NYC's Rats

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 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 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.

AIDS Denialists at

Looks like the AIDS denialists have made a run at, I hasten to add, is not affiliated with, the Obama transition team website. Questioning whether HIV is the cause of AIDS is now the second most popular item in the global health category of

It's not enough that AIDS denialists have killed at least 330,000 people in South Africa alone. It makes my blood boil to think their juvenile antics, like flooding the simplistic popularity contests at, will keep even a single person with HIV from getting the treatment that she or he needs.

Some valiant commenters have taken up the fight and taken on the denialists at The guy who originally posted the idea is a total lurker. As of this morning his profile shows he supports no non-profits, has taken no actions, raised no money or recruited anyone to any cause.

Memo to folks: you have been punked.

Monday, December 22, 2008

Wanted: A Brief History of Ideas

Journalists are often told to skip the history when writing the news. Contemporary context is okay. Extended history is out. In rethinking that advice, I offer up Tina Rosenberg’s masterful article on poverty in the Sunday Magazine of the New York Times.

In a few paragraphs, Rosenberg covers nearly half a century of thinking about “the culture of poverty”—at least as far as U.S. intellectuals have described it.

Summary and synthesis, the history of ideas.

That’s increasingly what I am looking for—whether in old media or on the web. And what I find missing in so many discussions about global health.

From Rosenberg’s NYT article:

FORTY-NINE YEARS AGO, the anthropologist Oscar Lewis published a book called “Five Families: Mexican Case Studies in the Culture of Poverty,” detailing a single day in these families’ lives. One family, headed by Jesús Sánchez, a food buyer for a restaurant, continued to tell its story in a second Lewis book, the widely read “Children of Sánchez.” Lewis singled out elements of a culture that, he argued, keep those socialized in it mired in poverty: machismo, authoritarianism, marginalization from organized civic life, high rates of abandonment of illegitimate children, alcoholism, disdain for education, fatalism, passivity, inability to defer gratification and a time orientation fixed firmly on the present.

We still call this the culture of poverty today. But the idea has taken on a life far beyond the world of Mexican peasants. And although the concept originated with Lewis, it has come to mean almost the opposite of what Lewis intended.

Lewis was a man of the left. He saw the culture of poverty as a defense mechanism adapted by the poor in response to capitalist inequality. For a while, the culture of poverty remained a leftist idea: Michael Harrington used it throughout his hugely influential 1962 book, “The Other America,” which laid the foundation for President Johnson’s War on Poverty. But Lewis soon lost control of the concept. With the publication of Daniel Patrick Moynihan’s 1965 report “The Negro Family,” the “culture of poverty” became a shorthand for black ghetto culture, a defect of the poor. Then Edward Banfield, a conservative political scientist, introduced the notion that the culture of poverty was immutable; his 1970 book, “The Unheavenly City,” attacked the key assumption of the War on Poverty — the idea that government can help. Banfield argued that poverty was a product of the poor’s lack of future-orientation, and that nothing government could feasibly do would change that orientation or stop parents from transmitting it to their children.

Banfield’s book is widely seen as retrograde today, but he still seems to own the culture of poverty. Lewis had used the phrase to describe habits acquired in response to structural factors — the standard left-wing argument that people are poor because of low wages, discrimination and bad schools. But the phrase has essentially become shorthand for the right-wing argument that poverty stems from the limitations of the poor and is largely impervious to outside intervention.

Persistent poverty has retreated from the political debate in the United States. But outside the headlines there has been a gentle evolution in thinking about the causes and cures for poverty, one that moves away from blaming capitalism and blaming the poor alike. Today, the most interesting development in that evolution — one with implications for fighting poverty around the world, including in the United States — is coming once again from Mexico, this time from the grandchildren of the children of Sánchez.

Links: Flu, Abortion, Google Data and TB

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)

Friday, December 19, 2008

Jailed Iranian AIDS Docs

Looking ahead to Monday.

The folks at Physicians for Human Rights expect the U.S. State Department to release a statement on the 6-month anniversary of the detention of two AIDS doctors in Iran.

Kamiar and Arash Alaei are internationally known for their work with AIDS and with heroin addicts. Iranian authorities accuse the brothers of trying to promote a "velvet revolution" under the guise of fighting AIDS. (Sounds a lot like the Haleh Esfandiari case to me.)

A quick Google News search shows the Alaeis' detention has so far garnered more mainstream press interest in Europe than the U.S., especially in French-language press.

I learned about the story in an e-mail from Physicians for Human Rights. Read more about their campaign to free the brothers here. (Note to PHR, you need to update the background page on the website. Kamiar Alaei has obviously not returned to his doctoral program at the SUNY Albany School of Public Health.)

The BBC profiled Kamiar and Arash Alaei for their AIDS work back in 2004 as did the Washington Post in 2006.

If you know about this story, please add to the comments below. I will give the comments that provide the most context a full-on post of their own.

Update: the State Department released its statement on the Alaei brothers on Tuesday, Dec. 23, 2008. It reads, in part:

The United States is also deeply concerned by the continued detention of internationally known Iranian HIV/AIDS physicians Dr. Arash Alaei and Dr. Kamiar Alaei. December 22 marked six months since the physicians were arbitrarily arrested by Iranian authorities and detained in Tehran’s Evin Prison. As a party to the International Covenant on Civil and Political Rights, Iran has the obligation to afford due process rights to anyone detained. The two have been active in various international exchange programs and academic research, helping to involve Iranians in the international academic and scientific community.

In November 2006, because of their work on HIV/AIDS, the Alaei brothers were participants in the first professional exchange program for Iranians in almost three decades, sponsored by the U.S. Department of State’s Bureau of Educational and Cultural Affairs. The program, which focused on public health, led to collaboration between American and Iranian medical professionals that could benefit the global fight against HIV-AIDS. Similar programs have brought citizens from over 165 countries to the United States.

The Iranian people have consistently expressed their desire to be connected to the global community. The actions of the Iranian Government against the Alaei brothers, Ms. Ebadi, and other human rights activists only serve to isolate further the Iranian people. With our friends and allies in the region, we stand by the brave people of Iran, who are trying peacefully to exercise their universal human rights, and call upon the Government of Iran to abide by its international obligations.

Thursday, December 18, 2008

Twitter and Global Health

I finally gave in and created a Twitter account back on November 4 so I could participate in the #votereport project. It reminded me somewhat of the way mobile phone or SMS texting has shaped elections in Africa, starting with the 2000 election in Ghana and continuing on to the more recent 2008 election in Zimbabwe. It also got me thinking about how such democracy-movement techniques could be adapted to global health. Perhaps to introduce some much-needed transparency in pharmaceutical supply chains?

Votereport was a volunteer-led project that called on U.S. voters to characterize their election experience by providing three major pieces of information: where they voted, how long they waited to vote and whether the experience was a good one or a bad one. If yours was a bad experience, then you were supposed to give a brief description why, e.g. mismatch of your name compared to driver’s license records caused an official to doubt your right to vote.

From a technical point of view, we’re talking about structured-data.

I messed up my first attempt at tweeting my own vote but fortunately someone named ZekeSaysSo showed me how to do it: “#votereport. #10019 #good #wait:40 at 6 AM. longest lines I have ever seen at this polling place at this hour.

Each specific piece of information was preceded by a # sign or hashtag, also known as a pound sign, to make the information more easily sortable by computer.

People like Adrian Holovaty have convinced a lot of us reporters that one major path to a future for journalism lies through structured data. As Holovaty defined it in 2006, structured data is “the type of information that can be sliced-and-diced, in an automated fashion, by computers.”

Holovaty’s breakthrough example in 2005: using the structured data from Chicago crime statistics mashed up with Google maps to automatically generate geographical pictures of a neighborhood’s character. You can see the latest iteration of his efforts at

The new wrinkle about Votereport, the Ghanian and Zimabwean elections is that “we the people” provided the structured data—in real time with tangible results. Mobile texting plus radio coverage stopped voting irregularities in Ghana in 2000 and prevented Robert Mugabe from being able to fudge electoral results in Zimbabwe earlier this year—although it didn’t stop him from hanging on to power.

Nothing quite so impressive in the U.S. but Votereport did help a number of individuals cast regular ballots instead of provisional ballots after minor misspellings of their name threatened their franchise rights. Because anyone who tweeted #bad and provided information as to why they couldn’t vote was automatically put into contact with an election protection lawyer. In many cases, simple misunderstandings were resolved before the voting booths closed.

See also Ethan Zuckerman’s thoughtful look at the pros and cons of twittering vs. texting elections.

Seems like you could adapt this type of technology to other uses. I’m thinking specifically about the government’s drug-supply chain in Malawi.

Many, many people I talked to complained about how they can’t get the drugs they need for hospitals and clinics from the Malawi government’s Central Medical Stores. Even the taxi drivers in Lilongwe know that a lot of the pharmaceuticals get diverted from the public sector to the private sector—despite periodic purges of the employees involved.

What if every hospital administrator, clinical officer and nurse used their mobile phone to text every encounter they had with Malawi’s CMS, giving information about the number and kind of drugs that were missing? And you compared that to the number and kind of drugs they started off with—many made available through international agreements?

How long would it take before CMS employees retaliated? Could you get enough people to participate so that no one individual would be targeted for retribution?

Just wondering. What do you think?

See also this Slideshare presentation on Twitter for Health by PF Anderson at the University of Michigan.

Monday, December 15, 2008

Can There Be Too Much Training?

There are many moments from my three-month Malawi trip that I just had to store away for later reflection. I recognized a ring of truth even if I did not quite understand what it meant or how it fit into the larger picture. What a number of people said to me about the role of training—which theoretically seems like a good thing—was just one of these moments that set my head spinning.

A number of managers I interviewed griped that excessive training sessions were distorting the health care system in Malawi. Too many nurses in a country with precious few nurses in the first place were out of their clinic or hospital for various two-week training sessions, often every other month. Several health care workers—particularly in government hospitals—said they depended on the extra pay they got from those training sessions. A couple of Malawians I met who did trainings admitted they could not get anyone to come unless they offered financial incentives.

Now I learn these were not just a few isolated cases. Training and sustainability have turned into perverse incentives in numerous HIV programs in Malawi, according to a new study by Ann Swidler (UC Berkeley) and Susan Cotts Watkins (UPenn and UCLA). I am trying to get a hold of the full paper but this excerpt, provided by Bill Savedoff at the Center for Global Development, is electrifying:

Swidler and Watkins follow the logic of the “sustainability” mantra [Savedoff writes] to show how incentives at every level – from the international donors to the national elites, interstitial elites and local population – make funding for training (and training of trainers) the dysfunctional outcome of an otherwise well-meaning effort. The donors can claim they are “teaching the population to fish,” the national elites get income and status from managing and negotiating the programs, the interstitial elites (usually young high-school-educated volunteers) get contacts and opportunities to rise socially and economically, and the local population gets .. well, relatively little.


Swidler and Watkins make the case for what is really needed quite clearly in their final remarks:

"It is hard to say precisely what constructive recommendations follow from the perspective we have offered here, but we do have several suggestions. First, the ideal of sustainability is a convenient self-delusion for funders and they would do much better if they could systematically and rigorously determine what projects are effective and then sustain them by paying local workers to actually do good—provide health care, sell discounted seeds and fertilizers, treat STIs, provide ARVs, supply children with books and school uniforms, or care for the ill and elderly (Kremer & Miguel, 2007).

Second, since few of the approaches to AIDS prevention currently in vogue have shown any measurable effect (Potts et al, 2008), we encourage funding that responds to Malawians’ desire to take care of the vulnerable in their communities, provide for their children’s futures, and build economic security, independent of the issue of HIV and AIDS. Indeed, reading the proposals that Malawian villagers submitted in their usually vain attempts to gain access to AIDS funding convinces us that villagers do know what they want, but little of it is training in how to prevent, mitigate, or treat AIDS. The first two they already know how to do as well as the experts who try to advise them (Watkins, 2004), and treating AIDS has to be done through the health-care system.

"Finally, we suggest that donors consider the “hidden curriculum” their procedures teach. Requirements for elaborate proposals, bank accounts, and monitoring and evaluation might better be replaced by simple procedures that would funnel more resources to villagers and less to monitors. Such resources would create continuing projects that both villagers and employees (perhaps the brighter, more successful of the villagers’ children) might rely upon. Rather than projecting a social imaginary that they find morally gratifying, donors and NGOs might provide opportunities that could sustain the realistic aspirations of those they claim to help."

Hat-tips to Alanna Shaikh and Bill Savedoff for the study.

Links: Varmus, Rape, Methadone

A few worthwhile links on U.S. policy, rape, to start off the workweek.

Harold Varmus speaks on the U.S. commitment to global health on on Tuesday, Dec. 16, 2008 at 11:30 AM Eastern time (U.S.). Videocast will be available at (NIH)

Update: Read the report on global health priorities from the Institute of Medicine on which Varmus bases his recommendations.

Journalist Pushpa Jamieson reports that even asking general questions about rape in a Malawi police station is stigmatizing. (The Chronicle)

Methadone project in Ukraine faces tough sell with public. (Global Voices Online)

Friday, December 12, 2008

Vaccines: Careful What You Pay For

Paying poor countries to vaccinate kids sounds like a good idea—as long as no one games the system. A new study from the Institute for Health Metrics Evaluation in Seattle shows that dozens of countries exaggerated their vaccination statistics in order to benefit from financial incentives. As the Seattle Times points out, the Gates Foundation paid for both the vaccine incentive program and the study that criticized it.

The larger issue: what role should financial incentives play in health care? The IHME study, which was published in the Lancet, is not the final word on this debate.

The idea that financial incentives can backfire is nothing new—look at the U.S. tax code for multiple examples. Or the Israeli day-care study by Gneezy and Rustichini (instituting a fine on parents who were late in picking up their kids at daycare resulted in an increase, not a decrease, of late arrivals). You have to pay close attention to how these deals are set up. See the cash transfer programs Julio Frenk championed in Mexico for examples of how to do things right.

Here’s a question for anyone who wants to dig deeper into the IHME study: the program was aimed at kids who wouldn't otherwise have gotten vaccinated. So, did more kids get vaccinated, despite the exaggeration, than would have otherwise? Did their health improve? And if so, is it okay to tolerate a little distortion? How much distortion--5 percentage points or 10, or in this case 16 (74% actual rate vs. 90% reported rate)? On the other hand, if you can't trust the numbers . . .

Update: See Ruth Levine's post at Global Health Policy for a more in-depth analysis of the IHME study.

Wednesday, December 10, 2008

Spotted Fever Caused Death in Brazil

Whew. It wasn't arenavirus after all. ProMed-Mail has the followup.

Related post: Mystery killer in Brazil.

Daulaire and Gayle for Obama Administration?

Catching up to the news. Helene Gayle, currently leading CARE, is being rumored as a possible pick to head up USAID, according to Al Kamen at the Washington Post. Nils Daulaire may be tapped for HIV/AIDS coordinator, displacing Mark Dybul. If true, I wonder where Dybul will go?

Repeating rumors is precarious business. The way the game is played in Washington, you can't help but feel you're being used by someone--you just never know by whom. (See Valerie Plame.) Maybe it's a trial balloon. Maybe it's wishful thinking. We'll know soon enough.

Related Post: US Food Policy Needs to Change (Editorial)

Update (Jan. 13, 2009) Looks like Dybul is staying on at Pepfar for now. Wonder how he gets along with Hillary Clinton, who as Secretary of State, would presumably be his boss?

Monday, December 8, 2008

Sharing and Global Health Blogging

How can we get more coverage of global health news when old media doesn’t seem to want to do it without outside support and new media (blogs, texting, sharedmedia) still seems a scattershot affair?

This is the fourth post in a series that began with “Rethinking Why I Blog.” The others are “What Plumpy’Nut Taught Me” and “Authentic Sharing vs. Selfish Sharing.”

One of my goals for my Nieman fellowship year was to develop a business plan for a web-based global health news service. I know, I know, “news service” is such a quaint phrase, reminiscent of teletype, telegraphs and Morse code. But it is descriptive. If it’s too old-fashioned for you, think “content platform.”

The idea was to aggregate posts from around the globe as well as to provide funding for original reporting. I further focused the goal by targeting transparency issues in global health funding by eight major organizations. I developed the plan as part of a class on non-profits that I took at the Kennedy School and pitched it to the Open Society and Ashoka folks. Both decided to pass.

Nowadays, though, I’m wondering if maybe I was just trying too hard or too soon? After all, I keep seeing efforts by individuals to write about what they find interesting or newsworthy in global health. The ones I find most interesting are not promotional or advocacy-oriented but rather add context and highlight overlooked news.

In addition to established blogs from academics in the field, e.g. Effect Measure, The Pump Handle, Aetiology, there are a few more student blogs, like these efforts from Karen Grepin at Harvard, GlobeMed at Northwestern University and Unacceptable from Brigham Young University. See others on my blogroll at right.

(Mostly US-generated, I know. Send me your recommendations for global health blogs from other countries using the comment section below!! I haven't been bowled over by what I have read in the health section of Global Voices Online. )

The development community is farther along in self-publishing. See especially blogs from organizations like DFID and the Center for Global Development as well as DFID-funded While trolling Twitter, I found “Blood and Milk,” a clear-eyed view by Alanna Shaikh of just how ethically challenged anti-poverty work can be despite good intentions.

Now that the Gates Foundation is investing in mainstream news organizations so they can cover global health news, you might say we don’t need individual efforts at reporting and commenting any more. Who needs amateurs, who post between bouts of norovirus or grant applications, when you can hire professionals [irony alert]?

And yet they write.

Update: PharmD+'s list of 100 global health blogs--three of mine are included, one of which is no longer active. But others on the list haven't been updated for quite a while either, e.g. BrownforGlobalHealth (last post Sept. 2007) and Don Burke's Global Health Blog (last post Jan. 2008).

Sunday, December 7, 2008

Mystery Killer in Brazil

Note to self: watch ProMed-mail for results of blood tests of South African man who fell ill and died in Brazil last week. Early reports suggested it might have been highly contagious arenavirus--and linked to earlier case in Johannesburg clinic. Two days later, health authorities from South Africa said that scenario was unlikely. The blood tests should say for sure. Unclear if results will be out this week.

Another reason to control rat populations in cities: arenaviruses are closely associated with rodents.

Update: Word from Brazil is that it's spotted fever, not arenavirus.

Thursday, December 4, 2008

Story-Telling Makes Sense

Making the obvious difficult. We tell stories to deal with information overload ( and understand complexity (

Monday, December 1, 2008

New Gates Grant for Global Health News

An announcement is due later today from The NewsHour with Jim Lehrer that the Bill & Melinda Gates Foundation is giving WETA, co-producer of The NewsHour, a $3.5 million grant over the next three years to cover global health issues. Foundation-funding of publicly funded news programs like The NewsHour is becoming more and more important as other sources of money, like corporate-funding, dry up.

Other recent investments in global health news coverage by the Gates Foundation include:

1. A nearly $1 million, three-year grant for National Public Radio in 2006.

2. A $5 million, three-year grant for Public Radio International in 2007.

This latest move suggests the Gates Foundation has made a strategic decision to fund news-coverage directly, as opposed to, say, training for journalists in global health issues. In 2007, the Gates Foundation gave the Knight Foundation $1.7 million over three years for health fellowships for journalists in sub-Saharan Africa. Earlier this year, however, the Gates Foundation chose not to renew its three-year grant to the Nieman Foundation for Journalism at Harvard.

The Nieman Foundation is continuing its global health program—although it will award two fellowships next year instead of three.

I’m very interested to see how the Gates-funded NewsHour navigates the challenge of reporting on global health programs that are funded by the Gates Foundation and of interviewing experts who are also receiving funding from the Gates Foundation.

Full disclosure: I received a 2008 Nieman Fellowship for Global Health Reporting. The Gates Foundation had no say in the choice of my field project. And I dealt with even the potential appearance of a conflict-of-interest issue by focusing on the nursing brain drain in Malawi—an issue that, as far as I can tell, has received no Gates funding.

Updated to add Knight Foundation information.

Tuesday, November 25, 2008

Help Needed on US Labor Rule Change

Celeste Montforton suspects that the U.S. Department of Labor might be engaged in midnight rule-making in the NEXT FOUR DAYS to weaken workplace safety protections. She is asking for help to determined whether Labor has "decided that the risk assessment rule does not require OMB review?" and plans to "publish a final rule on OSHA’s and MSHA’s risk assessment procedures ASAP, despite the load of comments they received and could not possibly have addressed in a final rule?"

Thursday, November 20, 2008

Authentic Sharing vs. Selfish Sharing

By all means, share what you are doing on the web. Just make it authentic.

Previous posts in the series: "Rethinking why I blog" and "What Plumpy'Nut taught me."

When Richard Lalleman of the Netherlands asked me to share my delicious feeds about development with his initiative, I came back at him with some questions to make sure I knew just what kind of sharing he was talking about. I wanted to make sure that he wasn’t going to use my freely available feeds for a commercial project and that it would NOT require any extra effort on my part.

That got me thinking about the nature of sharing on the web. And whether it’s any different from sharing in the real world.

My church, like many community organizations whether faith-based or not, collects cash and canned goods for our local food pantry. Every year, we need to explain to the youngest crop of Sunday Schoolers what sorts of items are worth sharing. Usually, one or two discover the brilliant strategy of sharing something they don’t like—like canned peas. It’s a two-fer. They get rid of something they don’t want and they get points—in case anyone is keeping score—for sharing.

And so every year we explain again that the point of sharing is not to share what you don’t like but to share your love, in this case something that you find tasty or that you would want to receive yourself.

That first impulse—to selfish sharing—is totally human and not something that we necessarily grow out of. Think about how many folks donate clothes that they would never wear. There’s the satisfaction of sharing, not to mention a tax deduction. We won’t even go into the harm that free clothing has done to struggling textile industries around the globe.

A lot of the potential of the web comes from what’s called the “gift economy” or the benefits of collaboration.

The more you look, the more you realize there are different levels of sharing, with differing levels of authenticity.

Here’s a list, with examples, that I am playing around with. Some of the layers overlap, of course. Feel free to play along, whether here or on your preferred social media.

Selfish-sharing: (see above)

Reciprocal sharing: You watch the kids on Tuesday and I’ll watch them on Wednesday.

Self-interested sharing (or enlightened self-interest): I’ll tweet my voting experience as a way of improving democracy.

Convenient sharing: I’ll share the idle time on my computer to help model new ways to control malaria parasites.

Sharing from abundance: I can’t eat all these tomatoes from my garden; would you like some?

Coincidental sharing: I had to do this anyway, but I don’t mind sharing what I learned about getting a cell phone in Malawi.

Catalytic sharing: let’s all get together and write the code for [insert favorite open-source program here] and watch it change the world when we’re done. Or let's share what we know about treating drug-resistant tuberculosis.

Sacrificial sharing: the stranger who dives into icy waters to rescue a child trapped in a sinking car. A soldier’s ultimate sacrifice.

Next: Sharing and Global Health Blogging

Wednesday, November 19, 2008

What Plumpy’Nut Taught Me

Online collaboration may be the wave of the future but it’s not so easy to convince people to do it. As I learned last year, lots of public health folks were willing to talk to me about the Plumpy’ Nut patent but most were reluctant to act as journalists themselves, to help dig for the story, pull the various threads together.

Many were intrigued by the patent issue but didn’t want to join in publicly because they didn’t think they were expert enough. A few, no doubt, also felt the need to play it safe. After all, who knows what future employers (or donors) might think? As always, the people who knew the most were often the least interested in going on the record—in whatever format.

This is the second post in a series that started with “Rethinking Why I Blog.”

I learned about the Plumpy’Nut patent in October of 2007. I was attending a nutrition conference in which I picked up some hallway grousing from a humanitarian group that had been told it could not whip up its own version of Plumpy’nut, a carefully fortified peanut butter that has done wonders in the fight against severe malnutrition.

There was a patent on Plumpy’Nut, taken out by its manufacturer Nutriset (and the French government, I later learned.) Even though the recipe is widely available and easy to follow, making a batch on your own in many countries would land you in plenty of legal hot water.

Fascinating case. Before then the only reports I had heard or seen about Plumpy’Nut were glowing accounts about its proven qualities to save young children’s lives.

My first impulse was to dig deeper and write a freelance piece. But here I hit a snag. The rule was no freelance while on a Nieman fellowship.

So then I thought about it a bit and rather than ask for an exception, I decided to use this as an experiment in online collaboration. Normally I would hoard the information until I could come out with a fully-fledged piece. Otherwise, I would risk being scooped.

Instead, I decided to share it all, from the beginning, starting with the first disgruntled vibes I picked up at that conference. I envisioned a group blog where a bunch of interested folks could pursue the story—each contributing a different piece. And so launched what I hoped would be a group blog at Patents and Peanut Butter.

Talked to a number of students at Harvard’s School for Public Health. All were unfailingly polite, many offered suggestions, a number were intimidated by the blogging software. Most found it easier just to talk to me and let me write whatever I wanted on the blog.

Talked to several faculty members, including Richard Cash, who helped develop oral rehydration therapy back in the 1960s. Like Plumpy’Nut, ORT is a dead-simple recipe that saves lives. Unlike Plumpy’Nut, ORT is not patented. Anyone can make it. Many manufacturers do, but so do folks at home.

Several legal types thought the Plumpy’Nut patent wouldn’t stand up to legal challenge. I learned about “prior art” and “non-obvious” innovations.

Once again, the old habit—of journalist interviewing source as opposed to source commenting directly on a web site—was hard to break. I was perfectly willing to break it. But most people I talked to were not.

And so the blog sputtered along. I continued adding notes as time and opportunity allowed. But the hoped-for group blog did not materialize.

And yet, after a few months on the Internet, I did start getting inquiries and a few people from around the world added their two cents—some of them anonymously (which brings up all sorts of other issues.). Most of the interaction was still via e-mail. Most people didn’t feel comfortable posting comments on the Internet—despite repeated encouragement on my part. A few got into the spirit.

This was not the instantaneous burst of community magic that I had hoped for. But a kind of long-amplitude wave eventually did materialize. My old Plumpy’Nut posts kept getting traffic. Maybe I had brought a fast-food mentality to a slow-cooking world.

And indeed, a year after the blog went up (and many months after I stopped posting anything new), I received an e-mail from Martin Enserink at Science, who was working on a story about Plumpy’Nut and wanted to include a sidebar on the patent controversy.

We exchanged some information—though I couldn’t tell him much more than what I had already posted on the Internet. And Enserink's article—a piece of real journalism—has advanced the story. That’s where I learned, for example, that the real sticking point in the patent controversy may be the French government—and not Nutriset.

On balance, I learned more by sharing the Plumpy’Nut information when I did than if I had hoarded the information. And other people—whom I would never have known about otherwise—learned a few things through our exchanges or just by lurking on the blog.

As for news gathering, this felt kind of like a disorganized (or is it self-organized) relay race. Sometimes I was the leader passing the baton, sometimes I was receiving the baton. And sometimes, much to my surprise, I was just one of the bystanders (formerly known as the audience) cheering the race on.

Next: Authentic Sharing vs. Selfish Sharing

Tuesday, November 18, 2008

What to Tell the Global Health Fellows?

Going to Cambridge, Mass. this weekend to impart whatever wisdom I can to the current global health fellows about the academic year at Harvard, the field project and life after the Nieman year. Looking forward to hearing what they’re doing and to catching up with David Kohn and Andrew Quinn, who will also be there.

But what to say that they don’t already know? All three of the current global health fellows have extensive experience in developing countries—Vietnam, Nigeria and India.

And how to prioritize? I still have trouble talking about the Malawi trip in anything less than treatise form. And so when friends ask, I often just say it was great and leave it at that.

If I had to focus on just three things what would they be?

1. Importance of sharing what you’re doing. e.g. Plumpy’Nut patent, putting Malawi proposal on the web. Solicit feedback but don’t be discouraged if you don’t get it or it doesn’t come as fast as you’d like it to.

2. Plan, plan, plan. Thinking of the field project as three distinct phases: pre-production, production and post-production. My own struggles with post-production. Don’t forget to bring the Malawi planning book I created. Also the laminated contact cards.

3. Bite off more than you can chew. But not too much more. Then let it happen.

Check with David and Andrew to see what they're thinking.

Rethinking Why I Blog

My journey from live-blogging to beat-blogging to transition-blogging to a new state of grace that you might call emergent-blogging. This is going to take a few posts.

I’m still not sure emergent-blogging is the right catchphrase but it will have to do for now. What I mean is that I am now using this blog more and more to grapple with the ideas, projects, etc. I am already working on. I find that writing things out often helps me figure out what I think, what I should be doing next. You just have to be careful not to force a conclusion or a takeaway message.

The Global Health Update was one of the first blogs at My co-workers and I launched it as a way of live-blogging TIME’s Global Health Summit in the fall of 2005. I was so taken with the medium that after the conference was over I convinced the powers-that-be to continue the blog because I wanted a place to cover global health news more often and in greater depth that we were able to in the limited real estate of the print magazine.

I quickly learned that blogging was a great way to keep up with global health news—and after TIME’s lawyers finally okayed the comment feed, we even managed to get some great conversations going. Nerd that I am, I loved checking out the web analytics software to see which .edu’s and .br’s and .mw’s were checking out the site. Traffic never grew to Swampland proportions but it grew nonetheless.

And after all, isn't that the point? That you don't need the mass audiences that make traditional media possible? It turned out there was an audience for global health issues and they didn’t all work for the same three NGOs. Also, it didn't hurt that I broadened my reputation as a global health journalist. A win-win, as the B-school folks like to say.

After I left my staff position at TIME and headed up to Harvard for a Nieman fellowship, I didn’t really know what I wanted to do with the blog—other than the fact that I wanted to continue blogging about global health. So I turned to Blogger, believing what folks said that the most important ingredient for success in blogging (whatever that means) was to be passionate about something—and I had plenty of passion.

I struggled a bit with how much I should write about what was happening in classes and often played it safe by posting about public lectures (by Ira Magaziner or Tim Wirth or Agnes Binagwaho) and other events. Or I’d post my reactions to some of the ideas and concepts I was picking up (like why the phrase “maternal mortality” just drains you of the desire to do anything whereas a book like Monique and Mango Rains fires your soul.)

Then in October of 2007, I learned about a brewing controversy over Plumpy’Nut, the nutritional supplement that saves starving kids' lives, and the decision by Nutriset (and, I later learned, the French government) to protect the incredibly straightforward recipe with a patent.

My first reaction was to write a freelance piece. But that wasn’t allowed under the terms of my Nieman fellowship. (The laudable idea being that a fellowship is supposed to get you away from the grind of deadline journalism.)

That's when I really started to grapple with the ins and outs of sharing on the Internet.

Next: What Plumpy'Nut taught me.

Friday, November 14, 2008

Friday Links: India, Bush Regs, Ignoring Systems

IBM researches information-web based on cell phones for the millions who cannot read in India. (SciDevNet)

Celeste Montforton says how you undo Bush-era regulations is just as important as what you undo. (The Pump Handle)

Karen Grepin on why so much debate over cost-effectiveness or even whether it's more important to fund AIDS or maternal and child health programs misses the point. Have to think about education, human capacity, health systems, she says. Makes me wonder if the latest Lancet piece that charges that too much money is going to infectious disease is also off base for the same reason. (Karen Grepin's blog)

Social Networks for Global Health and Development

Just last week I was thinking once again that the global health community has been slow to the digital social networking party. Then I received an e-mail from Richard Lalleman asking me to join a world-wide effort to build up a collaborative database of public bookmarks on global development.

Actually, Lalleman doesn’t want me, per se. He wants the RSS feed of my delicious tags (e.g. development, globalhealth, poverty.) After checking out Lalleman's web trail (LinkedIn, Twitter, blog, and asking for some clarification, it seemed like a good idea.

At first I was a bit confused—partly because Lalleman’s main site——is full of Dutch-inflected English and a fair amount of academic jargon. Lalleman is an information and knowledge management expert—which is to say the 21st century model of what we used to call librarians—a group of people I revere. So, I was willing to slog through all the abstractions and theory.

But here’s the essence: if more people in the development world would share their favorite sites on the web, it would make searching for credible information easier than what’s currently possible with generic search engines from Google or Yahoo.

Since I already make my bookmarks publicly available on delicious, Lalleman isn’t asking me to do anything extra. Just using what I’m already doing. He doesn’t even care if I use delicious or some other social bookmarking site.

And that’s key. A lot of idealistic types who think social networking is going to save the world seem to have a “if we build it, they will come” attitude. This typically requires a lot of work for not a lot of payoff. Example: Aaron Wallace’s global health social networking site at Looked great when he launched it a year ago. Still doesn’t have that critical mass needed to make a social networking site work.

Instead, social networkers have to figure out what folks are already working on and simply convince them to share that publicly.

Most social networks for global health are still toiling in the list-serv phase of global collaboration. Critically important—especially in areas where e-mail is more easily accessible than the web. ProMED-mail, for example, works incredibly well on this model and on a shoestring budget with a lot of volunteer labor.

But the web-based systems offer advantages in greater interactivity and facilitating many-to-many conversations. You have to get beyond thinking of blogging for its promotional value (that idea could really use a post of its own) and really start thinking of platforms. You also have to get beyond thinking about social networking for its fund-raising value (another theme worthy of many more posts; see especially Beth Kanter on fund-raising in Second Life).

In the meantime, I’ll keep my eye on

The other web-based social networking site for global health that I’m aware of is Global Health Delivery Online, an initiative out of Harvard and affiliated partners that’s trying to create online communities of practice around tuberculosis, AIDS and a few other targeted areas.

One of the big questions I have about Global Health Delivery Online is whether they can go beyond the Harvard brand? In other words, will folks from Columbia, Johns Hopkins, the Pasteur Institute, World Health Organization, the Novartis Institute for Tropical Diseases join the conversation?

But that’s enough about social networking for one entry.

Related posts:
Web 2.0 Comes to Public Health
Where are the Global Health Blogs?

Thursday, November 13, 2008

Logging More Malawi Video

Oh thank goodness. This past weekend I discovered that just about everyone finds logging video tedious. I was at the Nieman Foundation’s 70th Anniversary convocation and telling my tale of woe about logging the video I had shot in Malawi to friends who are television producers and documentary makers.

Here I was afraid that I was doing something wrong—that something about my print journalism training had messed me up forever for dealing with video. What other explanation could there be if logging video was taking me so long and seemed so excruciating?

All the TV and video folks assured me that what I was feeling was absolutely normal. And that that sense of being overwhelmed by all the material I had gathered would eventually go away as I got better at planning my shots, producing and editing on the fly.

It is a situation that’s very akin to the kind of ruthless editing you have to do when you write. My friend Lorie Conway urged me to focus on just two stories out of the gigabytes and gigabytes of video, audio and digital stills I have—at least for now. Log to those stories (leaving out the bits that don’t support those pieces). I can always return to the original material later as time allows.

This may be easier said than done. Every time I go through the material I see more avenues to explore. Plus I feel such a sense of responsibility to the folks who shared so much of their lives with me. But you can’t do everything at once.

So I have been back at logging video with renewed vigor and once again combing through the photos Eileen took. Have also hired a journalism student for help with logging some of the audio. Will probably focus on a story about malaria and another about nurses’ daily challenges and successes at just one of the several hospitals I visited in Malawi.

One thing is for sure, the pregnant woman's lament has got to find a home in there somewhere.

Friday, November 7, 2008

Friday Links: Twitter, Aspirin, Chinese Teflon

Twittering and micro-blogging for public health. (University of Michigan Libraries)

Soon all aspirin will be made in China
. Acetaminophen, too. (NY Times)

High levels of toxic Teflon precursor found in Chinese workers at a factory that had been open only one year. (Charleston Gazette via the Pump Handle)

Tuesday, November 4, 2008

Voting in USA

Everything points to an historic voter turnout. Just over 60% of eligible voters went to the polls in 2004--the highest number since 1968. News reports show we're on track to beat that figure.

I showed up at my voting place in New York City this morning at 6:08 AM and didn't leave until 40 minutes later. That's me in the picture getting ready to step behind the curtain to vote.

Monday, November 3, 2008

Mapping New York's Rats

High-tech approach to an age-old problem. New York City has just launched an interactive rat map online.

Update: A reader has pointed me to this book by Robert Sullivan, which has a cover of a map of Manhattan in the shape of a rat.

Further update: My story about GIS-mapping of NYC's rats and going on rat patrol in the Bronx is up on

And now the rat map video is up as well. You can read some behind-the-scenes stuff here.

A Trio of Aid Scandals in the News

There has been a trio of aid scandals in the news the past few days:

The Global Fund to Fight AIDS, Tuberculosis and Malaria accuses Robert Mugabe's government of diverting $7.3 million in money meant to fight disease in Zimbabwe.

The W.K. Kellogg Foundation of Michigan says several hundred thousand dollars is missing from its programs in southern Africa and is now suspending operations there, pending an investigation and restructuring by former U.S. Ambassador to South Africa James A. Joseph.

The bribery trial of a former Costa Rican president begins today. Rafael Ángel Calderón Fournier (1990-1994) and eight others are accused of taking bribes as a part of a $39.5 million Finnish deal to sell medical equipment to the Costa Rican health services. For an English language summary of the Costa Rican scandal, click here.

I'm told the scandal first came to light after reporters from the Costa Rican daily newspaper La Nacion noticed one of the key players was living way above the modest means his government salary would normally afford.

Thursday, October 30, 2008

Pharma Boom in Emerging Markets

While the pharmaceutical market for the US stagnates, IMS Health forecasts 14% to 15% growth in the so-called emerging markets, or what they call pharmerging markets. I think they need some help coming up with a better buzzword--something that rolls off the tongue more easily. Which syllable do you stress most? FAR-merging? How far is that merger? Who said anything about mergers? But I digress. The larger point still stands:

Rapid Expansion of "Pharmerging" Markets. The pharmerging markets of China, Brazil, India, South Korea, Mexico, Turkey and Russia are forecast to grow at a combined 14 - 15 percent pace to $105 - $115 billion. Along with the pharmaceutical industry's increased focus on these high-growth markets, these countries are benefiting from greater government spending on healthcare and broader public and private healthcare funding – which is driving greater access to, and demand for, innovative medicines.
Related Post: Growing market for malaria drugs

Wednesday, October 29, 2008

Kaiser Foundation Launches News Service

Kaiser Family Foundation to start non-profit news service - San Francisco Business Times:: "The Kaiser Family Foundation, a Menlo Park-based nonprofit, said Wednesday it plans to start an independent news service to report on the U.S. health-care system and “the increasingly urgent political and policy debates surrounding it.”

Friday, October 24, 2008

Lancet Series on China's Health

The special series in the Lancet on health system reform in China is fully available online, after free registration. See also Lancet's special online focus on China here.

Lancet is being a good global citizen in providing this material free of charge but navigating their web site continues to be something of a challenge.

Also, reading between the lines, it seems the rivalry between Harvard's Lincoln Chen and Bill Hsiao continues apace. Chen is co-author of four articles in the series while Hsiao does not appear at all.

Both men are experts on health care systems in general and China in particular. Chen often starts the conversation by focusing on health care workers while Hsiao begins with entire systems. Seems like you might want both views.

Thursday, October 23, 2008

Logging Malawi Video

They say logging your own video helps you understand better how to shoot video in the first place. I sure hope that’s true. I’ve been logging my video of Malawi nurses for days on end now and find myself yelling at the computer screen every now and then “Hold the shot! Hold the shot!” Fortunately, I seem to slow down and hold my shots better in the later videos.

Logging video means you write down a description of the action in different sequences, what people are saying and the time code from the video so you can easily jump to it if you need it.

Today I finished a whole series on Nurse Grace Nyirongo as she gives malaria medication and checks temperatures on the pediatric ward at Embangweni Mission Hospital and talks about her life and work.

It’s all in preparation for writing scripts that will combine different video sequences with photos and audio. It’s time-consuming work and, frankly, a bit tedious. But it’s allowing me to relive the trip to Malawi and revisit my deep respect and admiration for the men and women who work in the hospitals I visited.

Wednesday, October 22, 2008

Pandemic Flu Ethics at Seton Hall

Seton Hall Law School in Newark, New Jersey will be hosting a symposium on October 23-24, 2008, to examine the legal, ethical, and public policy issues related to developing a pharmaceutical response to an influenza pandemic. Panels will explore issues related to the development and approval of vaccines and antiviral drugs, both before and during a pandemic; the allocation of vaccines and antiviral drugs in situations of scarcity; and issues related to international equity.

Wonder if they will take up the ethics of withholding flu vaccine from North Korea, Iran and other countries the U.S. considers rogue states?

Meanwhile in Niger

Still haven't heard from an independent source about yesterday's post on malnutrition in Maradi, Niger. But the video below gives you a sense of conditions in Niger. It's from a new series on global health called ‘Survival’ that is currently airing on BBC World News.

The focus in the Niger piece is on what's going right in the battle against various neglected tropical diseases. And it features local villages distributing medications in places where there aren't enough nurses and doctors to do so.

Tuesday, October 21, 2008

What's Really Going On in Niger?

There's malnutrition in Niger and then there are the arguments about malnutrition in Niger, which is turning into a "he-said, she-said" fight between Issa Lamine, the health minister of Niger, and Marie-Pierre Allié, President of Médecins Sans Frontières (MSF)France.

Yesterday, Lamine accused MSF of exaggerating ongoing malnutrition problems in the Maradi region. Today Allié said in a press teleconference that the situation is worse than the government is willing to admit. "Despite all their efforts, the health care staff in the hospitals and health centers I visited cannot respond to the influx of malnourished children," Allié said, after returning from a visit to the Maradi region of Niger.

The government of Niger suspended MSF's operations back in July. Allié says another group, Action Contre la Faim, was given the boot in August.

The stakes are particularly high this time of year when food stocks are traditionally low before the harvest begins.

Allié took pains to say the MSF has worked with the Niger government before and she praised the government's past successes against malnutrition. But she was baffled by the latest setback and particularly worried to hear a government leader saying, "If MSF is not present, then there is no malnutrition in the area. MSF is creating malnutrition.”

Actually, Lamine's anti-aid agency stance sounds a lot like what I've gleaned from the Internet about a Norwegian documentary called "Sultbløffen" (or "The Hunger Bluff") that aired in March of 2008. The gist of the documentary is that aid agencies undermine local agricultural efforts and exaggerated the extent of the Niger famine in 2005 to justify their own existence. I hesitate to mention it since I haven't seen it, don't speak Norwegian and all the references to it I can find are suspiciously identical as well as identically vague as to who was behind the documentary.

If you've been to Niger recently, please share your thoughts on what's behind this unusual standoff.

Related post: Meanwhile in Niger

Monday, October 20, 2008

Science Looks at Plumpy'Nut Patent

As part of a larger piece in Science on whether Plumpy' Nut should be used to prevent malnutrition as well as to treat it, Martin Enserink takes a separate look at the patent controversy. I wish the piece was longer (and suspect Enserink does too) but it's a great introduction to the topic--well worth reading if you have access to Science online or a good library.

As regular readers know, I've followed this controversy for almost exactly a year now. (See two key posts here and here.) I even started a separate blog devoted just to Plumpy'Nut and patents while at Harvard when the parameters of my fellowship did not allow me to write freelance pieces. (I quickly learned public health experts don't want to become journalists in their own right.) So I applaud any attention this issue gets from traditional media.

Two data points I want to remember from Enserink's excellent article:

". . . Nutriset and the French Institute of Research for Development obtained patents for Plumpy’nut that last until 2018 and are valid in Europe, North America, and about 30 African countries. Nutriset has threatened lawsuits to keep others—including Compact in Norway and MSI in Germany—from selling similar pastes. . . ."


". . . the patent [IS NOT] valid in many malnutrition hot spots, including India . . . "

As I learned in my own reporting, Enserink says it's unclear the Plumpy' Nut patent could withstand a challenge.

But I was most intrigued by what Michael Golden, the developer of an older non-patented nutritional supplement, had to say. Golden told Enserink that

"the pressure should not be on Nutriset but on the French government; [Golden] hopes that France’s foreign minister, Bernard Kouchner, a physician who helped found MSF in 1971, will intervene."

Back to the Usual Suspects?

The great promise of the web is that it can take you beyond your usual circle of friends or sources of information. That ability, along with a few other things, is what really drew me to the web as a way of covering global health news. If most big media outlets treated international news as completely separate from health news, at least there was an alternative.

But it looks like we're swinging back toward centralization of media sources. In a story that's mostly about the declining popularity of Technorati and Bloglines, Nick Carr has some very trenchant insights into the growing centripetality of the web.

Friday, October 17, 2008

Investing in Africa's Private Health-Care Biz

Big meeting in Washington, D.C. on Nov. 20-21 to see how US companies can make money investing in the health care systems of African countries.

According to conference organizers, "Over the next decade, $25 to $30 billion in new investments will be needed in health care assets, including hospitals, clinics, and distribution warehouses, to meet the growing health care demands of sub-Saharan Africa. It is estimated that the market for health care will more than double by 2016. With a total health expenditure of $16.7 billion in 2005, roughly 60 percent—predominately out-of-pocket payments by individuals—was financed by private parties, and about 50 percent was captured by private providers."

Read more about the US-Africa Private Health Sector Forum at the Corporate Council on Africa website.

Update: has a good Dec. 9 post, with worthy links, on the public-private debate (via Jon at GlobeMed, in the comment feed)

Keeping Science a Secret

Two new transparency issues in global health news, on pandemic flu vaccine and scientific candor at US government agencies. For an example of how lack of transparency in one small area (say credit swaps) can spread around the world, see the current financial crisis.

Thursday, October 16, 2008

Discouraging News on Infant Mortality in US

When staying in place means falling behind. The Centers for Disease Control releases new statistics on infant mortality in the U.S.

Key point: "Increases in preterm birth and preterm-related infant mortality account for much of the lack of decline in the United States′ infant mortality rate from 2000 to 2005."

Tuesday, October 14, 2008

Look East, Young Idealist

Polymeme is fast becoming my new favorite source for news beyond the echo chamber. Today's gem, from the Financial Times: "Crisis marks out a new geopolitical order."

There's no doubt economic power is shifting eastwards, as Philip Stephens says. And, I would argue, along with that shift goes the power to set the agenda in global health.

Monday, October 13, 2008

US: No Vaccines for North Korea, Sudan, Other Rogue States

Official U.S. policy denies vaccines against bird flu, dengue fever and other deadly viruses to pariah states like North Korea, Iran, Cuba and Syria. This little-known 10-year-old policy, outlined in a must-read report from Robin McDowell of the Associated Press,

"could makes it harder to contain an outbreak of bird flu among chickens in, say, North Korea, which is in the region hardest hit by the virus. Sudan and Iran already have recorded cases of the virus in poultry and Syria is surrounded by affected countries. Cuba, like all nations, is vulnerable because the disease is delivered by migratory birds."

Effect Measure takes the story one step further in comments about information hoarding and siloing. As the AP points out, the Centers for Disease Control didn't even know the vaccine embargo is official policy. Given the nature of pandemics, which are no respecters of borders, CDC would have presumably opposed the policy on scientific grounds.

Making Flu Pay in China

Starting in 2012, Sanofi-Aventis will start selling regular flu vaccine in China from a factory it is building in the southern city of Shenzhen (the provincial capital of Guangdong, located near Hong Kong). Given the latest spate of bad news on food safety in China, there's bound to be a lot of scrutiny about on the quality of their manufacturing process--from the farms that provide the eggs for growing the virus to whatever adjuvents they may or may not use. And let's not forget Guangdong's unfortunate history with SARS.

Friday, October 10, 2008

Melamine Scandal Hits Europe

France recalls tainted sweets and biscuits from China. Between the ongoing melamine scandal and rising fuel costs, my money is on rising fuel costs to reshape the global food business. Robert J. Samuelson had a good explainer in the Washington Post last December. See also the Economist's End to Cheap Food.

New DFID Blog

There's a new blog from three intrepid field workers at the British Department for International Development. So far, it fits the anti-poverty label best but as befits folks on the ground they're not being rigid about the categories.

Thursday, October 9, 2008

Worst Case Scenario

Scary thought. The U.S. Centers for Disease Control starts monitoring influenza activity in October. Imagine what would happen if the world suffered a pandemic flu in the midst of the current credit crisis.

Not saying it will happen. Just imagine it.

Makes you realize the need to continue funding global health and development initiatives in the midst of the inevitable downturn.

Not saying that will happen either.

Jobs: Global Health Policy Director

An unnamed global health non-profit with a budget of $20 million is looking for a policy director. Location: Northeastern US. Salary up to US $135,000.

Blogs, Fellowships, Rights and Global Health

Karen Grepin wants you to know about new post-doc fellowships for global health at Duke University.

Jon Shaffer explores whether healthcare is a right.

I plan to study Tara Smith's paper in PLOS Biology on "Advancing Science through Conversations: Bridging the Gap between Blogs and the Academy." I have found that the same reticence that academics have about joining the global conversation permeates the global health community as well.

Wednesday, October 8, 2008

How Wars End

Jeb Sharp looks at Iraq through the prism of the American Civil War, as part of her amazing radio series for PRI on "How Wars End".

This 12-minute segment blew me away. It carefully covers the ground most American kids learned in grade school and then, bam, before you know we're going from Appomattox and the American Reconstruction to reconstruction in Iraq.

Most impressive of all, it leaves you thinking, "Wow, why didn't anyone make that connection before?"

You can also read the transcript but the audio had a much greater impact on me.

Here's a taste:

Sharp: Ayers thinks the messy struggle that followed the war is one reason Americans cling to the story of Appomattox. He says the gentlemanly handshake between two great generals gives us the illusion of a clean ending.

Ayers: “We just love that story, not thinking about days after that Abraham Lincoln's assassinated, two years after that military reconstruction begins, a decade after that Reconstruction finally comes to an end. Americans are most uncomfortable with the period of Reconstruction of anything else in our history, because it's not a story, it doesn't have any kind of shape to it, it just kind of explodes.”

Sharp: After the invasion of Iraq, Ayers was dismayed that in all the public debate over post-war reconstruction in 21st century Iraq, no one bothered to look at post-war reconstruction in the 19th century American South. After all, it involved many of the same elements: military occupation, democracy-building and economic development. But administration officials and pundits alike ignored it.

Conflicting News on Malawi's Maize

Something doesn't add up. Malawi is enjoying bumper maize crops according to James Morgan at the BBC. And yet the hunger season was already starting in northern and southwestern Malawi in August when I was there.

Tuesday, October 7, 2008

Global Health And Polymeme

Ethan Zuckerman has put me on to an intriguing news site called, which uses OpenCalais to "help you discover intelligent content that lies beyond the usual echo chambers of tech news, celebrity gossip or American politics."

Although there are other compound categories like "green and energy," there is still no category for global health. Just the tried-and-true-and ultimately not very informative "health" category.

As I've written before (here, here and here), the ways the traditional media and now the cybermedia define categories means that global health often falls between the cracks.

But maybe that just means there's an untapped opportunity for enterprising global healthalites. At any rate, Polymeme is intriguing enough that I'm going to check it out over the next few days.

Monday, October 6, 2008

Wall Street Down; Africa Up?

We'll see how long this trend lasts.

"For the first time, Africa's economic growth is sustaining an upward trend amid a global economic downturn induced by the financial crisis, high fuel and commodity prices and the immediate impact of measures against climate change." (The East African)

Nobel for AIDS Virus Discovery

Bob Gallo loses out to Luc Montagnier and Francoise Barre-Sinoussi in the Nobel sweepstakes. Harald zur Hausen shared the prize for his work linking human papilloma virus to cervical cancer.

Wednesday, October 1, 2008

Transparency in Global Health

Is this the start of a much-needed groundswell for greater transparency and accountability in global health? Data/ONE, UK Aid Network and others have launched a campaign calling on health, development and international aid organizations to Publish What You Fund.

Monday, September 29, 2008

Diabetes and Tuberculosis Link

It's well known that infection with the AIDS virus increases a person's susceptibility to tuberculosis--especially in regions where TB prevalence is already high. Now it looks like diabetes also increases a person's vulnerability to TB.

That's another sign that the double burden of infectious disease and increases in chronic illness doesn't just add to the problems faced by poor countries but actually multiplies them.


Links between diabetes mellitus and tuberculosis: ...[Trans R Soc Trop Med Hyg. 2008] - PubMed Result

Diabetes makes people more vulnerable to TB: study | Science | Reuters

Friday, September 26, 2008

Manto Out; Singing in South African Streets

One of the first acts of new South African President Kgalema Motlanthe was to remove Manto Tshabalala (a.k.a. "Dr. Beetroot") from her position as Health Minister. The new Health Minister, Barbara Hogan, was greeted with a public serenade from AIDS activists.

Tshabalala has not left the government entirely, however. She was moved to the Office of the President, where she'll be in charge of gender, youth, disabled affairs and government communications.

Thursday, September 25, 2008

McCain and Obama Promise to Target Malaria

How times have changed. Both Senators McCain and Obama have made commitments at the CGI meeting to eliminate the number of deaths due to malaria if they are elected President. Note, this is different from eradicating the disease altogether.

McCain addressed the meeting in person. Also in attendance were Cindy McCain and Sarah Palin. Obama spoke via satellite due to a previous commitment elsewhere.

Full text of McCain's speech is here and C-Span has video here. Couldn't find text of Obama's speech but the video is here.

Update: here's the text for Obama's speech.