Tuesday, May 19, 2009

Who Pays for Global Health News and Why?

To maintain credibility, news coverage of global health and development issues must be independent because who pays and why dramatically influences the process of what gets told. This is a sleeper issue that does not get enough attention. As a health journalist, I know we have been down this road before—with respect to misleading consumer news coverage of medications and research studies—and it’s not pretty. In the end, it actually hurts people and wastes money.

It hit me last night why I am so passionate about this topic. I went to a presentation about how to improve health care news coverage in the U.S., which was mostly about how many health news reports don’t cover basic issues like costs, availability or provide even a hint of context about whether something is truly broadly beneficial. The event was sponsored by the New York City chapter of the Association of Health Care Journalists, of which I am a member.

One of the presenters, Gary Schwitzer, a former CNN journalist and current journalism professor who founded HealthNewsReview.org, jokingly suggested that I might throw spitballs at him while he was at the podium. (The other presenter was Harry DeMonaco, who helps Boston's Massachusetts General Hospital decide what treatments are both beneficial and cost-effective.) Instead, Schwitzer provided me with an aha! moment.

For more than 20 years, I have worked in an environment where pharmaceutical and medical device companies have a huge vested interested in getting their products covered by the mainstream media in the best possible light.

As Gary Schwitzer and Harry DeMonaco noted, the economic incentives are so great that the influence extends even to what appears in medical journals. Drugs are often compared against placebo instead of current effective treatments, for example, because the results are more dramatic that way. No one can take a chance on a new medication being scientifically shown to be just as good or only marginally better than a less-expensive one.

Add to that human nature—it is very hard to be objective about something to which you have dedicated lots of your time and energy. So naturally, someone who is a principal investigator on a study is going to be enthusiastic about the work and its potential for alleviating human suffering.

I know that—as do many of my colleagues in the health journalism field. And I hope that I have taken account of those sorts of positive psychological and economic biases in my reporting by looking for more outsides sources, bringing a respectful-but-still skeptical attitude to most research studies.

Just as importantly, I benefited from the structural divide that was set up within TIME Magazine that kept the advertising side separate from the editorial side precisely so that I could be as independent as possible in doing my job.

So here I am, trying to get more news coverage—both online and offline—of important issues in global health and development and I find the same built-in biases that make health-reporting trickier than you might at first think.

There is a built-in bias in almost any story about non-government organizations against considering what governments are doing in health. Every story about a specific disease has a built-in bias against discussing primary care systems or the non-medical interventions (like better schools or roads or robust legal and civil rights for women) that could conceivably have an even greater impact.

The consequences are very real. To give just one example, I will never again be able to read another laudatory story about the “generous donation of medical supplies” without thinking about the amount of donated material that I saw in Malawi last year that had either passed its expiration date or was actually useless—and needed to be discarded, all at the expense of the receiver. This is the sort of problem that missionaries 50 years ago dubbed “junk for Jesus.” It makes the folks back home feel virtuous but it is a burden for the supposed beneficiaries.

Given the costs and the way things are going these days in journalism, there is bound to be money coming from interested parties whether in the form of grants, advertising or even accepting a ride in an aid convoy, to cover global health issues. That’s all the more reason to set up rigorous firewalls so that funders and advocacy groups don’t get editorial approval over the final product. News organizations also need to make those policies public so that the larger community can judge for itself how well they are doing.

Budding global health news organizations—or content providers—also need to be more creative about who they tap as funders/advertisers. Maybe recruit the folks who like to fund transparency projects, for example, instead of going after global health or single-issue advocacy money.

There may also be ways of crowd-funding global health news coverage that we haven’t explored.

But I know we need to be paying as much attention to managing these conflicts within the coverage of global health news as we are to “monetizing content,” to use the current buzz-phrase. And it's just as much an issue for citizen journalists/participatory media as for legacy or professional journalists.

Related posts (updated on May 20,2009)
Click #ghnews label for other posts on covering global health
See also "Pro-Publica and Conflicts of Interest"
Read Ivan Oransky's live tweets from Monday night's AHCJ event with Schwitzer and DeMonaco.

Monday, May 18, 2009

Barbara Hogan, Paul Farmer, Eric Goosby and More

And now for a little global health gossip--in between reading dispatches from the World Health Assembly, which is meeting in Geneva this week . . .

Barbara Hogan is out as South Africa's Health Minister--just a few days after being named one of Time Magazine's 100 Most Influential People in the World. Was she too outspoken about the need for greater transparency and accountability for South Africa's AIDS treatment programs? Too critical about the government's refusal to issue a visa to the Dalai Lama? Is the ANC government that petty? Or is this just normal shuffling of cabinet positions? South Africa watchers are taking a watch-and-see approach--especially since the new Health Minister, who comes from Limpopo, is not widely known.

Paul Farmer has told colleagues he is contemplating a possible position with the U.S. government.

And in other news,

Eric Goosby, who has been tapped by President Obama to replace Mark Dybul as U.S. Global AIDS Coordinator (head of PEPFAR), will be speaking at the Global Business Coalition on AIDS annual conference June 23-24 in Washington, DC. Dybul will be there as well in his new role as co-director, with Larry Gostin, of the Global Health Law Center at Georgetown University. (Dybul joined Georgetown in February).

Thomas Frieden, New York City's health commissioner, is Obama's pick to head up the Centers for Disease Control. Revere, in his unique way, highlights some of the challenges Frieden will face.

And if you're in Washington, D.C. for the Global Health Coalition annual conference, don't miss Katrin Verclas on Wednesday morning, May 27. She organized the excellent barcamp conference on Mobile Tech For Social Change that I attended in New York City back in February and is a crackerjack organizer and advocate for what mobile phones can do for health, finance, accessing the Internet, changing the world.

Oh, and this just in. . . the London School of Hygiene and Tropical Medicine, just won the $1 million Gates Award for Global Health, given out each year at the Global Health Coalition meeting.

Thursday, May 14, 2009

Afghanistan: First Acid, Now Gas Attacks Against Girls

Reuters reports that three girls' schools in Afghanistan have now been the targets of improvised gas attacks. Five girls fell into comas for a short while after the most recent attack, which occurred on Tuesday, while 100 others were hospitalized. Apparently, throwing acid at some girls, wasn't enough to convince many of their sisters to stop their education.

The news of the attacks has kept hundreds of girls from showing up at school, according to the Associated Press.

Still unclear: what kind of gas was used. Blood samples have been sent for testing. There is also a chance that a gas leak--as opposed to a premeditated attack was involved at the third school.

Also disturbing, the attacks are happening in Kapisa province, a region east of Kabul that has been relatively open and supportive of girls' education.

Related news:
Katie Couric had a piece on the CBS News about the assassination of a women's rights activist in Afghanistan and the passage of a new law that (may be changed) that would allow marriage as a defense against rape.

Wednesday, May 13, 2009

Crisis-Mapping the Sri Lankan Fighting

Is there a way to combine human and technological intelligence to figure out what is going on in a tiny section of Sri Lanka, which suffered heavy bombardment this past weekend? Can you, dear reader, help collect that information?

The American Association for the Advancement of Science has published satellite imagery which suggests heavy shelling and mass movement of people. (hat tip @mwmcelroy who works at the AAAS.)

According to the Associated Press (as quoted in the New York Times), "a government doctor said at least 378 civilians — and perhaps as many as 1,000 — had been killed and more than 1,100 wounded on Saturday and Sunday during intensive shelling of the combat zone on Sri Lanka’s northeastern coast, a boggy sliver of beachfront where Sri Lankan troops have surrounded Tamil separatist fighters." (Click here for the full AP report, which details three rounds of shelling on the hospital.)

Journalists report not being allowed into the area to report on what is going on.

This seems like quite a test case for folks who promote the benefits of crisis-mapping.

Crisis-mapping is an emerging technology that uses SMS or mobile texting plus other crowd-sourced pieces of information to map a crisis, while it is happening. The idea is to give folks on the ground as well as those far away some idea of what is going on and which areas are particularly dangerous in real-time. Click here for a video introduction to crisis-mapping from Patrick Meier, whose dissertation features a lot about crisis-mapping and who has been traveling the globe recently introducing folks to it.

I am asking my larger Twitter and blogging community for help in gathering resources. Will share the results here.

Monday, May 11, 2009

Human Health Effects of DDT

Several folks, after reading my last post on DDT, have asked me about DDT's health effects on people. Their point: while DDT may prevent some people from dying of malaria isn't there a cost to their long-term health?

Once again, context is key. The major negative effects of DDT have been on animals--particularly birds and fish. This is very important and not something the environment can sustain, especially since DDT accumulates in any animal's fat tissue (including people's).

As far as we know, DDT's health effects on people are minimal compared to that on fish and birds--something that was straightforwardly acknowledged last year on the website of the World Resources Institute, where Al Gore serves on the board of directors.

More recently there has been some research to indicate that DDT may act as a hormone disrupter and affect fertility as well as promote premature delivery. Animal studies have also suggested a possible cancer risk--but once again that would presumably be at very high dose.

So, if you are just going to look at health effects in people, the scales tip toward using DDT in those parts of sub-Saharan Africa in particular where it would be most helpful.

This is the same kind of cost-benefit ratio that is seen with giving polio vaccines that also sometimes cause the disease itself.

The cost to the environment is the more worrying issue--and something that needs to be addressed whenever DDT is used as part of an anti-malaria program. Fortunately, the amount of DDT that is needed for residential spraying is small. South Africa has shown the spraying can be done with minimal impact on the environment--by training sprayers and making sure no DDT is diverted to agricultural use.

It's a fascinating topic--and hard to find experts who are truly impartial. In my experience of reporting on the topic, people from both the left and right use DDT to score political points without regard to what facts are like on the ground.

Makes me think I should look more closely at the latest report that the World Health Organization has decided to work towards the total elimination of DDT, perhaps even in malarial zones.

Related posts:
Back and Forth on DDT Again
Can Malaria Be Eradicated?

Thursday, May 7, 2009

Back and Forth on DDT Again

What's missing from the latest news about the World Health Organization, DDT and malaria? Context! Context! Context! Namely, if DDT had been used from the time of its invention only for public health purposes--for indoor residential spraying against mosquitoes in areas hard-hit by malaria--it would probably never have developed its toxic reputation.

The fact that agricultural interests--particularly cotton farmers--adopted wholesale DDT spraying is what killed birds and poisoned entire ecological systems.

There is a special case to be made for judicious, environmentally-protective DDT spraying of residential homes--particularly in hard-hit African countries. South Africa has shown how to do this and still protect the environment. (I wrote about this in TIME Magazine five years ago. Please also note, it was the combination of DDT and treatment with an anti-malarial drug that turned the tide.)

The World Health Organization seemed to have acknowledged that point back in 2006.

Now comes word that they hope once again to achieve a total ban on DDT, thanks to pilot programs that have used other anti-mosquito pesticides and means in Mexico and Central America. Please note: malaria is much worse, much more prevalent in central and southern Africa so what works in Mexico may have little effect in malarial zones of Africa.

As for increased resistance of mosquitoes to DDT, the point is actually not to kill the mosquitoes but to keep them from biting. And DDT is actually a better mosquito repellent than anything else--exactly what you want, according to a 2007 study in Nature Medicine.Link

I suppose all public health programs have an element of politics but I find it very frustrating to read news reports that pretend that all decisions with respect to DDT are made solely on a scientific basis.

Related posts:
Can Malaria Be Eradicated?
Human Health Effects of DDT

Tuesday, May 5, 2009

How I Use Twitter Without Being Overwhelmed

Twitter does not have to be yet another echo chamber—provided you are selective about who you follow. By treating Twitter as a filtering device and NOT a broadcast medium, I think I have a better shot at getting at the story behind the story.

For my purposes, Twitter does three things very well: organizing people, collecting data and doing a quick temperature check.


The 20th century still has such a hold on many of us that we find it hard to give up certain broadcast assumptions—that your goals should be to reach as many people as possible and to drive the conversation.

So, most stories about organizing people with Twitter focus on large numbers—10,000 protesters showing up in a square in Moldova, even if later reports question just how much of a role Twitter or SMS texting or even the government itself played in the demonstration.

My goal is not as revolutionary, nor does it require as many people. I want to develop an independent editorial voice to shine more light on global health and development—both as issues and as industries.

Given the tumult in the news business these days, there is a lot we still do not understand about how to make such an enterprise sustainable. But I suspect there are enough people out there who are interested—and who have some good ideas and experience on how to get things done—that we might be able to figure it out eventually.

In the meantime, I am trying to develop a kind of network for global health news through Twitter, my email contact list and the people on my own and other global health blogs.


We have only begun to explore what is possible with structured data. I predict this area will explode with possibilities once it no longer takes a lot of computer programming skill and expertise to do this right.

For now, most of what I am collecting on Twitter are links—still very 20th century.

Often these are bits of information that do not necessarily relate to each other. Typically I look for links that deal with new models for delivering and sustaining news, that get beyond advocacy in global health and that grapple with some of the ethical dilemmas of how we tell stories, while trying to make money, working against deadlines and across cultures.

One of the most practical uses of Twitter for non-programmers is to figure out whether they should jump to another session at a conference. Check the twitterstream for a conference #hashtag to see which panel discussion looks most interesting and jump ship if yours isn’t meeting your needs. Likewise, let others know if the panel you’re listening to is really interesting.

Notice with conference #hashtags, we’re often talking about small groups with very concrete pieces of information. Indeed, the short messages often can only be understood by those who are already on site. Further, deeper reflection comes later—and is probably based on more research, phone calls, better data.

One of the best examples of collecting concrete data from lots of people is the #votereport project.

#Votereport was a Twitter project in which US voters were encouraged to tweet their voting experience last November 4. Because the predictions were of massive voter turnout, the goal was to see where the lines might be long and where newly registered voters might be encountering problems. Voters were asked to provide three pieces of information: their zip code, the length of the line and whether they had a good or bad experience. If bad (meaning they were turned away), then they gave more details about why.

The brilliant thing was that organizers then were able to put those folks who were turned away in touch with election protection lawyers in real time to see if their legal-electoral issues could be resolved before the voting booths closed.

The big picture issue was maintaining the integrity of the voting process. But the structured data that folks were asked to provide was easy to give and the connection with the larger point was easy to understand.

Eventually I think we will see more projects like #votereport adapted to global health.

But input from large numbers of people will not always be required.

Check out Frontline SMS for one example of what’s possible when you adapt text messaging tools for humanitarian work. I have also wondered if it would be possible to adapt something similar for ensuring the integrity of a country’s supply chain of medicine?


There’s a concept in biology called proprioception. That’s the body’s own awareness of itself in the environment. Because it goes on in the background, we don’t have to give conscious thought to keeping our balance when we decide to run for the bus.

I use Twitter as a kind of proprioception tool for health journalism. Another way to think about it is to use the phrase “situational awareness,” as developed by military strategists and later appropriated by folks in business.

To give just one example, when I tweeted about grappling with what to call the new human swine flu in my own news articles, I learned that several other health journalists I respect were dealing with similar issues. And indeed, that struggle later became the subject of official pronouncements from the Centers for Disease Control and the World Health Organization, as well as long-form news articles by others who are not in my Tweetstream but who I read on the Internet and in hardcopy.

There are only so many hours in the day and only so many minutes I want to devote to Twitter. So my Twitter philosophy is to keep the number of tweets low and to follow only those who also keep their tweets low. If you pick the people you follow right, you will get a much more manageable stream.

I aggressively unfollow people who tweet too much. No matter how good they are, they drown out the others. And messages from high-volume tweeters still get into my tweetstream if the people I follow find them particularly important.

I unfollow people who retweet links without checking them out first.

I don’t mind following someone for a while and then unfollowing them only to refollow them later as my needs change.

If you find you have to follow someone who tweets a lot, follow them through an RSS feed or one of the programs (Tweetdeck, Twhirl, etc) that allow you to segregate their stream from your low-volume crowd. For now, I still access Twitter through the web because I am trying to keep the volume low, not increase it.

I often do not follow my friends if they tweet a lot because we are already on Facebook, I read their blog or we are in constant email contact.

I do not read every tweet. I do not reply to every @message. If you adopt a "river of news" approach to Twitter (similar to the one many of us have had to use with RSS feeds), the stream is much more manageable.

In essence, I think of the people I follow as my filter, a way of getting a sense of important ideas but NOT as a way of getting first-hand information. We are already flooded with facts (not to mention half-truths and outright lies). What we need are better filters.

As in so much of life, you have to take active steps if you really want to understand what is going on as opposed to just being distracted.

If you want to follow me on Twitter, I'm @cgorman.

Related Posts:
Wanted: A Social Network for Global Health News
Sharing and Global Health Blogging