Posts by Mara Gordon
Panic Half as Much: Swine Flu Vaccine May be Doubly Effective
Published September 11, 2009 @ 11:57AM PT
Swine flu may expose the “global health apartheid,” as blogger Mike Smith argued this week — but we may have more resources to fight it than we think. According to new research published yesterday in the New England Journal of Medicine, a one-dose vaccine for H1N1 influenza may work much more effectively than researchers initially imagined.
This means that resources currently available for the flu vaccine will go much further than imagined. Twice as far, to be precise. Most experts had predicted that patients would require two doses of an H1N1 vaccine to be protected from the virus, which is now pandemic in 168 countries. It has infected approximately 100 million people in the United States since its arrival in spring of this year, according to the Centers for Disease Control and Prevention.
Dr. Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Disease, told the New York Times that research currently underway in the United States “corroborates and confirms the exciting data” that protection against H1N1 may require only one vaccine dose, not two.
[Photo credit: Diego Cupolo]
Elizabeth Pisani Interview: How do we spend the money?
Published September 04, 2009 @ 03:23PM PT
This is Part II of an interview with epidemiolgoist Elizabeth Pisani, author of The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS. Here, she talks about where she thinks HIV/AIDS funding is headed — and why in the past we've refused to spend it in ways that actually work. (Read Part 1 of the Pisani interview here.)
Mara Gordon: You spend a good section of your book debunking the "family values first, science-based facts second" global health policies of the Bush Administration. Where do you hope American HIV/AIDS funding -- and money for global health in general -- will be headed under the Obama administration? Where do you think it is actually headed?
Elizabeth Pisani: I think it is probably headed in the right direction. A lot of very smart people have had to keep a pretty low profile in US institutions such as CDC, USAID and NIH for some time now. But they do know what needs to be done -- clean needles for drug users, constructive work with people in the sex trade, effective prevention programmes for men in prison, full information and a very broad range of service options for people who are considering sex outside of the monogamous-from-marriage-as- virgins ideal so beloved of preachers in sermons if not always in practice. Those are some of the things that need to be done now, but as the data change, the needs will change, too
Sex. Drugs. Excel spreadsheets?
Published September 03, 2009 @ 10:13AM PT
Elizabeth Pisani does it all. A journalist-turned-epidemiologist who has worked to fight HIV/AIDS all over the world, Pisani is the author of one of my favorite global health books, The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS. Her book achieves that rare, wonderful thing when it comes to epidemiology: it's actually interesting.
You'll laugh (her descriptions of female condoms are laugh-out-loud funny). You'll cry (she puts a poignant, human face on the HIV statistics). And above all, it's based on sound science, which as she reveals in her book, isn't always the case when it comes to the big-bucks international HIV/AIDS industry.
She was kind enough to answer a few questions for me about her book and global HIV/AIDS policy.
Mara Gordon: To start off... What are you up to now? Your book is a wild ride that takes us from the brothels of Jakarta to the stuffy UN offices in Geneva. Where are you working? What could possibly top what you've done thus far?
Elizabeth Pisani: I'm trying to settle for a while in London, which I find wildly exotic. I've never really got over my frustration with the mis-match between the effort we put into data collection and the attention we pay to the results. If you look just at developing countries, we spend hundreds of millions on disease surveillance... and then we ignore the result... So right now I'm working with some of the big funders of health research to encourage researchers and even governments share their data. We've learned from genomics on the one hand and the open source software movement on the other that the more brains you get working on the same problem and sharing their findings, the faster you reach a solution. We ought to be able to bring that same approach to research that affects people's lives and well-being.
MG: One of the most important ideas I took away from your book was that we should stop looking at people affected by or at risk for HIV as victims. Instead, you seem to argue, if we equip people around the world with the tools, education, and resources to make healthy decisions, they often will. Why is the global health establishment so wedded to the first line of thinking? How can we change that?
EP: Do you want the polite answer, or the one I think is closer to the truth? If you want the latter, I have to preface it by saying that I love my work and most of my colleagues. But let's face it, most people don't go into public health policy work because they are by nature wild party animals who live lives of competing and highly unpredictable risk. And the pay is pretty crap, so you have to believe that most also don't do it because they have a very sophisticated understanding of the incentives that motivate a large part of humanity. You have to want to make the world a better place to be in public health, and that means that the profession attracts a higher goody-two-shoes quotient than, say, banking or drug-dealing or major league sports. A lot of people in public health are extremely rational, and extremely concerned about health. They expect other people to be rational and health-conscious too. The fact is that most of us ARE rational, but not always about our long-term health. Have really good sex right now (a dead certainty) or possibly come down with an annoying but treatable disease ten years from now, if I'm still alive. What's the rational choice?
As for how to change that, hmmm, don't know. Though I will say that the HIV epidemic itself has changed it quite a bit already, because it did bring into the field of public health a lot of people who ARE naturally party animals, or once were -- gay men and drug users and people who like sex principally but by no means exclusively. That's one of the reasons that HIV is such a fun area to work in, even though it obviously has its deeply depressing side.
In Part II of the interview, I talk with Dr. Pisani about where she thinks global HIV/AIDS funding is headed — and why we've made so many mistakes so far.
[Photo credit: JonRawlinson]
Will Global Health Be a Casualty of Mainstream Media's Decline?
Published August 25, 2009 @ 10:45AM PT
Where do you get your global health news?
Trick question. You already read this blog, which if I do say so myself, does a pretty good job keeping you in the know about both important global health policy updates and new science.
OK, OK, but beyond Alanna's fabulous blogging - how do you stay up to date? Like you probably do, I read quite a smorgasbord of health news offerings, ranging from the Washington Post to niche blogs written by people working on the front lines around the globe.
And increasingly, I rely on non-profit news sources. Unlike traditional newspapers, they take many forms: organizations funded by wealthy philanthropists, fellowships for journalists to write about neglected diseases, websites of organizations and academics whose global health research I respect. These sources give me perspectives I'd never get from simply following the mainstream media, but do they give me rigorous, fact-checked, accurate perspectives, too?
To get some answers, I turned to Maralee Schwartz, a former Washington Post editor and fellow at the Harvard Kennedy School of Government's Shorenstein Center on the Press, Politics, and Public Policy. I got in touch with Schwartz because she recently published a report on non-profit foundations that provide health news (most notably, the Kaiser Family Foundation, which produces an excellent daily aggregation of global health headlines). Her report focuses on U.S. health news, but it asks all the right questions.
Schwartz professed that she isn't an expert on global health news, but she is quite well-informed about an issue that I think will be increasingly relevant to all of us who work in and care about international health. If the information is free, can we really trust it?
"If journalistic standards are applied to the material, I don't have a problem," she wrote in an e-mail interview. "Information comes from lots of different sources -- the key is that the consumer of the information is clear about the source, and trusts the source."
So will global health activists of the 21st century be getting their news from do-gooder sources, not publications looking for a profit?
"During the course of my interviews, Harvard Professor Robert Blendon mentioned that he could see a time when, say, the Gates Foundation might become interested in funding global health news or news on global education issues," Schwartz wrote. "I think if these various nonprofit models on health care are viewed as successful, expanding the coverage to global issues is certainly a possibility."
Check out Schwartz's report on foundation-funded health news here.
Science, Public Health, and Risky Sex
Published July 28, 2009 @ 09:50AM PT
Liberals, like yours truly, always like to use the "science" argument when debating about public health.
A common version of the argument:
Conservatives: Telling kids about condoms makes them have premarital sex!
Liberals: They have premarital sex anyway. Condoms are scientifically proven to prevent pregnancy and STIs. We should definitely tell people about condoms.
Science is empowering. When people have the right to access accurate, rigorously tested information, they can make informed decisions about their own health. But what happens when the science - the real, statistically relevant science - isn't likely to encourage any healthy choices?
If you're a dedicated reader of this blog, you already saw Alanna's post on recent research suggesting that withdrawal may actually be an effective form of birth control. (For more information, take a look at the Guttmacher Institute study here.)
The New York Times published an article about the study this week, its headline proclaiming, "Withdrawal method finds ally." The Times' treatment of the subject got me thinking: What exactly is a publication's responsibility when it comes to controversial health news?
Science, that reliable argument for causes like comprehensive sex education, is also subtle, slow, and rarely as clear-cut as we would like - not exactly headline generating material. So when science does make the news, it tends to be oversimplified and sensationalized.
A quick browse through most major publications' health sections yields stunningly contradictory health news. To lose weight, don't eat carbs! To prevent cancer, drink green tea! And almost as quickly as the news arrives, new studies take their place, telling confused readers the new miracle cure for that which ails them.
It's easy to laugh when it comes to news on trendy weight-loss schemes. But what about an issue, like pregnancy and STI prevention, where the stakes are higher? How should journalists cover it, when the data are limited and likely to cause confusion - yet it's data nonetheless?
A decisively unscientific survey of some of my friends who work in public health yielded a pretty standard response to this issue. "Famous last words," one friend told me when I asked her about the New York Times article. Most people I talked to worried that the coverage of the study would give people an imaginary free reign to have unprotected sex. After all, the science seems to say, withdrawal is just as effective as condoms.
But the Guttmacher Institute study's leader author makes a compelling counter-argument: debates about public health should be data-driven, and she's got data. We should no more blindly trust the status quo in family planning than we should blindly hope teenagers won't figure out how to have sex if nobody talks about it.
What do you think? How should the mainstream media - and the public health community - cover an issue like this?
Mainstream Media and Global Health
Published July 09, 2009 @ 03:35AM PT
Denise Grady
Global health news isn't exactly the mainstream media's strong suit. American publications are slashing their budgets for international coverage, and news about healthcare inequalities - when there isn't a celebrity face attached - is not nearly as common as it should be.
A recent New York Times series on maternal health in east Africa is, thankfully, an exception. Health and science reporter Denise Grady traveled to Tanzania and reported on topics like maternal and infant mortality, orphan care, and unsafe abortions for the "Death in Birth" series.
I highly recommend you take a look at the series if you haven't already. Ms. Grady's writing cuts to the heart of complicated issues, and Béatrice de Géa's photographs are beautiful and moving.
Ms. Grady generously agreed to answer a few questions about the series.
Mara Gordon: Public health issues aren't known for generating headlines in the mainstream media. The problems are chronic and, especially when it comes to an issue like maternal and child health, complicated and intertwined. How did you choose to write about maternal health in Tanzania for the "Death in Birth" series? What choices have you made to make this very important issue "newsworthy" for the New York Times audience?
Denise Grady: I've been interested for a long time in maternal health in poor countries, particularly in the fact that so many of the injuries, deaths and illnesses can be prevented by things that are essentially basic first aid for women who are pregnant or in labor. I chose Tanzania because it is among the poorest countries in the world and its statistics are bad, but neither the best nor the worst in Africa. It has a stable government and so its problems cannot be blamed on war or a despotic regime. So it's a fairly decent representatitive of many other countries. I didn't have to do anything special to make this subject newsworthy. It is inherently newsworthy. My editors agreed. And I've had lots of response from readers. People do care.
MG: Tell me a bit about how you prepared for the trip to Tanzania. How did you decide who to interview and which hospitals to visit? What kind of background research goes into a major global health story?
DG: I prepared for this the way I think most reporters would - I read everything I could find and began to call people. Jeffrey Wilkinson, an obstetrician from Duke University who is working in Tanzania, was extraordinarily knowledgeable and helpful, and also offered to provide introductions and share the many contacts he had made in Tanzania. It can be difficult to make connections and gain access to people and places and institutions overseas, so when somebody offers to help, I seize the opportunity. Dr. Wilkinson helped open doors for me and Beatrice DeGea, the very talented photographer who also worked on these articles.
MG: What was most challenging about the reporting?
DG: The most challenging thing was selecting the stories to tell. For every one we published, there are several others untold. There just isn't room in the paper for all of it.
MG: As your series shows us, there's no easy solution to a problem like maternal mortality. But where do you think we can start? Which strategies in place in Tanzania - like training more auxiliary health workers, incentive programs to attract health professionals to rural areas - do you think are the most effective?
DG: I think that educating girls would be an important first step. I don't mean just teaching them about birth control. I mean providing a general education so that they could look forward to work of some kind and develop hopes and ambitions for themselves. Then they need access and information about birth control and childbirth. I spoke with young women in Tanzania who said they did not realize sex would make them pregnant, or who thought condoms or other types of contraception were dangerous. I think there is also a widespread misperception that sickness and death are inextricably tied to childbirth and are therefore women's lot in life, so people accept it with resignation instead of reacting with outrage. Education could change that.
In terms of specific, practical solutions - you need more trained people at every level, and you need ambulances, and courses in emergency obstetrics, and maternity waiting homes for women who live way out in the bush. I got the sense that when nurses and medical officers were taught things like how to prevent a woman from bleeding to death, they came to believe it could be done, and that they could do it. You need to instill a sense of urgency, and that depends on people believing there is hope, something to be gained by taking charge and dealing with an emergency. If you had to focus on one single thing, I think it would be in preventing and treating postpartum hemorrhage, because that is the leading cause of maternal deaths.
Deadly Roads Are Not Just a Metaphor
Published June 18, 2009 @ 09:15AM PT
(photo credit: richardmasoner)
Take a guess at the answer to this question: What kills 1.3 million people worldwide each year, 90% of them in developing countries?
The hot-button issues probably crossed your mind: AIDS, perhaps malaria. If you're a global health junkie (and regular reader of this blog), maybe you'd guess tuberculosis. When we think about large numbers of mortalities, we tend to think of the "big name" diseases. Editor's note: If you are a very diligent reader of this blog, you might already know the answer.
The answer, however, isn't even a disease, let alone one with a Global Fund and celebrity spokespeople to address it. It's traffic accidents. That's what kills hundreds of thousands of people in the developing world every year.
Earlier this week, the World Health Organization released its first Global Status Report on Road Safety. The statistics are chilling, especially considering how little international attention this issue receives. Very few countries have comprehensive road safety laws, and those that do rarely enforce them. Perhaps the scariest statistic of all: the WHO predicts that traffic fatalities will be the fifth leading cause of death by 2030.
Why doesn't road safety garner the same kind of developed-world sympathy - and aid dollars - that infectious diseases do? I've done a lot of thinking about this, particularly because road accidents have directly affected me and several of my friends in Africa.
The WHO statistics indicate, by any account, a bona fide public health threat. Yet it's rare to encounter any international NGOs working on the issue, let alone idealistic aid workers trucking off to new parts of the globe to fight for better seatbelt laws instead of HIV medication.
A few thoughts:
- Road accidents happen at home, too. A car crash doesn't seem exotic to an American in the same way that many tropical diseases do. I'm not trying to undermine the importance of prevention and treatment for infectious diseases, but sometimes the ordinary problems don't seem as noble to fix.
- We can't deliver a commodity to treat it. As a donor, it feels good to imagine your money putting a tangible object in somebody's hands: an anti-malarial bednet, a nutritional supplement for a child. We can't prevent car accidents with a deliverable product.
- Addressing the problem means uncovering many, many more. Road safety in poor countries is a result of many complex, interconnected factors - safety standards for vehicles, unenforced traffic laws, shortages of trauma centers. A drug can't cure it.
Take a look at the WHO report and let me know what you think. Where do we start?
