Sins of the Father

December 13, 2006


And you think the Catholic priests have problems in America…

CNN just ran a story about a Catholic priest who was a leader in Rwanda’s 1994 genocide. Athanase Seromba was just convicted by the International Criminal Tribunal for Rwanda (which meets in Tanzania) and sentenced to 15 years.

According to the charge sheet, Seromba directed a militia that “attacked with traditional arms and poured fuel through the roof of the church, while gendarmes and communal police launched grenades and killed the refugees.”

After failing to kill all the people inside, Seromba ordered the demolition of the church, the document said.

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Choosing Chavez

December 3, 2006


On Sunday the 16 million registered voters of Venezuela get a chance to select their next leader. Hugo Chavez is running for another six year term, and is opposed by former Zulia state Governor Manuel Rosales.

I honestly don’t know much about Rosales. There isn’t much on Wikipedia, and I hadn’t heard too much of him before. That, and the incumbent’s still soaring popularity among Venezuela’s poor, seems to bode well for Chavez’s reelection.

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Cutting Edge Movie

November 30, 2006


If you haven’t seen previews yet (or posters like this), a movie called Blood Diamond is coming out soon. Alberto over at GlobaLab brought my attention to an interesting controversy.

Apparently, the diamond industry claims the movie, which is set in Sierra Leone in the 90s, paints a dirty picture of a global industry that has really cleaned up their act. So they (the miners & distributors) set up a website to espouse their point of view: Diamond Facts.

However, Global Witness, the non-governmental organization that does the most to research and disseminate information about the origin of ‘conflict diamonds’ (which is an understandaby difficult, dangerous task) disagrees. Global Witness, along with Amnesty International and Warner Brothers (which is distributing Blood Diamond) have teamed up to make Blood Diamond Action, a website which counters the industry’s claims.

Call me a pessimist (or a realist), but when it comes to politics in the developing world, the dirtier answer is usually correct.

A Nationalist Feeding Trough

November 27, 2006

(An extension of Rotten Cotton)


While my full review of Bill Emmott’s book 20:21 Vision: Twentieth Century Lessons for the Twenty-First Century is still forthcoming, I’ve been pleasantly suprised by some of his positions. As the editor of The Economist, Emmott espouses an interesting brand of economic libertarianism. He is no pure laissez-faire economist. Instead, he recognizes that in many areas government intervention is necessary in order to allow the market to function optimally. Key areas are in reasonable environmental regulation, responsible control of the money supply, and the restriction of monopolies.

So Emmott’s economic libertarianism seems to be driven more by practicality than ideological devotion to smaller government as necessary for the preservation of freedom. This is important because, in my view, government intervention is often necessary to protect individual’s freedom (and to promote justice) from those who are more powerful- be they individuals or corporations. Faith that the unregulated market would be the best of all possible worlds is akin to religous belief for some, but falls shorts of tests of pragmatism.

Similar to Stiglitz’s critique of farm subsidies in general, here’s Emmott’s pounding of the European Union’s farm subsidies:

“Despite being planned at a supranational level, the Common Agricultural Policy [of the European Union] has become a nationalist feeding trough. It is a case study of how a system of subsidies is almost impossible to dismantle once it has been created, for farmers in every country lobby their politicians to maintain subsidies, quotas and rules that favor them. It is also highly protectionist and throttles poor countries’ farm exports….”

I also just found this interest, sometimes productive discussion of Jeffrey Sach’s poverty-elimination scheme over here.

Elimination of farm subsidies by the U.S. and E.U seem to be a necessity for African farmers to really develop successful business models that could yield exports, and thus a more productive economic base then mere subsistence. The only serious issue remaining, in my estimation, is what incentives to offer developed-world farmers for them to abandon their subsidies. At the very least, fat pensions and re-education programs to help them find new careers would be required. But after that, my mind’s a blank.

Patents and Patients (II)

November 25, 2006


As an addendum to my previous post, I’ll offer these quotes from Bill Emmott’s 20:21 Vision: Twentieth Century Lessons for the Twenty-First Century. Emmott is the chief editor for The Economist. I’ll be writing a review of this book briefly, but for now, here are some quotes that jive pretty well with Stiglitz’s take on pharmaceutical patents:

“Intellectual property (that is, patent) protection for rich-world firms enables them to keep their goods expensive in developing countries while preventing local firms from competing against them.

“This is particularly problematic in the pharmaceutical business. Medicines are cheaper in the third world than in the first, but they are still costly by local standards. Pharmaceutical firms argue that they need to make profits in order to maker their research into drugs worthwhile; without patents and profits, the drugs would not exist. Perhaps more pertinent, however, is a fear that if they sell drugs very cheaply in poor countries, traders will buy them up and export them back to the rich world, undercutting the drugs firms’ profits there.

“Both these arguments are sound. Without profit, the drugs would not be invented. But there remains a question of quite how much patent protection is really needed. And, most important, there remains a question of who should pay to help make drugs cheap in the third world: the drugs firms’ shareholders or rich-world taxpayers. There is a strong moral case for the second, for the use of aid money to bridge the gap between the need for profits to repay research and the difficulty the poor face in paying the bills. This is especially important for diseases that are prevalent only or mainly in poor countries, and thus provide no profits at all in the rich world. Such aid, targeted clearly at medicines and health care, especially for scourges such as AIDS, malaria and tuberculosis, would come with risks. Over time, for instance, the drug firms might raise the prices charged to the donor governments, thus creaming off more of the aid money for themselves. The risk of smuggling back to the rich world would also persist. But it would still save millions of lives. And the moral point would be clear: it is not capitalism that is at fault in making drug prices too high and unaffordable in the third world, it is poverty.”

Patents and Patients

November 20, 2006

The right to intellectual property is fundamental to much Western innovation. If I write a book, I own that book and can sell it for what I like. If I invent a new type of automobile (or spaceship for that matter) I can profit from its sales. But should intellectual property rights be extended into all areas of creative endeavor?


I’ve been telling my friends for some time that much stronger government-provided incentives are necessary to bring the level of research on drugs for the poor to badly needed levels. Funding for HIV, malaria, and tuberculosis have improved in recent years, but their funding is still disproportionate to the scale of their impact. Other diseases that primarily affect the developing world don’t get as much attention from the Global Fund and the Gates Foundation, either.


I am always appreciative when someone well-known articulates something that I’ve been telling my friends all along, and Nobel Prize-winning economist Joseph Stiglitz (who I’ve written about before) has done just that (thanks Joe). His short piece in The New Scientist, “Award Prizes Not Patents,” offers a workable alternative to patents for drug research.


The absolute right to intellectual property has at times been overlooked in many of the fastest advancing fields of science. If Watson and Crick had been able to patent the structure of DNA because they first discovered it, they would have profited beyond imagination from the myriad technological advances that have stemmed from our knowledge of DNA.


But their ability to monopolize the use of that knowledge and ask whatever price they desired could also have stymied much additional research, and made its benefits unavailable to the poor.


Historically, scientists have published their research in journals and felt free to use the data and techniques originated by others (giving ample credit where it is due, of course) in the course of advancing our knowledge of the physical world. Some scientists and inventors have of course been quick to patent specific inventions which are easier to monopolize/protect.


But the patenting of a new drug by a pharmaceutical company makes as much sense to me as Watson and Crick patenting the shape of DNA. They were only able to discover the double helix because they stood on the shoulders of giants. And despite their lack of a patent, the rewards for research were still strong; professional respect, international fame, a place in history, career stability, and the not-insignificant monetary compensation of a Nobel Prize.


As Stiglitz writes, what is needed is a strongly funded program that provides large prizes for drug development based on the national and global need for new treatments. Breakthroughs in treatments for cancer, heart disease, diabetes, malaria, tuberculosis and AIDS would be rewarded prizes similar in proportion to their need, giving research companies more than enough incentive to pursue new drugs. Once developed, drugs could be distributed at cost.


Sound socialist to you? Well, some goods, like having drugs available to treat HIV and tuberculosis (where treatment also slows the spread of disease), are social goods that benefit entire communities, nations, and the world. Funding medical research based on the impact of disease is merely a recognition that the development of new drugs should be guided by the extent of someone’s suffering, not the depth of their wallet.


In addition, this particular alternative system would maintain the current level of competition among pharmaceutical companies (which is what makes the U.S. the world leader in drug development) while focusing research on drugs that would lead to the greatest public good, not the diseases for which rich people are willing to expend millions.


We are not isolated—disease has no respect for international boundaries—and the perverse incentives our current system gives pharmaceutical companies to research impotence and baldness have a very really cost on the poor of the world.

Quitting for Democracy

October 26, 2006


This guy might be on to something.

Mo Ibrahim is a billionaire from Sudan (he has British nationality but was born as a Sudanese Nubian). He made his fortune by founding the cell phone company Celtel, which markets primarily in sub-Saharan Africa. Vanguard has some good background information.

When I was in South Africa & Zambia in 2004, I was shocked by the proliferation of cell phones. It seemed most of the people I met–rich and poor–knew more about cell phones and SMS-ing (text-messaging) than I did at that point. Well, more so in South Africa than in Zambia. In Mr. Ibrahim’s words, cell phones are better than computers for most Africans because they’re less expensive and you don’t need constant electricity. Many areas that have never seen landlines now have cellular coverage.

Mo Ibrahim sold Celtel to Kuwaiti telecom giant MTC $3.4 billion in 2005. And what’s he going to do with his money?

Yesterday The Guardian published a story on Ibrahim’s plan to offer a $5 million prize for African governance. Basically, each year a committee will select a democratic leader who has fought corruption and encouraged accountability, and pay them to quit.

Many African countries have transitioned to democracy since decolonization, while others are still mired in military dicatorships. But many governments that are democratic in name are anything but democratic in spirit, largely because grass-roots power and accountability don’t simply blossom overnight after hundreds of years of subjugation. One of the most impressive things about America’s government to me is that despite the massive power at stake, we’ve responded relatively peacefully to transitions in leadership for centuries, discounting the Civil War, of course. Well, at least for decades…

Many African presidents, while elected in some way, find ways to extend their power and crush the opposition. Egypt’s Mubarak and Zimbabwe’s Mugabe come to mind, and Uganda’s Museveni and South Africa’s Mbeki could be headed that way.

Ibrahim says that giving rulers motivation to step down and turn over the reins to their successor is vital for democracy, a fourth option besides “relative poverty, term extension, or corruption”. Meanwhile, Transparency International derided the prize as a reinforcement for African “strong men”.

I think the prize could have positive effects, depending on who it’s given too. But by itself it won’t be nearly enough to stem the tide of corruption on all levels of African government. Transparency International is correct in seeing the prize as incomplete solution to a multifaceted problem, but getting popular leaders to quit sure seems like a worthy goal to me.

Quotes for Thought

October 18, 2006

Some quotes to ponder from two of my favorite doctors…

Dr. Jim Kim:

“There are more billionaires today than ever before. We are talking about wealth that we’ve never seen before. And the only time I hear talk of shrinking resources among people like us, among academics, is when we talk about things that have to do with poor people.”

“Farmer got hold of a pamphlet about how to equip labs in third world places published by the World Health Organization. It made modest recommendations. You could make do with only one sink. If it wasn’t easy to arrange for electricity, you could rely on solar power. A homemade solar-powered microscope would serve for most purposes. He threw the booklet away. The first microscope [at Partners in Health’s medical clinic in] Cange was a real one, which he stole from Harvard Medical School. ‘Redistributive justice,’ he’d later say. ‘We were just helping them not to go to hell.'”

Paul Farmer:

“God gives us humans everything we need to flourish, but he’s not the one who’s supposed to divvy up the loot. That charge was laid on us”.

“I recommend the same therapies for all humans with HIV. There is no reason to believe that physiologic responses to therapy will vary across lines of class, culture, race or nationality.”

“In an era of failed development projects, and economic policies gone bad, I sometimes feel very lucky as a physician, since my experience in Haiti has shown me that direct services are not simply a refuge of the weak and visionless, but rather a response to demands for equity and dignity.”

“Shuttling back and forth between what is possible and what is likely to occur is instructive and a lot of what shapes our sentiment.”

“I critique market-based medicine not because I haven’t seen its heights but because I’ve seen its depths.”

“For me, an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.”

Partners in Health

October 18, 2006

Boston was amazing. I wrote a report for the group that funded my trip, and I realized it would make a decent blog post. And I got to meet Paul Farmer, who’s basically my hero/role model in many ways. I don’t think it quite qualifies as a “hero” because that implies you idolize the individual. Dr. Farmer is a figure worth looking up to because of his extraordinary work ethic, the good he’s been able to accomplish for global health, and the fact that he is an icon for like-minded individuals.

Partners in Health’s 13th Annual Thomas J. White Symposium was attended by approximately 1500 people–students, volunteers, admirers, and donors of all ages–at the Kresge Auditorium on the campus of MIT in Cambridge, MA. Partners in Health (PIH) is a non-profit organization that has grown over the past two decades to include 4000 employees in Boston, Haiti, Russia, Peru, Guatemala, Rwanda, Lesotho, and soon in Malawi, who last year provided health care to over 1 million people, including 1000 on antiretroviral treatment for HIV. PIH has had a significant impact on global health policy because of the personal dedication of its founders and the principles on which it is founded, which were expressed well by the 2000 People’s Health Assembly in Savar, Bangladesh; “The attainment of the highest possible level of health and well-being is a fundamental human right”.

The symposium, designed to summarize the past year’s activities, and to outline the policy and programmatic struggles to come, began with remarks by Ophelia Dahl, Executive Director of Partners in Health, on the last year’s expansion of PIH�s operations into Rwanda. A video was shown that highlighted the adaptation of clinical models developed in Haiti, incorporating HIV and TB treatment with community health workers and housing support, for Rwanda.

The keynote address was given by Dr. Jim Yong Kim, current head of Harvard’s Division of Social Medicine, and co-author of Women, Poverty, and AIDS. About ten years ago, Dr. Kim and Dr. Paul Farmer, cofounders of PIH, demonstrated the possibility of treating patients with HIV and Multi-drug-resistant Tuberculosis (MDR-TB) in resource-poor settings. Their research findings changed World Health Organization policy, which had previously recommended against treatment in impoverished countries. Dr. Kim recently spent three years in Geneva as the director of the World Health Organization’s AIDS program, where he pioneered a campaign to get 3 million poor patients on HIV treatment by 2005. He spoke of the triumphs and pitfalls of working within the WHO bureaucracy, of which he was previously a well-known critic. While lauding the continuing research into new cures, Dr. Kim also introduced a new program at Harvard Medical School in Global Health Effectiveness, helping to improve worldwide access to therapies currently available in high-income countries.

Dr. Paul Farmer, who has become a minor celebrity to students of international health and development after being featured in Tracy Kidder’s Mountains Beyond Mountains, spoke charismatically about the interconnection of social and economic factors with the health of the poor, and about the continued need for an equity plan to prevent and cure treatable diseases worldwide. He also praised donors like Thomas J. White, the millionaire who made PIH’s early work possible, and in whose honor the annual symposium is held.

Other presenters included Lucette Fetire, a Haitian HIV patient and advocate who told her story of how PIH first treated her, then empowered and employed her as a community health worker to help her HIV+ neighbors. Dr. Ludmilla Kashtanova, director of PIH�s Russian programs, talked of treating MDR-TB in Russian prisons, and changing the course of Russian policy to prevent further spread of the disease. Veronica Suarez Ayala and Jason Villarreal, community health workers for PIH in Peru and Boston respectively, shared stories of their patients, sometime succumbing to disease, and sometimes recovering to help others.

Personally, I found the event extremely affirming and encouraging. Meeting many likeminded undergraduate and medical students was uplifting, and being in a large crowd that affirmed a belief I strongly hold�that people should not die of treatable diseases regardless of their country of birth�only helped crystallize my goals.