Credit Where It’s Due

What will be Bush’s greatest positive legacy? I think PEPFAR is a likely candidate, despite its flaws. I can’t think of any other program initiated by Bush that has helped so many people.

Good News, Bad News

The World Health Organization has announced that polio has been eradicated from Somalia. This was an incredibly difficult task, given Somalia’s endemic violence and instability. And it took a huge effort:

More than 10,000 Somali volunteers and health workers vaccinated more than 1.8 million children under the age of five by visiting every household in every settlement multiple times.

However, this has happened before. Polio was eradicated from Somalia back in 2002, only to be reintroduced from Nigeria. The fact that polio was reintroduced from a country on the other side of the continent calls attention to the interrelatedness of disease control efforts in different countries (diseases know no borders) and the tragedies that occur when vaccination efforts clash with local cultures or religions.

But despite its tenuous progress in terms of total eradication, the WHO’s $4 billion polio campaign has made great steps forward:

When WHO and partners began their anti-polio campaign in 1988, the worldwide case count was more than 350,000 annually. The disease’s incidence has since been slashed by more than 99 percent and remains endemic in four countries: Afghanistan, India, Nigeria and Pakistan. Polio cases were also detected last year in Angola, Cameroon, Chad, Congo, Myanmar, Nepal, Niger and Sudan.

So that’s the good (albeit cautiously so) news. The bad news for Somalia:

Somalia’s Government Teeters on Collapse

If you read that and asked “wait, Somalia has a government?” you’re not alone. But it does have a government of sorts:

By its own admission, the Transitional Federal Government of Somalia is on life support. When it took power here in the capital 15 months ago, backed by thousands of Ethiopian troops, it was widely hailed as the best chance in years to end Somalia’s ceaseless cycles of war and suffering.

But now its leaders say that unless they get more help — international peacekeepers, weapons, training and money to pay their soldiers, among other things — this transitional government will fall just like the 13 governments that came before it.

Less than a third of the promised African Union soldiers have arrived, the United Nations has shied away from sending peacekeepers and even the Ethiopians are taking a back seat, often leaving the government’s defense to teenage Somalis with clackety guns who are overwhelmed.

Confession Time

I’m a feminist. I think women deserve equal political and social rights, equal access to the same jobs as men if they want them, and equal pay for the work they do. If that doesn’t sound extraordinary, then maybe you’re a feminist too.

This is a video of men being asked on the street what they think of feminists. It’s rather sad, but watch it for the best two answers–the last two. One guy uses the Bible to justify men being the head of women, and his wife’s reaction is absolutely priceless.

As with many types of injustice, it really took traveling outside my own country, especially in Africa, to realize the problems we have here. The interpersonal, social, and economic conditions for women abroad are often much lower than even in the American South, but that certainly doesn’t mean things are perfect here.

I think overall the name’s gotten a bad rap, so I go out of my way to describe myself as a feminist, which usually raises interesting questions. So, do you know a feminist? If so, thank s/he for being who they are.

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If You Don’t Like to Think About AIDS, Don’t Read This.

Nicholas Kristof wrote a piece recently entitled “Save the Darfur Puppy.” I think he was going for getting a reaction with the title, and it worked, at least with me. You’ve probably notice that the media loves stories about endangered species–always cute, cuddly ones, never rodents–because people are moved by these stories. On the other hand, a crisis like the genocide in Darfur is unlikely to get airplay commensurate with its magnitude. And likewise with AIDS, which despite being of tragic scale–two or three flaming World Trade Centers full of people dying every day–rarely hits the news, in part because it’s the same old, depressing story, every day.

So, when I saw that Truthdig had an interview called “Stop Ignoring AIDS and Africa,” I gravitated light-wards. The piece is an interview of Stephanie Nolen, the author of a new book called “28: Stories of AIDS in Africa” which tells one narrative of a (real, actual, living and breathing) human being with HIV in Africa for every one million of the estimated 28 million living with the virus. I certainly plan on reading this book, but here’s what really caught my eye–this picture:

And its caption:

Bongos, an 8-year-old HIV-positive boy, waits in a hallway at the Sparrow Rainbow Village medical clinic in Johannesburg, South Africa, in November 2005.

This really hits home, because I volunteered at Sparrow back in 2005. They do incredible work, and my few weeks there were extremely moving. Sparrow is an orphanage and adult hospice–a “village”–where those with HIV are cared for. The corridor in the background is the central part of Sparrow’s administrative center, which connects some of the hospital rooms (for the sickest patients), a kitchen, administrative offices, and even a makeshift morgue. Because most of the patients there receive some level of antiretroviral treatment Sparrow is really, sadly, one of the best places to be in Johannesburg if you’re a kid with HIV.

Here are some compelling quotes from Nolen’s interview on Truthdig:

You show people a picture of one sad-looking puppy and everyone runs for their wallet, and you tell them that 30,000 children die a day of diseases that can be prevented for less than a buck and nobody gives a rat’s ass. I don’t know what it is, what that says about us as a species, but I certainly know from a long time reporting about HIV in Africa that it’s true.

On narrating an issue where the statistics are numbing:

Their lives could not look more different in some ways than the lives of an American or a Canadian. But when you sit down in the little counselor’s booth in Malawi or Lusaka and they say to you, “You have AIDS, you’re going to die,” that doesn’t feel different than it would if you were in America. And it’s getting people to realize that those people had all—sure, they’re Africans—but they had all those same expectations around their lives. They want to graduate from high school, they want to start a little business, they want to, you know, persuade that really cute girl they’ve been eyeing for a long time to go out with them. It isn’t any different. You’ve really got to go, go really micro to make people understand that story, to get them past the numbers.

On finding stories of progress:

You know, I think we get very often this perception of it being a grim story where not very much changes…We also don’t hear that huge progress has been made in responding. There were, for example, when I started reporting on this full-time, there were fewer than 100,000 people on treatments and today there are 1.5 million in Africa. And everybody said, “You can’t do it, there’s no way you can treat in Africa.” Well, that’s a 13-fold increase in four years, and those people have better survival rates on treatment than most Americans on treatment do. So lots of victories.

On money and broken promises and the real roadblock to widespread treatment programs (trained health care professionals):

And there’s a lot more money available than there was….They need about $6.8 billion to meet those proposals, and they have, you know, like, $1.85 in change. Constantly, countries promise money and don’t deliver or don’t promise anything like what’s needed to respond. So we need money. I think, even more than money, these days we’re realizing that there are some more intractable problems that are going to need more creative solutions. So you can use that money to fly in boxes and boxes of pills. You can’t fly in nurses, doctors, pharmacists. I mean, you can fly in a few, but not enough to meet the needs of a whole, continent-wide healthcare program, right?

On the underlying economic inequalities that drive the epidemic:

You know, I meet lots of young women who’ve been given information about HIV but who are selling sex down at truck stops because their parents have died, they’re raising their siblings and that’s the only option that they have. So, you know, they say, “Fine, we’ve been told about HIV in the safe-sex textbooks, but HIV might kill me in five years or 10 years and we’re all going to starve to death next week if I don’t do this.” So, you can address some of the obvious things around prevention, but unless you change the factors that drive people into risky behavior, then you haven’t achieved very much.

And, a bit further afield, but still in Africa, on Darfur and the war in Uganda:

And, you know, it’s also interesting to talk about Darfur because, yeah, there are probably 300, 350,000 dead there and a lot of people displaced, but it is in fact a far smaller conflict than the war in northern Uganda which has been going on for 21 years. You have four times as many people displaced in northern Uganda. You have four times as many people dead. Well, when did we last hear about that one, right? I mean, Darfur is suddenly sexy because George Clooney goes there and, meanwhile, the war in northern Uganda that relies almost entirely on child soldiers … you don’t hear about that one.

On Bush’s PEPFAR program (providing treatment for AIDS in Africa):

Well, you know, I’ve done a lot of call-in radio lately where people call up and are yelling about the Bush administration letting people die, and here they are, spending all these billions of dollars in Iraq. Why don’t they do something in Africa? So I say to people, “Well, guess what? Actually the $15-billion, five-year program to intervene for AIDS in Africa, that the Bush administration dreamed up, has been the single greatest response to the pandemic ever.” And then there’s kind of silence on the end of the phone, you know?

And its problems:

…They’re saying a group that’s going to get U.S. funds to distribute condoms or put AIDS programs in schools or care for sick people, has to sign a piece of paper condemning sex work. And that’s like crazy moral language that just has no place in a place where people are selling sex to eat.

I like Stephanie Nolen. And I like Truthdig.

(If you’d like to learn more about or donate to Sparrow, please do so!)

McCain’s Agnosticism Kills

I now officially loathe John McCain. When asked simple questions about whether condoms protect users from sexually transmitted diseases, including HIV, McCain simply “didn’t know.” In other words, he’s so afraid of offending his “moral conservative” base that he professes to be agnostic about the most basic of scientific facts, and ends up supporting policies that kill.

A transcript borrowed from The Caucus blog:

Reporter: “Should U.S. taxpayer money go to places like Africa to fund contraception to prevent AIDS?”

McCain: “…Let me think about it a little bit because I never got a question about it before. I don’t know if I would use taxpayers’ money for it.”

Reporter: “What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush’s policy, which is just abstinence?”

McCain: (Long pause) “Ahhh. I think I support the president’s policy.”

Reporter: “So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?”

McCain: (Long pause) “You’ve stumped me.”

Reporter: “I mean, I think you’d probably agree it probably does help stop it?”

McCain: (Laughs) “Are we on the Straight Talk express? I’m not informed enough on it. Let me find out. You know, I’m sure I’ve taken a position on it on the past. I have to find out what my position was. Brian, would you find out what my position is on contraception – I’m sure I’m opposed to government spending on it, I’m sure I support the president’s policies on it.”

Reporter: “But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: ‘No, we’re not going to distribute them,’ knowing that?”

McCain: (Twelve-second pause) “Get me Coburn’s thing, ask Weaver to get me Coburn’s paper that he just gave me in the last couple of days. I’ve never gotten into these issues before.”

Mr. Senator, this is absurd. I’m nauseous. Actually, this reminds me of the President of Gambia. He had a vision from his ancestors telling him about a magical cure for HIV. And because of his ignorance, people are going to die.

And it reminds me of Thabo Mbeki, the President of South Africa. In 2000, while under pressure from activists to begin providing life-sustaining antiretroviral treatment for HIV using public funds, Mbeki found the easy way out. He publicly questioned whether HIV causes AIDS, and suggested people should opt for good nutrition alone, with no other treatment. Mbeki’s dithering was eventually overcome, but the delay in providing public treatment for HIV in South Africa cost lots of lives, and those lives aren’t just statistics. In 2004 I watched several kids die of HIV in Johannesburg–kids who might have been on treatment by then if Mbeki hadn’t publicly encouraged ignorance and backpedaling.

And with McCain, it’s worse. Really, who do you expect to be more scientifically informed, and more likely to use financial resources to promote condoms, a former revolutionary and current president of a country in Africa? Or a United States Senator, who is a leading politician in a country with massive resources?

And how did McCain respond? He laughed. He hedged. He refused to acknowledge that condoms in any way prevent the spread of HIV or STDs. He probably would deny they prevent pregnancy as well!

This is no laughing matter. McCain will get some negative publicity, but his conservative base will say “look, he’s really anti-condom, so we like him,” imagining that not sending condoms to Africa is actually going to make people celibate and turn them to God.

May McCain be cursed with a stingy bout of gonorrhea and ongoing neural degradation (if he can afford it, since he’s obviously already lacking) from syphilis.

Shooting the Messenger

Turkish journalist Hrant Dink was shot and killed in broad daylight on a street in Istanbul. Dink had been outspoken about the Ottoman genocide of Armenians at the start of the 20th century. While this may seem like ancient history to present-minded Americans, it plays heavily into regional politics in Turkey and Armenia. Many Turks think the killings were a justifiable part of a civil war, while Armenians see it as genocide (most non-Turkish sources I’ve read agree with the latter).

Being a prominent journalist about an unpopular issue is never an easy task. But in some places the messenger is more likely to get shot than in others. For example, I don’t think Anderson Cooper has gotten many death threats lately. (However, this may be a symptom of how any prominent journalist–especially American ones–pander to the system. If you’re not getting death threats or hate mail, your work might not be that important…)

So how big of a deal is calling the killing of Armenians genocide in Turkey? Evidently it’s illegal to insult the Turkish state (in America it’s mostly legal, just unpopular). From CNN:

Described as a “well-known commentator on Armenian affairs,” Dink had been called into court a number of times on allegations of “insulting” the Turkish state in his writing.

And apparently Dink isn’t the first Turkish journalist to be targeted for unpopular beliefs:

Joel Campagna, Mideast program coordinator for the Committee to Protect Journalists, said, “Like dozens of other Turkish journalists, Hrant Dink has faced political persecution because of his work. Now it appears he’s paid the ultimate price for it.”

Campagna said that Turkey “must ensure that this crime does not go unpunished like other cases in the past and that those responsible for his murder are brought to justice.”

He said that over the last 15 years, 18 Turkish journalists have been killed — making the country the eighth deadliest in the world for journalists in that period. He said many of the deaths took place in the early 1990s, at the peak of the Kurdish separatist insurgency.

Unlike Anna Politkovskaya, who was likely assassinated by the Russian government itself (for criticism of atrocities in Russia’s war on Chechnya), Dink’s death is more likely that of an Islamist or Turkish ultra-nationalist extremist (the assassin reportedly shouted “I shot the infidel”), categories which can often become blurred, but the Turkish government is anything but blameless for the overall situation:

Aram Hamparian, executive director of the Armenian National Committee of America, told CNN that the case is the “product of the environment that the Turkish government has created” — its persistent denial that the killings of the Armenians last century did not amount to genocide.

How Turkey handles this event, along with its relations with the Kurds, will also inevitably tie into Turkey’s desire to join the European Union. But while this killing raises political questions, it also brings me to a more philosophical inquiry.

Is there really a right to free speech? Do people inherently have an inalienable right to life, liberty, and the pursuit of happiness? Where do any of these rights come from? In the idealistic sense the answer may be yes, we have these rights, but many authors on human rights (Farmer ‘s Pathologies of Power comes to mind) would be the first to admit that they can’t “prove” rights. Nobody truly possessed a right to freedom of speech or freedom of religion until people decided that they had those rights, declared them, and made them a reality.

A right can exist as an ideal that has no real correspondence to actual conditions, but over time the ideal may come closer to realization. Our freedom of speech is still imperfect, but there are arguably more people in the world today who can speak freely than ever before. There will always be people and governments who will shoot the messenger, but if we shed light on and punish those who violate the right to speech, we may move closer to the ideal, if only incrementally. In the same sense, I hold that people have a right to health care–a right that is inseparable from our right to life–but recognize that this right is less realized in America than any other wealthy nation. The act of smoothing over the edges between the ideal and the reality is the whole pursuit of social justice.

Update: A suspect has been arrested in the case.

Animals, AIDS and Evolutionary Epistemology

Peter Singer writes in the India Times about how certain aspects of American democracy hinder the movement for animal rights. In this case, it’s nothing “extreme,” just laws that would allow pigs and calves raised for meat to have enough room on their tethers or in their cages to turn around and lie down. Arizona and Florida recently passed measures like these, but Singer points out that America’s lack of federal animal welfare legislation for farm animals is largely a result of political lobbying. Our political parties are relatively weak, forcing candidates to raise their own money for campaigns and therefore making them subject to pressure from special interests. In other countries, where parties fund reelection campaigns, this pressure is less direct.

Patents and Patients (II)

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

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.