McCain’s Agnosticism Kills

March 20, 2007

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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

January 20, 2007

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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.


The Arithmetic of Souls

December 29, 2006

(A continuation of the oh-so-controversial “Souls on Ice” post I made back in October.)

Read the rest of this entry »


Patents and Patients (II)

November 25, 2006

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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.


Souls on Ice

October 19, 2006

I just finished reading a fascinating (though lengthy) article on the fate of embryos called Souls on Ice: America’s Embryo Glut and the Wasted Promise of Stem Cell Research. This ties in well to some things we’ve been discussing into my (occasionally though not usually) enlightening course on medical ethics.

In brief, the article discusses how the massive use of fertility treatments like in vitro fertilization have led to the existence of thousands of frozen embryos– more than will ever be implanted, gestated, and born. There are only a few options for embryos: implantation, indefinite freezing, destruction through thawing, or destruction through medical research.

Many people who did not hesitate to undergo in vitro fertilization procedures now hesitate to donate their frozen embryos for research, and those embryos are accumulating in warehouses… somewhere. And embryonic stem cell research, contrary to some popular belief I’ve encountered, is not illegal. Rather, Bush vetoed federal funding for embryonic research (excepting a few pre-existing lines), but several states and many universities have procured other sources of funding to make up for the shortfall.

As for the ethics of it all, one of the weakest arguments Christians make for not pursuing embryonic stem cell research (and this one was made to me within the last week) is that somatic stem cells can be used for everything that embryonic stem cells can be used for. This is ludicrous as stem cells are by definition more pluripotent than somatic stem cells. In other words, embryonic stem cells removed early in development can differentiate into many types of tissue that somatic stem cells removed from adults simply cannot.

Another flawed argument often presented goes thus: “There are absolutely no medical applications from embryonic stem cell research.” Reply: Of course not- there hasn’t been much of it. In the 1950’s no one used the argument “there are absolutely no medical applications for DNA research” because there simply wasn’t a state of knowledge available that would lead to viable therapies. Seriously, why would many of the premiere medical researchers be publicly bemoaning the federal funding ban if embryonic stem cells were really nothing new?

The strong arguments against stem cell research are based on the moral status of the embryo. If an 8- or 16-cell embryo has the same moral value as an adult human, then pursuing embryonic stem cell research is tantamount to murder. In fact, these arguments are compelling and unavoidable if one believes the Bible is the word of God.

Of course, these arguments are only strong if one agrees with conservative Christians that the early embryo is of the same moral value as an adult- a conclusion not reached by many secular ethicists and liberal Christians with a less strict application of Biblical precepts to modern existence.

While I believe embryos are worthy of respect, I don’t assign them the same moral worth as myself, or someone dying of a possibly curable disease. In other words, destroying them needlessly would be wrong, as they represent potential human beings. But the needs of fully conscious humans with full personhood should not be secondary to an 8-cell blastocyst that no one has a problem with freezing. And I will continue to hope that embryonic stem cell research will be one area in the “culture war” where conservative Christians won’t succeed, because that triumph could hurt us all. Read the rest of this entry »


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.


Reverence for Life

October 18, 2006

I just finished reading James Brabazon’s definitive biography of Albert Schweitzer. I had heard of Schweitzer before, but had never known much beyond his wikipedia entry. All in all I find reading about extraordinary people such as Schweitzer to be both encouraging and thought-provoking.

Schweitzer was a German who lived from 1875 to 1965. He had doctorates in theology, music, and medicine. He learned Hebrew and Greek and subsequently wrote the Quest for the Historical Jesus (his most famous work), and the actually more theologically significant Mystery of the Kingdom of God. Schweitzer refuted the ‘liberal German theological school’ that had painted a picture of Jesus as a modern liberal, preaching universal love and killed by some mistake or enmity of the Jews. Instead, Schweitzer read the original texts and contemporary Jewish thought to paint a picture of Jesus as an eschatological zealot- convinced that the end of the world was near and that through his own actions he could bring about the Kingdom of God. As the kingdom failed to show up year after year, Paul and Jesus’ other early followers reinterpreted the ‘Kingdom of God’ into a spiritual force in the here and now, and created the doctrine of atonement. (Doctrines such as the Trinitarian concept of God, Jesus, and the Holy Spirit as being a coequal divinity, came much later.) It’s probably one of the most convincing historical pictures of Jesus out there.

I particular enjoyed Brabazon distillation of Schweitzer because it addresses both the shortcoming of the traditional ‘liberal theology’ view of Jesus as a modern liberal saint. I studied the phrase ‘Son of Man,’ which is Jesus’ almost exclusive self-reference in the early gospels. The vagueness of this phrase, with its eschatological overtones from Daniel and contemporary Jewish thought, make it heavily debated among theologians. Schweitzer’s framework takes this and the historical context and wraps it into a coherent view.

Along with his world-reknown in Biblical scholarship, Schweitzer literally wrote the book on playing Bach and building organs in Europe. And then at the age of 30 he chose to train to be a doctor so he could act out his religious and ethical principles. Schweitzer moved to Gabon, West Africa and established a hospital at Lambarene, where he worked more or less constantly until his death at age 90. In the meantime, Schweitzer was detained by the French colony for his Germany citizenship during both World Wars (despite his outspoken early denouncements of both nationalism and the Nazis!), and funded his hospital by organ recital and speaking tours in Europe and America.

He then proceeded to win the Nobel Peace Prize for his work in Africa, and to use his subsequent popularity to jump-start Linus Pauling’s (ultimately successful) campaign to ban testing of nuclear weapons. Along the way he was smeared by the U.S. government and Western press as a commy stooge and a racist. (Certainly he had some paternalistic attitudes that in the 60’s seemed anachronistic, but like all men Schweitzer should be judged partially against the times in which he lived, and by those standards he was both enlightened and an incredible humanitarian).

But possibly Schweitzer’s greatest contribution was his philosophy which culminated in his ethic of “Reverence for Life.” Out of the realization that he was alive and longed to live, and was surrounded by other life that longed likewise, Schweitzer believed that all creatures should be valued and life, existence, and health should be affirmed. Schweitzer was ahead of his time in recognizing the value of environmentalism and ecological balance (without the absurdity of putting animal life on the same plane as human) and a universal ethic of service for individuals in their relationships as social creatures. Refusing to codify his ethic in a list of rules or priorities, Schweitzer set about making his life his argument. I think he proved his point.