Posted tagged ‘public health’

Of E-Books, Reviews, And the ReMaking of Literary Journalism. (Shameless Self and Project Promotion…)

August 23, 2012

Hey all —

For those that might be interested, I’ve got a review up of TED Senior Fellow Alanna Shaikh’s What’s Killing Us:  A Practical Guide to Our Biggest Global Health Problems.  It’s good-not-great IMHO, for reasons I go into with my usual gift for brevity.  I’ll post the full review below the jump — but I urge you to click on the link, as it will take you to the Download the Universe site, which is the project I’d like to bring to your attention.

DtU is the brainchild of uber-science writer Carl Zimmer, who while talking on a panel about e-books at last January’s Science Online conference was challenged to do something about his complaint that popular science writing lacks the community and infrastructure that the romance and mystery/thriller worlds have used to great effect.  On the spot he agreed to get something going.  He got in touch with some of his colleagues, me included, and we all agreed to put together (under Carl’s leadership) a site that would review as many e-books/apps/shorts and the like as we could.  The site’s been running since the beginning of the year; the editorial board, present company excepted, of course, is solid gold; and we’ve built up a reasonable archive of takes on stuff you might like to read.    For the snarkaholics among us, let me point  you to a couple to get started:  David Dobbs ripping several new orifices in Ron Gutman’s TED offering Smile; and Carl himself rendering  bodily harm to another TED published work (a theme here?) on Zimbardo and Duncan’s ghastly-sounding The Demise of Guys.

There were works we liked too.  Some favorites?  Steve Silberman’s take on the rescue of William Craddock’s psychedelic classic Be Not Content; Carl again on the app-book Leonardo which he asserts is “the first great science e-book;” Ed Yong on  The Electric Mind, an Atavist app-and-e-book; Deborah Blum on one of my all time favorites, Michael Faraday’s  Chemical History of a CandleThere are lots more.  Again, this site is populated by as fine a list of popular science writers as I can imagine; I’m honored to join them.

Here’s the thing.  These writers have come together because we are in the midst of a revolution in the way we talk to each to other– the existence of this blog is an example of communication and community that would not have been possible a very short time ago.  One consequence of that change is that models for making a living through the craft of writing are being remade.  Publishing has been disintermediated, which to my mind is mostly a very good thing indeed.   (I do know that all this is old hat to everyone reading this.)  But DtU came into existence because such disintermediation makes it harder to get the word out about good stuff.  So as science writers, working in an area we think surpassingly important (and lots of fun) we’ve taken matters into our own hands, as the technology requires us to do.  So, if you do have an interest in the construction of a culture of smart lay conversation about science, Download the Universe may be very useful to you.  I hope so.

Shameless self-and-other promotion complete.  As promised, the review of Shaikh’s work, complete with all the DtU apparatus, follows below the jump.

Image:   Jacques-Louis David, The Death of Marat (Marat assassiné), c.1693. (more…)

Annals of Stupidity (Sex in America Edition)

July 22, 2012

Via the Guardian, we learn of the latest act of stupidity in America’s war on sex:

The International Aids conference, held in the US for the first time in 22 years next week, is a chance for the country to celebrate its contribution to HIV and Aids prevention. Yet in Los Angeles, San Francisco, New York and Washington DC, state police forces are stopping, searching and arresting sex workers – and using condoms found on them as evidence to support prostitution charges, undermining decades of HIV and Aids harm reduction work in the process.

Via the Human Rights Watch report that forms the basis of the Guardian piece we learn this:

Police use of condoms as evidence of prostitution has the same effect everywhere: despite millions of dollars spent on promoting and distributing condoms as an effective method of HIV prevention, groups most at risk of infection—sex workers, transgender women, and lesbian, gay, bisexual, and transgender (LGBT) youth—are afraid to carry them and therefore engage in sex without protection as a result of police harassment. Outreach workers and businesses are unable to distribute condoms freely and without fear of harassment as well.

Carrying guns and thousands of rounds of ammunition around town? No problem.  A couple of dozen condoms? Call out the guards!

File this under WASF.

PS:  If you want to read a clear-headed account of sex-work, HIV, and appropriate public health responses, see my friend Elizabeth Pisani’s excellent The Wisdom of Whores. (Go to the right hand column of the website.)  As Elizabeth regularly notes, condoms are hardly a perfect barrier to STD infection, HIV in particular, not least because in real life it turns out to be hard to persuade oneself/one’s partner to use them as needed every time they are needed. That said, condoms from an essential component of a sex-worker’s ability to take direct action on her or his own behalf as she or he goes about a working day (or night).  Creating barriers to their use is both stupid as a public health measure and an unacceptable — I would say, un-American — infringement on an individual’s right and duty to take care of oneself.

Bonus: Video via Elizabeth’s site from condom maker DKT’s home video collection:

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(Translation of the caption at the end:  “With a year’s supply of free condoms, any place is the right place.”)

Image:  Henri de Toulouse-Lautrec, The ladies in the brothel dining-room, 1893

Poverty and Aids: Who Does What To Whom/Elizabeth Pisani edition.

December 4, 2008

So, to get back to business, a little follow up on the MIT talk by Elizabeth Pisani touted below.

Elizabeth, whose book, The Wisdom of Whores I admire both as a ripping read and as a powerfully argued polemic – with – the -facts, is a passionate advocate for clarity in our description of and response to HIV and AIDS.  A journalist, and then an epidemiologist, as well as a self-admitted member of the AIDS mafia, Pisani emphasizes that HIV is a virus that is transmitted by a few well known pathways: basically unprotected sex, unprotected anal sex, and needle sharing among IV drug users.

In her book and in her talk at MIT on Monday, Elizabeth admitted her own complicity in what she sees as the original sin (my phrase, not hers) of the public health community’s response to the epidemic.  In order to secure funds to fight the disease, public health folks and epidemiologists de-emphasized in public the central roles of commercial sex, homosexual sex and drug use in the dissemination of the virus, choosing instead to highlight more broadly sympathetic and politically acceptable potential victims:  children, “innocent” women, and the ultimately, the public at large.

That spin worked, Elizabeth said, attracting a torrent of money. But there was a catch:  a ton of that new cash was restricted to taking care of the politically attractive categories, leaving the problems at the core of the epidemic — sex and drugs — still drastically under-addressed.

That’s the broad stroke argument, very broad — so don’t blame Elizabeth for my shorthand and no doubt inaccurate attempt at a gloss on her talk. Among her caveats:  much of what she had to say applied not to the two thirds of the epidemic taking place in southern and eastern Africa, but to the one third spread out over the rest of the world.  But the discussion that followed raised two crucial points of contention that are worth thinking about.

One was a reaction to Elizabeth’s complaint of what she did not call, but I will, AIDS whoring.  By this I mean the habit that Elizabeth pointed out of all kinds of (presumptively) well-intentioned organizations trying to claim some connection to the fight against HIV/AIDS, no matter what they actually do, just to take a sip or two from that river of money flowing towards the disease.

In particular, the trope that HIV is a disease of poverty got Elizabeth’s goat.  No, she argued. HIV is a virus, and to the extent that it is a disease of anything….wait for it…it’s one of sex and drugs.

Money spent on projects to alleviate poverty, or to increase women’s economic power, or any of the other entirely important and necessary development goals someone might have will not, in this view, do much of anything to deal with the problem of HIV and AIDS.  If you really want to deal with the disease, she argued, attack the problem directly. Needle exchanges work.  Proper prison HIV projects work.  Condoms work…that’s where the emphasis should lie.

Not so, argued one member of the audience in a conversation after the talk.  Too reticent to push the point during the q. and a., this person argued that Elizabeth was too much the epidemiologist.  From where she sat — a physician with experience in the Middle East, now studying the interface between technology, culture and history in the context of health and medicine — poverty was indeed a significant part of the equation.

That is hard won knowledge, and I’ve heard the same from other people up to their elbows in responding to the epidemic.

And yet, stripping down the question to its core — what will save lives most directly, right now — it’s hard to ignore Elizabeth’s central point:  the argument that addressing HIV/AIDS head on is not the same thing as saying that one should not attack poverty, the evils done to women and or children and so on.  It is just that improved sanitation installed over the next months or years; a new micro-loan program, even one laptop per child is not going to affect the infection being transmitted right now on a thin mattress in a brothel, in the passage from one arm to the next of droplets of blood mixed with heroin, in the late night, alcohol and dance fever-fueled “decision” to forget the damn condom after all.

In this view diseases are not — or at least not only — social phenomena.  From the point of view of someone actually about to be infected, they involve specific pathogens moving through known pathways to inflict harm on identifiable individual people.  And there are methods available, were political and moral will strong enough, to find both those people already suffering, and to reach those near them at risk. Given that capacity, what should the course of action be?

Look at another example:  Paul Farmer has achieved a justifiable fame (some would say apotheosis) through an approach that says you do what you have to do to make sure the miserably poor, no-hoper ten miles away across three mountain ranges takes his or her damn TB meds.

All the medical interventions that Farmer’s approach has generated have not transformed the fundamental conditions of poverty and oppression in Haiti or in other communities where his efforts have been directed.  But they do, of course, save lives — and I’m comfortable with the claim that basic health is a necessary pre-conditions to any such change. Even if you argue that there is an intimate connection between social pathologies and the medical ones associated with AIDS, there is the brute fact of a feedback loop:  poor and oppressed communities, marginalized and reviled groups (think junkies and whores) do not improve their ability to press a claim on the society or polity as a whole when they are mired in the struggle with a spreading infection.

All this, of course, is open to dispute on points of principle.  It is certainly true that absent structural change, the poor and the marginalized have more or less unlimited paths to suffering and death.  Hence, any given amelioration of suffering can be seen as the rearranging of the deck chairs on the Titanic. There is every reason to argue that what is needed is transformative change that addresses blighted lives and communities across the range of problems confronting them.

Fair enough — but in practice, as Elizabeth has described with potent fury in her book, the dilution of AIDS efforts into generalized anti- this or that has does not prevent infections, nor does it, so far at least, seem to have transformed the world of the poor.  There are the usual problems of aid:  those who live well off doing good are always with us, for example.

But more deeply, this seems to me to be a case of the best being the enemy of the good:   There is the blunt fact that structural change is slow and uncertain, and HIV infection and its consequences often are neither.  It is my hope that come January 20th, the worst diversions of effort and emphasis in US global HIV/AIDS policy will be reversed.  Just dumping the abstinence-only set-aside would be a major step forward.  Here’s hoping.

Of course — this begs the question of whether any policy involving culture, society and behavior can work, given the freight that comes with anything involving sex, drugs, conceptions of sin and purity and all the rest…and that came up too in Elizabeth’s talk.

But this post has gone on long enough.  I’ll write up the debate on this point that came out of Elizabeth’s talk in another one.

Jean Agélou, “French nude smoking opium” c. 1910.

Things To Do (Today) in Cambridge Before You Die: Elizabeth Pisani edition

December 1, 2008

Elizabeth Pisani, author of the seriously good The Wisdom of Whores — an account of what it really takes to take on the HIV epidemic — and of the blog by the same name, in which all kinds of sacred cows fall to the slaughter on the altar of good science/public policy, is speaking at seven p.m. tonight at the MIT Museum.

Announcement here.  Interactive map to get you to the museum here.  Well worth the time of anyone interested in a real world look at the pandemic.

Image: Louis-Léopold Boilly, “Absolutely no agreement,” 1787.

Quick Hits: Really bad, sad news dept.

July 17, 2008

See this update on the state of the war against polio.

A little context: In this post, I made a glancing reference to the eradication of smallpox, a victory achieved in 1979 after a twelve year campaign. It is still the only human viral pathogen to have been completely eliminated from the wild.

The effort to eradicate polio formally got under way in 1988. By 2006, endemic polio remained in just four countries, Nigeria, India, Pakistan and Afghanistan. It still does today.

One of the reasons that the disease has not progressed rapidly to elimination is because of a deep, anti-science bias within the remaining affected communities, couched in Islamic fundamentalist terms. In Pakistan, site of the most recently reported case, (an eight month old girl — have a thought for this tiny stranger amidst the larger fury of the day), the impact of the Taliban and allied militants in the border territories has basically stifled the anti-polio campaign.

For example, last November, the New York Times reported, inter-alia, that Maulana Fazlullah, leader of one of the pro-Taliban movements in the region demanded a halt to polio vaccinations for children, claiming that the vaccination made men impotent.

Such nonsense is hard to combat, especially when backed up by credible death threats to vaccine workers.

This is clearly first and foremost a home-grown, and tragically self-destructive pathology within the communities in which endemic polio persists.

But at the same time, there is no doubt that the war on terror makes it harder to push past such craziness to perform basic public health. As the Times story concluded:

Moving the polio campaign back into those restive areas depends on “local teams adapting constantly to the conflict,” as the W.H.O. delicately put it in its most recent annual report. Or in the words of Dr. Bruce Aylward, the campaign’s director, ‘’We dialogue with NATO and tell them, ‘These are the days of our campaigns, these are our people — don’t bomb them!’ ”

And yet — at least according to the Times, (quoting a UC Davis researcher, Chris Albon)

“vaccination programs can be an effective strategy for winning hearts and minds.

So while the wars in region are implicated in the persistence of an eradicable scourge under the heading of unintended consequences — it is at least conceivable that those campaigns might be advanced by the soft-power of a public health campaign. Here’s hoping.

Image:  NIcholas Poussin, “La Peste d’Asdod” (The Plague of Ashdod) 1630-31.  Source: Wikimedia Commons.

Bad Science Kills, take two: Bush admin. fears sex, other people die edition.

February 19, 2008

From 365Gay.com via No Capital by way of Eschaton comes this reminder why it really hurts when we are led by those who fear not just sex, but facts.

The Bush administration and Congress are arguing about the renewal of the African Aids initiative. At issue: whether or not to preserve the rigid requirement that one third of the funding must go to abstinence programs.

Bush argues (Sunday, February 16, in Tanzania) that there should be no problem with his approach. Why, says he? Because

My attitude toward Congress is, see what works…PEPFAR is working. It is a balanced program. It is an ABC program – abstinence, be faithful and condoms. It is a program that’s been proven effective.

Except, of course, that it is not, for two reasons — both captured in (let’s be kind) two mistatements in the brief quote above.

Does abstinence education work? Not in this country. See this post for my earlier take on that issue. In Africa? Not so much there either. From Britain’s The Independent comes a report from Uganda, once the poster child for successful government-led HIV/AIDS prevention policy.

Aids activists and development officials point to the 130,000 Ugandans infected with HIV last year alone – up from 70,000 in 2002 – and say the recent obsession with abstinence is handicapping the country’s once-successful fight against the virus.

How successful was that earlier approach? Try this:

Under the previous “balanced” strategy, condom distribution grew from four million a year to 118 million by 2001. Thanks to the abstinence message, teenagers lost their virginity about 18 months later than before. People with several partners realised they needed to stop sleeping around so much. In 1992, one in five Ugandans had Aids. By 2001 that dropped to one in 20.

Not bad. Damn good, in fact. To take the Talmud’s view that to save one life is to save a world, here’ s a public health intervention that has preserved a human multiverse.

But what of the claim that Bush’s policy is balanced? Not so much there, either. On the ground where services are actually delivered, the mandated requirement to promote abstinence has squeezed the condom message out of what was supposed to be a program that worked by enabling individuals to exercise choice and responsibility for their own actions. Instead…

What has changed in Uganda is that condoms are no longer promoted to the general population. In line with US Aids policy under Mr Bush, condoms should be promoted exclusively to high-risk groups such as truck drivers, soldiers and “discordant” couples (where just one of the partners is HIV-positive). Everyone else should hear the rubber-free virtues of abstinence and fidelity only. Yoweri Museveni’s government hungrily devoured the American abstinence policy and the attached cash. It is dependent on foreign donors for half its budget.

“We have worked so hard to get people to understand HIV and that there are three options open to them: A, B or C,” says Dr Henry Katamba. “That’s Abstain from sex, Be faithful or use a Condom, whichever is the one for you. That’s what our government used to say – and everyone understood. The message recognised that it wasn’t realistic to ask for abstinence from everyone who’s not married.” Dr Katamba is health co-ordinator of the Uganda Protestant Medical Bureau, an umbrella of churches providing clinical help in the absence of government hospitals.

“Because of the US, our government now says Abstain and Be faithful only,” says Dr Katamba. “So people stop trusting our advice. They think we were lying about how condoms can stop Aids. Confusion is deadly.”

“Deadly.” Let that word sink in.

I’ve written elsewhere on this blog about the way that some of our leaders, at least, choose death before dishonor, as long as it is someone else — someone negligible, like an anonymous heroin addict, or some distant African at risk for HIV/AIDS — who actually does the dying.

The usual analysis of this disgraceful division of labor turns on the political calculus of interest groups and the Rovian tactic of keeping the literalist evangelical “base” calm and happy. But whatever the truth of that argument (and who knows whether Bush argues for abstinence out of calculation or genuine belief), such mind reading misses the larger point.

Scientific illiteracy is not ignorance of any given fact. George Bush does not need to know the curve that fits the data on the rates of infection in different sub-Saharan countries. He does need to pay attention, though, to the fact that such knowledge exists, and says something important about the world and the consequences of US action.

Instead, in the government we have now, facts and the process of inference from facts are subordinate to pre-existing certainties.

Among them: Sex is bad in and of itself, except in certain, tightly defined circumstances. If you choose to go ahead and do the nasty in defiance of that moral “truth,” then be prepared to take the consequences. (Even if you didn’t choose – of course, but I’m not even going to go down that sewer just now). You made your bed, man or woman (or unborn child) … now die in it.

This is how science matters in public life. It’s not, to my mind, the question of funding choices – should physics get more than chemistry; neuro more than endocrine biology or what have you. It’s not about Obama liking NASA and the manned space mission less than Clinton. It’s whether or not our leaders understand the idea that facts have consequences.

When someone makes a claim about material events in the world, scientific thinking provides the only reliable method to test that claim. You have to get the data, analyze it, and expose the tools of your analysis to scrutiny as well. If you don’t you get what we have: policies that defend ideological purity, literally to the death.

I’ve written this before; I’m sure it’ll come up again. That’s what makes the practical consequences of bad science not just tragic, but criminal.

Images: Nicholas Poussin, “The Plague of Ashdod.” 1630-31. Source: Wikimedia Commons
Special costume to be worn by medical men confronting the plague. Germany 17th century.  Licensed under a GNU free documentation license Ver. 1.2 or any later version published bythe Free Software Foundation.  Source:  Wikimedia Commons.