Global Health Report

Jobs: Global Health Reporter/Blogger in Seattle

2010-04-19T09:27:00.004-04:00

Job posting in global health journalism. My friend Keith Seinfeld sent this along. He's part of a new venture being funded by a grant via the Knight Foundation and the Corporation for Public Broadcasting and channeled through a team at NPR.

Here's what Keith writes:

KPLU/Pacific Public Media is seeking a reporter-blogger who is a first-rate writer and communicator to report on global health-related issues relevant to the Seattle area and beyond. This new position is part of a web-only project, launched by NPR in cooperation with member-stations.

About Us: Ranked as one of the most popular public radio stations in the nation, KPLU has been bringing award winning local and National Public Radio news, jazz and blues to the Puget Sound Region since 1966. KPLU is a community service of Pacific Lutheran University in Tacoma, Washington with broadcast studios located in Tacoma and Seattle, extending coverage from Vancouver, B.C. to Vancouver WA. Pacific Lutheran University is committed to diversity, endorses the goals of equal opportunity and affirmative action, and actively seeks applications from women and persons of color.

About the Position: The reporter-blogger will be charged with building a dedicated online following around coverage of local research-oriented health organizations, global development organizations, public health policy, infectious diseases, and other topics related to global health. The position requires that you establish yourself as the area's most authoritative voice on the issue, with a strong local profile and a national reach through NPR.org and the wider public broadcasting system. Candidates should have subject-matter expertise and a solid journalistic track record befitting KPLU's reputation as a trusted local news source. The strongest candidates will have a demonstrated ability to cultivate sources, identify important trends in global health, generate original story ideas, and collect and verify information through a variety of online and offline channels. Candidates should be conversant with blogging and social media applications, along with digital photography and video. Proven experience developing a successful niche news site, building audience, establishing a social media brand, or stoking community engagement are desired.

This is a full-time position, under the terms of a two-year grant, and receives a salary plus a benefits package. It is based in downtown Seattle.

For full description, qualifications and to apply for this position, visit: http://employment.plu.edu/applicants/Central?quickFind=50607.

Nutriset Sued Over Plumpy'Nut Patent

2010-04-09T07:24:00.002-04:00

Two American non-profit organizations file suit against Nutriset, contesting the patent for Plumpy'Nut. This has certainly been a long time coming, as my previous reports and links on this patent issue indicate. Read the full BBC on the Plumpy'Nut patent controversy.

Plumpy'Nut: Tabatchnick Takes On Nutriset

2009-11-11T08:03:00.008-05:00

The debate over Plumpy'Nut and whether it should have been patented in the first place continues.

Now US food company Tabatchncik Fine Foods is talking about creating its own peanut-based therapeutic food to feed severely malnourished youngsters, according to IRIN. And Tabatchnick is considering making its product open-source so anyone can copy their recipe.

From the IRIN piece, as aggregated by Reuters:

"Ben Tabatchnick, head of the family business, said his product was still in the development phase, but the patent would be "open-source", which would allow other producers to replicate his recipe.

His company "was trying to take the fear out of other producers from producing RUTF and keeping up with demand; no one producer can supply (even with licensed franchises) the world demand for RUTF and RUSF [ready-to-use supplementary foods]", he commented. "By allowing others free access (with proper oversight by UNICEF and MSF), this can and will be accomplished." "

For a quick introduction to the patent, see "What Plumpy'Nut Taught Me"

To see all my past posts and links on Plumpy'Nut, click here:

Nurses and the Web: Text For My Talk

2009-10-07T10:07:00.006-04:00

Here is the prepared text for the talk I gave yesterday at the American Journal of Nurses conference in Chicago. The slides to go with it are available here and here.

Nurses and the Web: Staking Out Your Territory as an Expert in Health Care
Christine Gorman
Oct. 6, 2009
American Journal of Nursing conference
Chicago, Illinois

[Title slide] Thank you very much for inviting me to Chicago and to share some ideas and experiences about staking your claim on the web.

[next slide: Web Sites] Here is a list of the places you will most easily find me on the Web. I have also posted the PowerPoints on slideshare.net so that if you are following the talk via the audiocast or you just want to refer to it later, you can do so. I will also post a write-up of what I say on my blog at globalhealthreport.com.

There are basically two main points I would like you to take away from today’s talk.

[Next slide: Platform shift] The first is summed up in this slide.

The world of media—all the ways that we get information, that we are entertained, that we interact with and respond to others at a distance—is going through a major shift in platform. The delivery system if you will. We are transitioning from a broadcast platform to a network platform. The often satirized “Voice of God” message that gets delivered to the masses is being replaced by what you might call “the Big Hum” — the constant murmur of many conversations amongst many much smaller groups.

[Next slide: Implicit to Explicit] And the second major point I want to make has to do with the soaring value of taking what you know implicitly and making it explicit.

Providing context has always been important. But its value increases dramatically in a world where we get bombarded by information and voices and opinions all vying for our attention with very few built-in filters to help us separate what is real from what is fantasy.

Now you might expect a lot of how-to guidance and cool technology tips from a talk about how nurses can stake their claim on the Internet. Something like Christine’s top five tips for getting other people to listen to you. Or 7 ways to profit from the social media revolution. Lists are so easy to grasp that they are a popular way to boost your circle of influence on the web—whatever the topic.

And the truth is, you can find many good introductory how-to instructions about lists and other attention-getting devices on the Internet after a couple of searches or by asking questions in various forums.

But I think it is important to have a theoretical framework to understand these issues so that you can adapt them to your own situation. Otherwise, you spend most of your time boosting somebody else’s influence and credibility without building up your own. A little theory makes it easier to evaluate which shiny new tool on the Web you should be paying a lot of attention to—or even helping to build. And which you can avoid wasting your time on.

So the first part of my talk is going to give a fair amount of background. And then we will get into some guidelines and rules of thumb for staking your claim on the Web. Finally, there will be time for questions at the end.

[Next slide: Influences] A lot of the ideas in this talk are inspired by my own experiences on the web and in journalism. But I have also been helped a great deal in my thinking and understanding by the work of a number of Internet thinkers and practitioners. Here are a few of the key ones who have influenced me.

• Yochai Benkler – Berkman Center at Harvard
• Mindy McAdams – University of Florida
• Persephone Miel – Internews
• Clay Shirky – NYU
• Matt Thompson –University of Missouri
• Michael Wesch – Kansas State University
• Ethan Zuckerman – Berkman Center

[Next slide: Literary Heroes] I’ll also admit taking inspiration for this talk from some American literary giants as well, particularly Mark Twain and Upton Sinclair. Mark Twain for his wry insights into the world as it is and how we might like it to be. And Upton Sinclair for his righteous anger and passion for addressing injustice.

Any mistakes, however, are my own.

[Next slide: Platform shift] So back to this platform shift, which starts off as a technical shift—“How are news, entertainment and information created and delivered?” This technical shift has also become a cultural shift, a change in the way we organize our thoughts and ourselves.

Most of us, myself included, grew up in a world where broadcast media dominated. Whether you’re old enough to remember Walter Cronkite or Woodward and Bernstein or you get most of your news from Jon Stewart, you didn’t think much about the fact that this was a one-way conversation. One message to millions of people—hence the “Voice of God” tone.

Listeners, viewers and readers absorb the message, maybe even talk about it with their friends, but what they have to say won’t have much of an impact on the newscaster --unless of course they are already a powerful figure – like a President, a talk show host, a CEO or a celebrity.

This mostly one-way conversation has its advantages and disadvantages but the point I want to make here is that it was not set in stone somewhere. It is actually a function of the enormous costs of production and distribution. Costs which weren’t necessarily there at the beginning but that grew over time.

If you look at the early days of radio, you find a lot of amateurs, enthusiasts, small community groups –like churches – and even lectures by the U.S. Public Health Service on the airwaves. Broadcasters transmitted from low-power stations over a very limited range.

There is a finite amount of electromagnetic spectrum over which you can transmit radio waves, however. Two radio stations trying to transmit over the same frequency from nearby locations would end up interfering with each other’s signals. Eventually the U.S. government started assigning different spots on the spectrum through various licensing arrangements.

Scarcity and regulation favored more powerful transmitters. The amateurs and small groups were priced out of the market. The escalating lawyers’ fees and the cost of building and maintaining powerful transmitting stations eventually meant that, with notable exceptions here and there, only large commercial interests could afford to be in the radio business.

Similarly for newspapers and magazines, the capital required to reach a large metropolitan audience – not to mention a national one – meant tremendous expenditures for presses, distribution trucks and mailing costs – and all the people to keep the process flowing.

But once these initial startup and distribution expenses were met, the cost of adding each additional customer was rather small in comparison. So you could create and deliver huge audiences. And those big audiences were exactly the sorts of people that advertisers wanted to attract.

From an advertiser’s point of view, it wasn’t a terribly efficient system. You never had a sense of how effective any particular advertisement was at bringing in new customers. But broadcast distribution to a mass audience—over the airwaves, via print--was the only game in town and so advertisers played along and were handsomely rewarded.

[Next slide: Advertising inefficiency.] Here’s where it gets interesting—where we can see that inefficiency isn’t always a bad thing. For you see, advertising inefficiency allowed news organizations of the 20th century to invest in professional journalists who spent years covering the same beats, building up an expertise. That inefficiency allowed them to pursue months-long, even years-long investigations. When you think of the great icons of investigative journalism – Watergate and the Pentagon Papers – or more recently the neglect of Iraqi veterans at Walter Reed Army Medical Center or the massive foul ups that occurred both prior to and after Hurricane Katrina – you also have to think about the Ivory Soap and used car ads that made them possible.

Of course, when one person—or a small group of people—has the only megaphone, you have to get that person’s attention unless, of course, you own a megaphone yourself.

It makes sense, you have to pay attention to the biggest voice in the room—even if there are a lot of softer voices around. And if everyone with a message is trying to get the ear of the person with the biggest voice, then that biggest voice grows even more powerful.

The Internet has changed all that and is still changing all that.

[Next slide: Internet map]
This is a map of the Internet and was put together by the folks at Lumeta Corporation and ATT. They kindly gave me permission to use it in this talk. Actually, it’s a map of the Internet as it was at a given point in time in August 2007. And it’s not even a map of the whole Internet. It’s a map of the backbone—the basic skeleton as it were of the major pipes that make up the Internet. It’s not even a complete map of the backbone. If it were, it would be so thick you wouldn’t be able to make any sense of it.

As the creators note, quote “Each line depicts the shortest outgoing route from a test computer to each of more than 320,000 network nodes around the world. The map does not represent the physical or geographic location of servers, but rather is a topological representation of the various networks that combine to form the Internet.” unquote

Now how on earth do you get a one-to-many conversation going in here? Where do you find a Walter Cronkite or a Bob Woodward or an Oprah Winfrey in here? It’s much harder to dominate the conversation. That doesn’t mean it’s impossible—and you could introduce chokeholds and gateways into the Net that would make it easier to control the pathways. But for now, this is more or less the shape of the Internet.

So besides being rather beautiful in a geeky kind of way, this map makes the point very graphically that the Internet is a network. There is no central transmitter broadcasting to everyone else. There may be some conversations that dominate large sections of the Net. But the potential for many, many conversations among smaller groups of people that can go as deep as the group wants to go is suddenly enormous.

This is the network that allowed Craig’s list and web-based ads to shorten the distance between a willing seller and a willing buyer. This is network that cut out quite a lot of the inefficiency out of advertising. This is the network that drove the production and distribution costs of news and information to near zero.

Now a lot of energy and words have been devoted to what this means in terms of maintaining a viable news industry both as an economic issue as well as a larger societal issue.

A free press is every bit as important to democracy now as it was in Benjamin Franklin’s day. And that’s something in which all citizens of the United States –whether they realize it or not – are deeply invested. The economic reality, however, is that we just can’t pay for a free press the same way we have since about the 1920s.

But while others are hard at work trying to figure out a viable business model for the news industry, there is a different part of this story that I want to highlight today.

I believe that most people are still using and thinking about the Internet as a broadcast medium. They are still mesmerized by the idea of being THE BIGGEST VOICE in the room. They want the most page hits, the highest page rank, the most followers on Twitter or friends on Facebook. They are still stuck in the broadcast mindset where the predominant communication is a one-to-many conversation.

We still haven’t grasped what is possible when there are lots of conversations among small groups happening in parallel. We assume it’s chaotic but I think that’s only because we don’t have a lot of experience with it yet.

And because so many of us are still oriented towards using the Internet as a broadcast medium—like the ones we grew up with—we miss the Internet’s extraordinary potential for organizing people. The real Internet revolution is not its broadcast abilities, but the various ways that, as Clay Shirky of NYU puts it, the Internet makes the formation of groups ridiculously easy.

You don’t have to be in the same geographic area, belong to the same clubs or have gone to the same schools. People with the same interests or passions find each other via text, list-servs, blogs and virtual communities.

And with the ubiquity of easy messaging, they can create temporary groups that form and melt away in order to do everything from the very silly to the very serious.

[Next slide: photo of Toronto pillowfight]

This is a flash mob that got together in response to a group of text messages that were forwarded and reforwarded to produce a seemingly spontaneous pillow fight in downtown Toronto.

[Next slide Iran 2009 election protects; Milad Avazbeigi]

Here we have demonstrators protesting apparent election fraud in Iran. The organizers’ were so adept at using social media to focus people’s anger that the government had to shut down the cell phone networks across the country in addition to resorting to violence to put down the protests.

There’s just something about our broadcast upbringing that makes us focus first on the largest groups – the greatest number of connections – but I’d like to argue today that we still have not seen the revolution that can come from the increased formation and connection of small groups and small networks.

I have written a lot of stories over the past 20-plus years. I am particularly proud of the articles I helped to shape at TIME Magazine during the early days of the AIDS epidemic in the U.S. –

[Next slide: AIDS wordle]

The 1980s were a time when tremendous stigma still attached to the disease and to the people who struggled with it. I believe those early stories – by myself and others – eventually helped to change the national conversation.

Those stories could have just as easily NOT been published. I remember lots of fights in the early days within TIME magazine about whether to cover the topic at all – and how to frame the subject. One editor said he wanted to see only stories about “innocent victims” in the opening paragraphs – by which he meant babies who had been infected in utero or hemophiliacs who had been infected due to contaminated blood products. In his thinking – and that of many people at the time – gay men, IV drug users and poverty-stricken Haitians were all suspect, all guilty, all deserving of what befell them.

This was my first real-world education about the potential benefits as well as the limitations of journalism. About how much time and energy are required to make sure that certain stories get told and told well – the stories about people who do not travel the corridors of power.

And it is a lesson that has stayed with me through the years. It certainly was not true all the time but for so many stories, the size of the audience trumped the merit of a story. Size or the power of the constituency. Since there was only a finite resource, a limited amount of space in which to put the news, size and power mattered.

Just as important, however, was the lesson of how the gay community – a community that was fragmented and did not even always think of itself as a community – could come together to tell its own story and to get the public at large – including mainstream media and the powers that be – to pay attention to that story.

The success of AIDS activists in getting more attention and funding to focus on a hitherto obscure and highly stigmatized disease did not, of course, go unnoticed. Most notably, those in the breast cancer advocacy community started adopting some of the strategies and techniques they saw in the AIDS community to great success in order to raise money and awareness.

Indeed, single-disease advocacy has become so successful that some folks are starting to see it as the elephant in the room. The mammoth that is helping to keep us from looking at larger health systems – another one of the siloes that keeps us from looking at bigger but ultimately, perhaps greater payoffs in primary care, and chronic care and the social determinants of health.

But those are all subjects for a different talk.

What I want to get back to is this idea of a community taking ownership of its own story and its own destiny.

Communities have always been important. And under extraordinary circumstances they can do extraordinary things.

But the Internet makes it easier for communities to come together under ordinary circumstances to do both ordinary and extraordinary things.

I’m not talking about orchestrating mass movements – that is still, to my mind, a broadcast way of thinking. I’m talking about bringing together smaller groups that may or may not later grow in numerical size.

The truly revolutionary use of the Internet is not for broadcasting messages but for organizing people.

This is the part that speaks most specifically to where nurses are today.

Over the past two decades and especially in the past two years, as I have spent more and more time with nurses in the U.S. and overseas, I keep hearing some familiar laments.

[Next slide: familiar laments]

The nursing community is fragmented. Nurses are nearly 3 million strong in the US and the largest health care workforce. Only 6% of nurses in the US belong to a professional organization – any professional organization – compared to the United Kingdom where nearly every RN is a member of the Royal College of Nursing.

Nurses have lots of responsibility but no power. They save and protect life and limb but have relatively little power at either at their own institutions, clinics or society at large.

Nurses are not utilized to their maximum potential. I actually found an article about nursing I wrote 20 years ago that made this very point. Things still have not changed. As we move forward with health care reform, will we finally start to address this issue?

Few people in the general public understand what nurses do. Despite the fact that the general public trusts nurses a great deal – as seen in Gallup poll after Gallup poll.

Mostly I have heard these laments in my role as a member of the mainstream press. And it’s absolutely true – nurses are not covered or quoted in the mainstream press to the extent that their role in providing effective, high quality health care would merit.

But the landscape, as I have tried to demonstrate this afternoon, is changing.

And if you keep trying to get the broadcast media to pay attention to your message, your mission and your values, you are going to find yourselves chasing an increasingly diminishing target. Now more than ever, the message is in your hands to deliver.

So let’s start looking a little deeper at the ins and outs of making the network work for you.

For such a supposedly free-wheeling place, you still hear a lot of shoulds on the Web:

[Next slide: various social media brands on the Internet]

You should be on Twitter, Facebook, Posterous or other social media sites. You should contribute entries to Wikipedia, share photos on Flickr, share book marks on Delicious or Digg. You should develop your own social network on the web through Ning or LinkedIn. You should be in the Document Cloud, riding the Google Wave. You absolutely must participate in your professional list-servs. You should share your reviews on Amazon or Netflix. You should. Should. Should. Should. Should.

It’s enough to overwhelm anyone. Especially when you consider you can put a lot of time and energy into something that could just as well disappear tomorrow – the way MySpace is doing.

In fact, sometimes when I look at all these social media innovations, I can’t help but think of Tom Sawyer and that white picket fence.

[Next slide: Tom Sawyer stamp] Here’s a Normal Rockwell illustration of the story. Aunt Polly has told Tom to whitewash the picket fence—it’s his punishment for getting into trouble yet again. But Tom cleverly tricks his friends into doing the work for him by making it seem like something that not everyone can do. Soon they are competing for the honor of whitewashing the fence. And there’s Tom supervising to make sure they do it right.

What was true in 19th century Missouri is true for the 21st century Internet as well. If you’re not careful, you will wind up doing someone else’s work for them – helping them build a new platform – and all for free.

There are only so many hours in the day – only so much time you have available. So your first priority when staking a claim on the web is to figure out what will be most beneficial to you – whether on the job, or as part of your continuing education or advocacy work or to help you in your personal life.

[Next slide: Basics]

Once you’ve decided that something is potentially beneficial, you need to answer a few more basic questions.

Are my friends or people I admire here, too? What good is being on Facebook if all your friends are on Orkut, which is apparently the most popular social platform in Brazil?

Is it easy? – The easier it is to do, the more that people you WANT to hear from will get involved.

Is it fun? – Naturally it can’t JUST be fun if you want to get any work done. But a little bit of fun keeps people going.

The next part is still something of a work-in-progress for me – but here are the guideposts I am now using to help me to decide what is important and where to invest my time. I have arranged them under three areas: organizing people, organizing information and the benefits of sharing.

[Next slide: Organizing people]
Here are five points that I find myself coming back to over and over again when thinking about organizing folks on the web.

Groups are easy to set up – It is also easy to join and leave groups

The collaboration itself still takes lots of time and energy

Who you know is just as important as it ever was – maybe more so

Diversity diminishes groupthink. You need rules and practices to keep a few loudmouths and extroverts from dominating the conversation

Watch out for spammers, viruses, worms, porn pushers, hateniks. We’re not going to find utopia on the Internet. You need to keep a step ahead of the destructive elements.

A lot of this will be familiar to you from your work on teams in the health care setting. So translating this to the Web – what groups are you a part of – keeping in mind that they don’t have to be permanent ones? To what extent are you breaking through silos? Breaking outside your professional limits? What percentage of the folks you engage with online are other nurses? Do you talk online about health care issues with health professionals other than nurses as well as folks outside the health professions?

I would like to give you two examples from my own experience –

My first example has to do with patent issues and a product called Plumpy’Nut.

While I was doing a Nieman fellowship at Harvard, I discovered a weird cross-section of patent law and hunger relief. I learned about a product called Plumpy’Nut – which is basically ultra-fortified peanut butter that is shelf-stable for two years and so doesn’t require a source of clean water. Plumpy’Nut has done wonders to save very young children’s lives in famine settings. In essence, it does for severe acute malnutrition, what oral rehydration therapy did for diarrhea. It doesn’t cure the larger public health problem -- but it dramatically decreases the need for intravenous solutions and the skilled people who provide them – thereby saving many more lives.

The recipe for Plumpy’Nut is also very simple. You can use locally grown peanuts and a modest-sized industrial mixer. The fortified milk powder usually has to be imported but it’s also ubiquitous. As with ORT, the recipe is simple – but somebody had to do the research to figure out the right ingredients and prove it works.

Unlike ORT, however, Plumpy’Nut is protected by a patent – which was sought by its manufacturer Nutriset at the urging of the French government. I learned that Nutriset had issued a cease-and-desist order to a humanitarian group that used the very basic recipe to make its own versions of Plumpy’Nut.

I thought, what a great topic for a group blog. We could get patent lawyers and public health experts and peanut farmers and local communities around the world involved. Naturally some of the big name foundations that have been fighting to bring essential medicines to the poorest countries would want to comment – given similarities with access to AIDS medicines.

And you know what? While I got the blog set up very easily, an interactive group of contributors never materialized. Let me be clear, I discovered several lawyers and health experts and activists who were very willing to talk to me about the issue. But they would rather I wrote about what they said than to write it themselves. Or they didn’t want to be quoted by name. Or – to be brutally honest – they really didn’t see what was in it for them to participate. My original motivation – isn’t this a fascinating case study about how intellectual property concerns are shaping development – wasn’t enough for them.

In other words, the technology was easy to set up but the collaboration proved much more difficult.

On the other hand, I shared all my notes, the summaries of various conversations – in person, online and via email. And once the search engines picked up the posts and others referred to them, people started sending me more bits of pieces of information.

A year after the Peanut Butter and Patents blog first went online, I got an email from Martin Enserink of Science magazine who decided to write up a sidebar on the patent issue for a story he was writing on Plumpy’Nut. A US peanut manufacturers’ association emailed me that they were hiring a lobbyist and using some of the material I had gathered to see whether overturning the patent would lead to greater use of peanuts. More recently, as the issues of whether or not to use Plumpy’Nut has heated up in India, I have heard from a number of journalists there.

So the original idea of a more cohesive group didn’t take shape – but a series of ad-hoc groups did form. Each of these temporary groups contributed a little more information – and then disbanded.

I no longer maintain a separate blog on Plumpy’Nut. If I learn anything new I include it in my regular sporadic blog on global health. And yet, even today, if someone puts the words “Plumpy’Nut” and “patent” into the Google search engine, the first four items that are returned are all written by me and will take you to a collection of material I have pulled together – or curated, which is the term of art now favored by a lot of journalists.

By the way, if you want an example of a group blog for public health that I think works particularly well, check out The Pump Handle. Just put the phrase “the pump handle” in quotes into the Google or Bing or Yahoo search engines and you’ll find it. Good stuff.

My second example has to do with “What to call swine flu?”

Just last spring we all learned about the new swine flu that was then wreaking havoc in Mexico and parts of Texas and California. Several health journalists, myself included were pressed into action to cover the story for various outlets. As it happens, one of the top flu journalists in the world, Helen Branswell of the Canadian Press, was just starting to make her debut on Twitter. She and Maryn McKenna of CIDRAP (which is the Center for Infectious Disease Research and Policy) and Dick Knox of National Public Radio, Jon Cohen of Science, Nancy Shute at USAToday and I quickly found each other on Twitter. Mind you – we are all journalists with competing affiliations but we respect and admire each other’s work.

In the midst of all this, a conversation developed amongst us over Twitter about what to call this new flu. I wish I had the actual Tweetstream to show you but Twitter doesn’t archive old posts and so I cannot now recreate what happened exactly.

The early press reports, of course, were about swine flu. Then the pork producers started complaining that folks would get the wrong impression and worry they could catch the flu virus from eating pork.

The public health authorities who were having their own internal debates about exactly what to call the new flu strains themselves – settled on H1N1 flu for the general public.

The group of journalists I interact with on Twitter, thought that name – H1N1—was too confusing because there was already a seasonal H1N1.

I remember proposing California flu since that’s where the new H1N1 strain was actually first identified. But that seemed much too hard to explain to editors – why we would go with a phrase no one had heard of before.

So each of us made our own decisions but the general consensus was to go with “swine flu” or the “new swine flu” because we weren’t in the business of protecting the pork industry from mistaken concerns.

It was quick, it was easy. No votes were involved. But it was a great chance to take the temperature of what other journalists were doing – not all journalists, mind you – but the journalists that I respect and admire on this topic. And anyone could listen in on and participate in the conversation if they wanted to—if they acted quickly.

Because that conversation happened very quickly. It didn’t need to last long to fit our purposes. As an extra benefit, it also didn’t allow enough time for spammers to break in.

So that’s a little bit about organizing people. And let me reiterate, I think this is the easiest part to overlook about the Web. The true revolution and value of the Web isn’t so much about organizing INFORMATION as it is about organizing PEOPLE.

Nevertheless, organizing information plays a big role and there are four areas that I see coming up again and again here --

[Next slide: Organizing Information]

Out of this group, I want to focus on providing context, which I believe is one of the greatest values that anyone can offer on the Web today. But before I do that let me just say a little about the other three items on this slide:

Crowd-sourcing—is a great way to organize people AND information. In crowd-sourcing, you recruit a lot of people to provide very specific pieces of information. Crowd-sourcing has produced some incredible results, particularly when it comes to monitoring elections. But we are starting to see its use in health care as well.

Some of the best and earliest examples of crowd-sourcing come from sub-Saharan Africa. Citizens in Ghana in 2000 started texting the JoyFM radio station with reports about voters being turned away from polling booths. The radio reports then forced election officials to rectify the situation in real-time, before the voting booths closed.

Nine years later, the use of short but very specific messages has been adapted to help health care personnel penetrate the very murky world of pharmaceutical stockouts in Malawi and Zambia.

Here in the US, Josh Micah Marshall and the folks at Talking Points Memo blog used crowd-sourcing to bring to light a pattern of firings for political purposes in the US Justice Department, which is supposed to be a partisan-free zone. Talking Points Memo won a Polk Award for investigative journalism as a result.

The next item is Structured data. Learning your way around a database is providing more and more insights as large data sets becomes ever more transparent and accessible. And it’s important we keep them open and compatible with each other. More folks are paying attention to Nursing Home Compare, for example, as they make choices about long-term care—despite some glitches in the software.

This massive amount of data is fueling the need for better ways to find and visualize patterns in the numbers. The Dartmouth Atlas folks have been pioneers in showing us these patterns in distributions of health care, staff and variations in costs. Hans Rosling of Sweden has done some great work showing how public health measures change over time—and he makes it fun, too.

But none of this –the crowd-sourcing, the structured data, the visualizing of complex patterns—makes sense without context—without a story that gives greater meaning to all the pieces.

In a world that is just exploding with information, being able to provide the context by which alls those bits and pieces of data make sense has never been more important. It is also, I think, the surest way to stake your claim on the web.

[Slide: implicit to explicit]
So how do you take what is implicit and make it explicit? How do you take what you know implicitly from your professional education and experience and share that with the rest of the world? How do you provide context?

First, talk about what you know. What you are already expert in – the ins and outs of keeping people alive, preventing complications, limiting pain and maximizing quality of life. Name the elephant in the room. Talk about how much time you spend on paperwork versus caring for patients. Tel us about the move to restrict the use of Tylenol and what it will mean to your practices. Just because it’s obvious to you doesn’t mean it’s obvious to anyone else.

Clearly, you don’t want to break HIPAA rules on patient privacy and if you’re going to take on your employer, you’d better make sure you’re part of a big group. [pause]

It’s also imperative to be a part of the important conversations of the day. And of course, what bigger conversation can there be in the public realm these days besides health care reform? Despite what President Obama said when he addressed Congress on Sept. 9, we all know that health care reform is going to be with us for many years to come –even if some kind of health care financing law passes later this year.

IF you want nurses to play more of a role in deciding what health care looks like, make sure that health care – the way it is designed, the way it is delivered, how it could be improved – is part of the ordinary conversations you are having on the Web.

Context does not have to be long and complicated. I am not asking you to write review articles worthy of publication in your spare time. You’d be amazed the amount of context you can pack into 140 characters on Twitter, for example. Listen to Ramsey Baghdadi of the Regulation Policy Market Report, who was live-tweeting the markup of the Senate Financing committee’s bill on health care reform on Sept. 23, 2009:

Baghdadi tweeted: “Two hours into Day 2 of Finance Committee Death March and still not a single vote on 1 of close to 600 amendments. Bring it.”

Right away you get a sense of the complexity, the politics and the timing of it all.

Someone who is particularly good at providing this sort of context at a slightly longer length is Ethan Zuckerman at Harvard’s Berkman Center for Internet and Society.

Back in February when the streets of Madagascar erupted into violence – I’m sure you all remember that right? – there were a handful of reports in the New York Times. Each did a good job of identifying the protagonists and the events of the day but Zuckerman decided to do them one better. He tried to understand what major themes – besides vainglorious politicians – might be underlying the unrest.

After a few phone calls to friends with ties in Madagascar, he quickly outlined the real underlying tension. There was, Zuckerman writes, quote “an unprecedented agreement to lease 3.2 million acres of arable land from Madagascar at $12 an acre.” unquote

This land was being leased to the Korean conglomerate Daewoo. And, as Zuckerman made clear, the reason that is important is because quote: “That swath of land represents half the arable land in the country – it’s an area half the size of the nation of Belgium. Daewoo plans to put most of the land under corn for export to Korea and the remainder under oil palms, hoping to export the oil on the bio-fuels market.” unquote

No wonder everyone was upset.

This little bit of context provided better understanding of what was going on half a world away – it made my reading in the New York Times that much more informative. But as Zuckerman says about his own experience, until he learned the context, quote “the news [about Madagascar] largely floated over me, despite the fact that I have an interest in Madagascar through my Malagasy friends.” unquote

In other words, the context made him more receptive to taking in and searching out even more news on the topic.

Over and over again, we are seeing both in mainstream media and online, providing the right context can drive the conversation. The better you are at providing the context, the more likely people are to listen not only to what you have to say but what others are saying that reinforces what you have to say.

Another person who does this so well is Jeb Sharp, a journalist with Public Radio International. Her series on “How We Got Here” provides a brilliant little history lesson behind the headlines of the day.

Now stories about Plumpy’Nut and Madagascar may seem obscure and even a little tangential. But doesn’t that also describe where nurses find themselves today—often outside the conversation, clamoring for a seat at the table, a chance to influence the decisions?

The point is to get from here to where you want to be by harnessing the tools of communication and organizing people that the Web offers.

Remember, you want your circle of influence to include folks who aren’t nurses. That means forgoing a lot of the nurse-speak that is second nature to so many RNs. For a whole treatise on how to do this, I recommend a book you may already know about: “From Silence to Voice” by Suzanne Gordon and Bernice Buresh.

Also, let me emphasize, this is a conversation – not a broadcast – there has to be give and take. Ask questions, admit mistakes. By all means share what you know but also share what you don’t know.

Which brings me to my last point – about the benefits of sharing in a networked world.

[Next slide: share what you learn}

When people talk about sharing and collaboration on the Web, they can start to sound very utopian and even magical. I’ll just say that being more forthcoming with what I share on the Web has helped me often enough that I keep doing it.

For example,

When I tweeted the other day about some outdated projections about the nursing workforce from the Bureau of Labor Statistics, someone sent me a paper with more up-to-date figures within five minutes.

When I traveled to Malawi last year, I spent three months interviewing nurses throughout the country about their working conditions, the health care system, their challenges and their successes. I posted most of my notes whenever I could get an Internet connection and was in turn contacted by several young people who were looking for logistical information for their own trips to Malawi. That is perhaps not so surprising.

But what did surprise me was that a nursing professor in England reached out to me for advice on a graduate clinical program they wanted to create with a school in Malawi—one of the very ones I had visited. I was able to reassure the professor of the school’s good reputation locally. And I provided constructive criticism on aspects of the UK plan that seemed destined to promote rather than deter the brain drain of nurses out of Malawi.

There is no doubt that sharing and collaboration provide tremendous benefits. But there are still only 24 hours in a day. When thinking about social networks you are designing, have been asked to join or are asking others to join, think about the different motives people have for sharing. What cost – in terms of time and attention are you asking them to bear? What level of commitment do you seriously think you can achieve?

These are extraordinary times. Everyone is out there staking a claim on the Web, trying to get heard. You can improve your chances of success by remembering

ONE: that this is not a broadcast contest – small groups are more powerful than ever before. Don’t get bullied into thinking you have to keep up with Oprah or CNN.

and TWO: your greatest value often lies in providing the context with which to make sense of all the other information floating around out there.

[last slide]
Thank You.

Nurses and the Web: Slides for My Talk

2009-10-02T16:29:00.004-04:00

Here are the slides for the talk I am giving on Tuesday (Oct. 6, 2009) at the American Journal of Nursing conference in Chicago. They probably don't make a lot of sense without the text that accompanies them. Still tweaking the narrative (and practicing my delivery). Will post the words next week.

Nurses and the Web

View more presentations from Christine Gorman.

More on Cipla, Plumpy'Nut and India

2009-08-26T07:19:00.005-04:00

Stephanie Nolan, the South Asia Correspondent for Canada's Globe and Mail, and I have been corresponding on Twitter about the goings on in India with respect to Plumpy'Nut, RUTFs and official government policy. As part of an article she wrote about the Plumpy'Nut controversy in India, she says, she tried to find out exactly what the Cipla product is and whether it's equivalent to Plumpy'Nut and got ten different answers.

Today she writes that "further invstigation shows Cipla product, whatever is, not WHO-approved & not officially RUTF. Delhi-based Compact closest 2 making."

Related post: India, Plumpy'Nut and Cipla
Related posts on Plumpy'Nut patent issues under intellectual property tag.

India, Plumpy'Nut and Cipla

2009-08-06T12:24:00.004-04:00

More on the Plumpy'Nut controversy in India. Cipla, a company more famous for its generic versions of AIDS drugs, makes pre-packaged food supplements for export to Africa, according to Sumana Narayanan in the India environment magazine Down to Earth.

Cipla also told Narayanan that there is no market for such so-called ready-to-use claims no market in India. I find this hard to believe and hope Narayanan follows up on that idea. (She pointed me to her article in a comment to yesterday's post.)

Not sure if this is still true but from what I've heard about India regulation of AIDS drugs in the past, the government's own rules actually probibit the sale of the inexpensive AIDS generics made by Cipla and others locally in India. Makes you wonder if a similar "only for export" rule applies to RUTF as well?

For an update on Cipla, see "More on Cipla, Plumpy'Nut and India."

Click on "intellectual property" tag for previous posts on Plumpy'Nut patent issue:

India Blocks Use of Plumpy'Nut

2009-08-05T07:42:00.004-04:00

The Indian government has told Unicef to stop using Plumpy'Nut for the treatment of severe acute malnutrition in that country over concerns about importing and becoming dependent on "foreign food." This is a separate issue from the patent controversy that I have blogged about in the past.

The Indian government questions whether RUTFs (ready-to-use therapeutic food) are better than hot-cooked food, as reported by the Times of India.

On that score, the government's concerns about efficacy seem overblown. Plumpy'Nut is a fortified peanut paste that has a good track record as a ready-to-use therapeutic food in several African countries. And hot cooked meals aren't going to provide the concentrated calorie and nutrient power needed in an emergency situation.

But the larger issue--of having to depend on commercial food imports should not be dismissed lightly. Yes, there's a strong whiff of protectionism but that's understandable in light of the growing crisis in the world's supply of staples. (See Lester Brown's article in Scientific American, or for an even more provocative view, this piece by Deborah Fahy Bryceson in the Monthly Review.)

The solution to the Indian impasse, as reported in the Times Online, may be to use locally produced RUTF. Two Indian companies are starting to get into the business of doing just that.

Planning is Key to Good Multimedia

2009-08-03T08:54:00.013-04:00

Multimedia is not easy--takes much, much longer to create than pure text--and requires more thought, cooperation and collaboration.

At each stage of creating the Malawi video that is up on CNN's website--pre-production, production, post-production and distribution--I kept realizing how many different pieces there were. I'll admit there were times when I felt pretty low as each stage seemed to take longer than I anticipated. But I think the result is worth it.

Several multimedia journalists I respect keep emphasizing that you need to do a good job matching up various aspects of the story to the medium. Text--at whatever length (even captions) is particularly good for facts and analysis. Images for action or "slice of life." Audio for emotion.

So, even before I went to Malawi to report on its severe nurses shortage, I knew that I wanted the video to complement the text--not be the whole story. I wanted the video to give a sense of a couple of individual nurses and what they face in a real-world way that is much harder (although not impossible) do to with text.

And then the text could focus on context and analysis. For example, look at these three sentences from my CNN article:

"By the late 1990s, however, Malawi was reeling from the AIDS epidemic. As if that weren't bad enough, the government also had to cut spending on health care and education as a condition for getting help from the U.S. and other countries to liberalize its trade and economy. The publicly funded health system, on which more than 95 percent of Malawians still depend for treatment, quickly started to fall apart. "

Very quickly, I was able to provide the necessary context: the twin ravages of the AIDS epidemic and structural adjustment programs that crippled the Malawian health care system.

The photo essay was the least well-developed part of the CNN package--it really happened almost as an afterthought, when the CNN producer asked me if I had any still photos. But I was able to throw it together in a couple of hours (maybe 20 minutes to pick the photos and longer to export and email them to the producer) because I have organized all the photos Eileen Hohmuth-Lemonick took for the Malawi project as well as caption information in Lightroom, a terrific photo management/database program from Adobe. (And no, nobody paid me to mention Lightroom.)

Once again I wanted to touch on themes of showing nurses in a wide range of activities both inside and outside the hospital/clinic. Given how many negative images of poverty and despair we see from Africa, I specifically chose photos that show success--or at least active engagement. That's something I have thought about a lot over the years and so was able to act quickly.

FYI, I produced one other video based on the Malawi trip, called "Telling Stories, Saving Lives." You can see it in either Flash or Quicktime. I chose to upload it to blip.tv because of the Creative Commons license.

"Telling Stories" is more of a self-contained piece -- but could probably also be paired with a good text story (on women's rights or domestic violence or the arts and health). Why not all three articles connected to that same video. Ahh, my next project!

Related Post:
My Malawi Nurses Video Featured on CNN

My Malawi Nurses Video Featured on CNN

2009-07-30T13:24:00.012-04:00

I'm happy to report that my story and video of the crippling shortage of nurses in Malawi has now been published in CNN's new health section "Vital Signs."

I actually shot two videos from my trip to Malawi. You can see the other one on blip.tv. It's called "Telling Stories, Saving Lives."

The videos, as many of you know, were months in the making. Who knew there were so many parts to putting moving images together?

And I have to question the idea that anyone truly is ever alone in producing video.

Many thanks to Nieman Fellow classmates (Ayelet, Joan, Walter, Simon and Stuart) who, along with Jeb Sharp and Joe Neel, gave me guerilla lessons in shooting video, Katherine Bates (who helped ferry all the equipment), Eileen Hohmuth-Lemonick (who took the still photos) Ed Robbins (who edited the videos and wrote the script), Stefanie Friedhoff (who believed in the project and provided the funding) and, of course, the great people at Embangweni Mission Hospital itself.

The two institutions to thank are, of course, the Nieman Foundation for Journalism, which awarded me the fellowship on global health reporting--and the Bill and Melinda Gates Foundation, which supported the Nieman Foundation.*

I haven't even won an award or anything and I'm just gushing with all the people to thank--but perhaps I'll stop there.

*I believe there is no conflict on interest posed by the Gates funding since I was free to chose my project and did my reporting without editorial input from the Gates Foundation.

Anyway, just wanted to share the joy.

Related Post:
Planning is Key to Good Multimedia

Plumpy'Nut: WBAI Radio Interview

2009-07-24T13:31:00.003-04:00

Just finished talking with Diana Mason and Barbara Glickstein about patent issues and Plumpy'Nut on WBAI. Intriguingly, the conversation broadened out to food and water issues generally. Here's a list of previous posts about Plumpy'Nut that Diana referred to in her questions.

Unintended irony about cost-effectiveness

2009-07-02T11:52:00.008-04:00

Some thoughts on the unspoken history in an article from the Wall Street Journal about cost-effectiveness in global health.

I have been spending more time these past several weeks on Twitter, the short-form micro-blogging platform, rather than on the blog. (I'm @cgorman.) There are obvious limitations to Twitter's 140 character limit. But I find it's a great way to quickly pass along time-sensitive information, as well as get a kind of "temperature reading" of what some of the big issues are thought to be.

It's also exactly the right format to quickly point folks to news articles--like the one that Amy Dockser Marcus of the Wall Street Journal wrote in an intriguing piece titled, "To Fix Health Care, Some Study Developing World."

But it's hard to fit into 140 characters what I thought was missing in Marcus's article. It's a perfectly fine piece of journalism, a good introduction. But there is a lot more to this story.

You get a hint of it in Marcus's praise of the Prevention and Access to Care and Treatment (PACT) Project in Boston. That program was started by Partners in Health in 1995.

The main thrust of Marcus's article is about international programs that provide better health for less money. In other words, the benefits of cost-effectiveness--as seen in poor countries.

Regarding cost-effectiveness: PIH leaders like Paul Farmer and Joia Mukherjee will tell you over and over again that too many in global health are slaves to the idol of cost-effectiveness. (Note, these are their friends they are talking about--the folks who believe in global health.) Farmer and Mukherjee see an unthinking allegiance to cost-effectiveness as a sledge hammer that is often used to deny access to health care for the poor and marginalized.

Regarding health care in poor countries. Mukherjee recently had an op-ed in the Boston Globe slamming the IMF for cutting public sector spending in health and education amongst poor countries as a condition of receiving loans in the 1980s. Part of the reason so many countries were open to working with PIH to develop the sorts of programs praised by the WSJ was because their original government health plans were destroyed by budget cuts demanded by "structural adjustment programs."

The irony, as Mukherjee and her co-author wrote, is astounding. "Today, market-based, financial-sector strategies have failed so miserably that nothing but massive public spending can rescue even the wealthiest economies. The United States itself has used trillions of dollars of public monies to stimulate the economy and secure private institutions. Yet expansionary public spending will not be possible in poor countries if the IMF is given free reign to restrict public expenditures."

So, Twitter for short bursts of information (like headlines). Blogs for looking a little deeper. All of it is a process that sometimes even produces good products.

Related Posts:
Do We Get Our Money's Worth in Global Health?
How I Use Twitter Without Being Overwhelmed

Do We Get Our Money's Worth in Global Health?

2009-06-19T07:32:00.005-04:00

Two carefully researched reports in the Lancet argue that the world is not getting its money's worth in global health.

The first, from the World Health Organization, says that a focus on making improvements in individual diseases--like AIDS--has come at the expense of comprehensive programs that offer treatment for all the most pressing health problems.

The other, from Institute for Health Metrics and Evaluation in Seattle, documents a quadrupling of funds for global health since 1990 but shows that some of the poorest countries with the highest disease burdens have actually received less help than somewhat healthier and wealthier countries. In addition, the IHME paper documents the shift in power and influence from government and public agencies to private foundations--like the Gates Foundation, which funded the study--and individuals.

Both research articles--and the accompanying comments and editorials--are well worth reading at length and at leisure (which I plan to do this weekend). I do not know if these articles will spur any changes in direction or action on the ground but I have a feeling we will be hearing about these pieces for some time to come.

Several of the blog posts I have read so far about these studies are rehashes of the press releases that accompanied them. Given the nuances of the arguments and the complexity of the data, it may take a while for more thoughtful reviews to appear.

Maria Cheng's article for the Associated Press is a good, if basic, introduction to the papers. Kaiser Health News says they will post an aggregation soon--and here it is.

Health-Eight Meet in Seattle

2009-06-17T14:49:00.003-04:00

Sandi Doughton of the Seattle Times lifts the lid a bit on one of the more exclusive clubs in global health--the Health-8 or H8--meeting this week in Seattle.

Her report documents one more step in the ongoing privatization of global health as power and influence drain away from public groups--like the World Health Organization--to private foundations and non-profit organizations.

Given the reactions in Doughton's article, folks don't seem too concerned about the lack of transparency. After all, it's not like Hilary Clinton having secret talks about health care during her husband's administration or Dick Cheney chatting about energy policy with petroleum execs--right?

Related Post:
Who are the Health 8 (or H8)?

Malawi Project Featured in American Journal of Nursing

2009-06-05T09:11:00.010-04:00

I am happy to report that a photo-essay about my Malawi project is the cover story for the June issue of the American Journal of Nursing. That great cover photo of Mphatso Nguluwe was taken by my friend Eileen Hohmuth-Lemonick who joined me on my three-month Malawi trip last year.

Mphatso is a great story-teller, who likes to tell her fellow Christians that she is the mother of nine children by eight different fathers. It's a great teachable moment that I wrote about last July.

My project focused on the nursing shortage in Malawi as a kind of a kind of window into how health systems function in poorer parts of the world. Malawi is in the midst of a six-year program to address its nursing shortage by paying nurses more and supporting more nursing education and training.

Part of what I learned in Malawi is how fragmented and overly narrow most efforts at improving health turn out to be. We think that having more drugs or more nurses and doctors will automatically improve conditions without considering the need for better roads, clean running water or functioning secondary schools to make sure those efforts succeed.

Because it's easier to raise money for a single issue--like AIDS or polio vaccines or girls' education, we continue to maintain (and tell stories about) siloed efforts that don't intentionally contribute to broader, more long-term needs like primary care. There was a study about that from the Institute of Tropical Medicine in Antwerp just yesterday in the Public Library of Science.

I don't understand why--if it took me only three months to figure this out--the professionals who do this for a living still can't seem to adjust their efforts accordingly. As the PLOS study suggests, they must already know this. But then, as the saying goes, "It is difficult to get a man to understand something when his salary depends on his not understanding it."

I tried to get at some of these themes with the photos and captions that are part of the AJN essay as well as the supplemental material that is available online. When I suggested to Diana Mason, the outgoing editor-in-chief, that both be made available for free to non-subscribers as well since they reflect on health in the developing world, she readily agreed. Well, as another saying goes (two aphorisms in one post--that probably exceeds the limit), "it is better to strike even a tiny light than to curse the darkness."

Related posts:
Hiding Broken Practices Behind New Catchphrases
At Work with Malawi's Nurses

Update: Related 10-minute podcast with Christine Gorman on the AJN site

Hiding Broken Practices Behind New Catchphrases

2009-06-04T10:35:00.006-04:00

Here is another example of why we need more independent reporting on global health and development. A study from the Public Library of Science found that many global health initiatives are still effectively siloed efforts that focus on single diseases or institutions and do not, despite claims to the contrary, support overall health systems.

And yet, as I have seen in my own travels through Malawi, Lesotho, South Africa and Zambia, improving health systems is precisely what is needed in many poor countries and impoverished areas. "Health system strengthening" has become the new catchphrase but, according to the PLOS report and the lived experience of many in the global health field, there has been no real change in action to support this goal.

One positive trend: the researchers note that while their funding came from the Institute of Tropical Medicine, Antwerp, "the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." This slightly more detailed conflict-of-interest statement should be adopted more widely when reporting or writing about global health.

Related post:
Who Pays for Global Health News and Why?

Who Pays for Global Health News and Why?

2009-05-19T12:14:00.014-04:00

To maintain credibility, news coverage of global health and development issues must be independent because who pays and why dramatically influences the process of what gets told. This is a sleeper issue that does not get enough attention. As a health journalist, I know we have been down this road before—with respect to misleading consumer news coverage of medications and research studies—and it’s not pretty. In the end, it actually hurts people and wastes money.

It hit me last night why I am so passionate about this topic. I went to a presentation about how to improve health care news coverage in the U.S., which was mostly about how many health news reports don’t cover basic issues like costs, availability or provide even a hint of context about whether something is truly broadly beneficial. The event was sponsored by the New York City chapter of the Association of Health Care Journalists, of which I am a member.

One of the presenters, Gary Schwitzer, a former CNN journalist and current journalism professor who founded HealthNewsReview.org, jokingly suggested that I might throw spitballs at him while he was at the podium. (The other presenter was Harry DeMonaco, who helps Boston's Massachusetts General Hospital decide what treatments are both beneficial and cost-effective.) Instead, Schwitzer provided me with an aha! moment.

For more than 20 years, I have worked in an environment where pharmaceutical and medical device companies have a huge vested interested in getting their products covered by the mainstream media in the best possible light.

As Gary Schwitzer and Harry DeMonaco noted, the economic incentives are so great that the influence extends even to what appears in medical journals. Drugs are often compared against placebo instead of current effective treatments, for example, because the results are more dramatic that way. No one can take a chance on a new medication being scientifically shown to be just as good or only marginally better than a less-expensive one.

Add to that human nature—it is very hard to be objective about something to which you have dedicated lots of your time and energy. So naturally, someone who is a principal investigator on a study is going to be enthusiastic about the work and its potential for alleviating human suffering.

I know that—as do many of my colleagues in the health journalism field. And I hope that I have taken account of those sorts of positive psychological and economic biases in my reporting by looking for more outsides sources, bringing a respectful-but-still skeptical attitude to most research studies.

Just as importantly, I benefited from the structural divide that was set up within TIME Magazine that kept the advertising side separate from the editorial side precisely so that I could be as independent as possible in doing my job.

So here I am, trying to get more news coverage—both online and offline—of important issues in global health and development and I find the same built-in biases that make health-reporting trickier than you might at first think.

There is a built-in bias in almost any story about non-government organizations against considering what governments are doing in health. Every story about a specific disease has a built-in bias against discussing primary care systems or the non-medical interventions (like better schools or roads or robust legal and civil rights for women) that could conceivably have an even greater impact.

The consequences are very real. To give just one example, I will never again be able to read another laudatory story about the “generous donation of medical supplies” without thinking about the amount of donated material that I saw in Malawi last year that had either passed its expiration date or was actually useless—and needed to be discarded, all at the expense of the receiver. This is the sort of problem that missionaries 50 years ago dubbed “junk for Jesus.” It makes the folks back home feel virtuous but it is a burden for the supposed beneficiaries.

Given the costs and the way things are going these days in journalism, there is bound to be money coming from interested parties whether in the form of grants, advertising or even accepting a ride in an aid convoy, to cover global health issues. That’s all the more reason to set up rigorous firewalls so that funders and advocacy groups don’t get editorial approval over the final product. News organizations also need to make those policies public so that the larger community can judge for itself how well they are doing.

Budding global health news organizations—or content providers—also need to be more creative about who they tap as funders/advertisers. Maybe recruit the folks who like to fund transparency projects, for example, instead of going after global health or single-issue advocacy money.

There may also be ways of crowd-funding global health news coverage that we haven’t explored.

But I know we need to be paying as much attention to managing these conflicts within the coverage of global health news as we are to “monetizing content,” to use the current buzz-phrase. And it's just as much an issue for citizen journalists/participatory media as for legacy or professional journalists.

Related posts (updated on May 20,2009)
Click #ghnews label for other posts on covering global health
See also "Pro-Publica and Conflicts of Interest"
Read Ivan Oransky's live tweets from Monday night's AHCJ event with Schwitzer and DeMonaco.

Barbara Hogan, Paul Farmer, Eric Goosby and More

2009-05-18T08:05:00.016-04:00

And now for a little global health gossip--in between reading dispatches from the World Health Assembly, which is meeting in Geneva this week . . .

Barbara Hogan is out as South Africa's Health Minister--just a few days after being named one of Time Magazine's 100 Most Influential People in the World. Was she too outspoken about the need for greater transparency and accountability for South Africa's AIDS treatment programs? Too critical about the government's refusal to issue a visa to the Dalai Lama? Is the ANC government that petty? Or is this just normal shuffling of cabinet positions? South Africa watchers are taking a watch-and-see approach--especially since the new Health Minister, who comes from Limpopo, is not widely known.

Paul Farmer has told colleagues he is contemplating a possible position with the U.S. government.

And in other news,

Eric Goosby, who has been tapped by President Obama to replace Mark Dybul as U.S. Global AIDS Coordinator (head of PEPFAR), will be speaking at the Global Business Coalition on AIDS annual conference June 23-24 in Washington, DC. Dybul will be there as well in his new role as co-director, with Larry Gostin, of the Global Health Law Center at Georgetown University. (Dybul joined Georgetown in February).

Thomas Frieden, New York City's health commissioner, is Obama's pick to head up the Centers for Disease Control. Revere, in his unique way, highlights some of the challenges Frieden will face.

And if you're in Washington, D.C. for the Global Health Coalition annual conference, don't miss Katrin Verclas on Wednesday morning, May 27. She organized the excellent barcamp conference on Mobile Tech For Social Change that I attended in New York City back in February and is a crackerjack organizer and advocate for what mobile phones can do for health, finance, accessing the Internet, changing the world.

Oh, and this just in. . . the London School of Hygiene and Tropical Medicine, just won the $1 million Gates Award for Global Health, given out each year at the Global Health Coalition meeting.

Afghanistan: First Acid, Now Gas Attacks Against Girls

2009-05-14T10:51:00.005-04:00

Reuters reports that three girls' schools in Afghanistan have now been the targets of improvised gas attacks. Five girls fell into comas for a short while after the most recent attack, which occurred on Tuesday, while 100 others were hospitalized. Apparently, throwing acid at some girls, wasn't enough to convince many of their sisters to stop their education.

The news of the attacks has kept hundreds of girls from showing up at school, according to the Associated Press.

Still unclear: what kind of gas was used. Blood samples have been sent for testing. There is also a chance that a gas leak--as opposed to a premeditated attack was involved at the third school.

Also disturbing, the attacks are happening in Kapisa province, a region east of Kabul that has been relatively open and supportive of girls' education.

Related news:
Katie Couric had a piece on the CBS News about the assassination of a women's rights activist in Afghanistan and the passage of a new law that (may be changed) that would allow marriage as a defense against rape.

Crisis-Mapping the Sri Lankan Fighting

2009-05-13T12:00:00.005-04:00

Is there a way to combine human and technological intelligence to figure out what is going on in a tiny section of Sri Lanka, which suffered heavy bombardment this past weekend? Can you, dear reader, help collect that information?

The American Association for the Advancement of Science has published satellite imagery which suggests heavy shelling and mass movement of people. (hat tip @mwmcelroy who works at the AAAS.)

According to the Associated Press (as quoted in the New York Times), "a government doctor said at least 378 civilians — and perhaps as many as 1,000 — had been killed and more than 1,100 wounded on Saturday and Sunday during intensive shelling of the combat zone on Sri Lanka’s northeastern coast, a boggy sliver of beachfront where Sri Lankan troops have surrounded Tamil separatist fighters." (Click here for the full AP report, which details three rounds of shelling on the hospital.)

Journalists report not being allowed into the area to report on what is going on.

This seems like quite a test case for folks who promote the benefits of crisis-mapping.

Crisis-mapping is an emerging technology that uses SMS or mobile texting plus other crowd-sourced pieces of information to map a crisis, while it is happening. The idea is to give folks on the ground as well as those far away some idea of what is going on and which areas are particularly dangerous in real-time. Click here for a video introduction to crisis-mapping from Patrick Meier, whose dissertation features a lot about crisis-mapping and who has been traveling the globe recently introducing folks to it.

I am asking my larger Twitter and blogging community for help in gathering resources. Will share the results here.

Human Health Effects of DDT

2009-05-11T15:49:00.003-04:00

Several folks, after reading my last post on DDT, have asked me about DDT's health effects on people. Their point: while DDT may prevent some people from dying of malaria isn't there a cost to their long-term health?

Once again, context is key. The major negative effects of DDT have been on animals--particularly birds and fish. This is very important and not something the environment can sustain, especially since DDT accumulates in any animal's fat tissue (including people's).

As far as we know, DDT's health effects on people are minimal compared to that on fish and birds--something that was straightforwardly acknowledged last year on the website of the World Resources Institute, where Al Gore serves on the board of directors.

More recently there has been some research to indicate that DDT may act as a hormone disrupter and affect fertility as well as promote premature delivery. Animal studies have also suggested a possible cancer risk--but once again that would presumably be at very high dose.

So, if you are just going to look at health effects in people, the scales tip toward using DDT in those parts of sub-Saharan Africa in particular where it would be most helpful.

This is the same kind of cost-benefit ratio that is seen with giving polio vaccines that also sometimes cause the disease itself.

The cost to the environment is the more worrying issue--and something that needs to be addressed whenever DDT is used as part of an anti-malaria program. Fortunately, the amount of DDT that is needed for residential spraying is small. South Africa has shown the spraying can be done with minimal impact on the environment--by training sprayers and making sure no DDT is diverted to agricultural use.

It's a fascinating topic--and hard to find experts who are truly impartial. In my experience of reporting on the topic, people from both the left and right use DDT to score political points without regard to what facts are like on the ground.

Makes me think I should look more closely at the latest report that the World Health Organization has decided to work towards the total elimination of DDT, perhaps even in malarial zones.

Related posts:
Back and Forth on DDT Again
Can Malaria Be Eradicated?

Back and Forth on DDT Again

2009-05-07T15:17:00.008-04:00

What's missing from the latest news about the World Health Organization, DDT and malaria? Context! Context! Context! Namely, if DDT had been used from the time of its invention only for public health purposes--for indoor residential spraying against mosquitoes in areas hard-hit by malaria--it would probably never have developed its toxic reputation.

The fact that agricultural interests--particularly cotton farmers--adopted wholesale DDT spraying is what killed birds and poisoned entire ecological systems.

There is a special case to be made for judicious, environmentally-protective DDT spraying of residential homes--particularly in hard-hit African countries. South Africa has shown how to do this and still protect the environment. (I wrote about this in TIME Magazine five years ago. Please also note, it was the combination of DDT and treatment with an anti-malarial drug that turned the tide.)

The World Health Organization seemed to have acknowledged that point back in 2006.

Now comes word that they hope once again to achieve a total ban on DDT, thanks to pilot programs that have used other anti-mosquito pesticides and means in Mexico and Central America. Please note: malaria is much worse, much more prevalent in central and southern Africa so what works in Mexico may have little effect in malarial zones of Africa.

As for increased resistance of mosquitoes to DDT, the point is actually not to kill the mosquitoes but to keep them from biting. And DDT is actually a better mosquito repellent than anything else--exactly what you want, according to a 2007 study in Nature Medicine.

I suppose all public health programs have an element of politics but I find it very frustrating to read news reports that pretend that all decisions with respect to DDT are made solely on a scientific basis.

Related posts:
Can Malaria Be Eradicated?
Human Health Effects of DDT

How I Use Twitter Without Being Overwhelmed

2009-05-05T11:03:00.019-04:00

Twitter does not have to be yet another echo chamber—provided you are selective about who you follow. By treating Twitter as a filtering device and NOT a broadcast medium, I think I have a better shot at getting at the story behind the story.

For my purposes, Twitter does three things very well: organizing people, collecting data and doing a quick temperature check.

ORGANIZING PEOPLE

The 20th century still has such a hold on many of us that we find it hard to give up certain broadcast assumptions—that your goals should be to reach as many people as possible and to drive the conversation.

So, most stories about organizing people with Twitter focus on large numbers—10,000 protesters showing up in a square in Moldova, even if later reports question just how much of a role Twitter or SMS texting or even the government itself played in the demonstration.

My goal is not as revolutionary, nor does it require as many people. I want to develop an independent editorial voice to shine more light on global health and development—both as issues and as industries.

Given the tumult in the news business these days, there is a lot we still do not understand about how to make such an enterprise sustainable. But I suspect there are enough people out there who are interested—and who have some good ideas and experience on how to get things done—that we might be able to figure it out eventually.

In the meantime, I am trying to develop a kind of network for global health news through Twitter, my email contact list and the people on my own and other global health blogs.

COLLECTING DATA

We have only begun to explore what is possible with structured data. I predict this area will explode with possibilities once it no longer takes a lot of computer programming skill and expertise to do this right.

For now, most of what I am collecting on Twitter are links—still very 20th century.

Often these are bits of information that do not necessarily relate to each other. Typically I look for links that deal with new models for delivering and sustaining news, that get beyond advocacy in global health and that grapple with some of the ethical dilemmas of how we tell stories, while trying to make money, working against deadlines and across cultures.

One of the most practical uses of Twitter for non-programmers is to figure out whether they should jump to another session at a conference. Check the twitterstream for a conference #hashtag to see which panel discussion looks most interesting and jump ship if yours isn’t meeting your needs. Likewise, let others know if the panel you’re listening to is really interesting.

Notice with conference #hashtags, we’re often talking about small groups with very concrete pieces of information. Indeed, the short messages often can only be understood by those who are already on site. Further, deeper reflection comes later—and is probably based on more research, phone calls, better data.

One of the best examples of collecting concrete data from lots of people is the #votereport project.

#Votereport was a Twitter project in which US voters were encouraged to tweet their voting experience last November 4. Because the predictions were of massive voter turnout, the goal was to see where the lines might be long and where newly registered voters might be encountering problems. Voters were asked to provide three pieces of information: their zip code, the length of the line and whether they had a good or bad experience. If bad (meaning they were turned away), then they gave more details about why.

The brilliant thing was that organizers then were able to put those folks who were turned away in touch with election protection lawyers in real time to see if their legal-electoral issues could be resolved before the voting booths closed.

The big picture issue was maintaining the integrity of the voting process. But the structured data that folks were asked to provide was easy to give and the connection with the larger point was easy to understand.

Eventually I think we will see more projects like #votereport adapted to global health.

But input from large numbers of people will not always be required.

Check out Frontline SMS for one example of what’s possible when you adapt text messaging tools for humanitarian work. I have also wondered if it would be possible to adapt something similar for ensuring the integrity of a country’s supply chain of medicine?

DOING A QUICK TEMPERATURE CHECK

There’s a concept in biology called proprioception. That’s the body’s own awareness of itself in the environment. Because it goes on in the background, we don’t have to give conscious thought to keeping our balance when we decide to run for the bus.

I use Twitter as a kind of proprioception tool for health journalism. Another way to think about it is to use the phrase “situational awareness,” as developed by military strategists and later appropriated by folks in business.

To give just one example, when I tweeted about grappling with what to call the new human swine flu in my own news articles, I learned that several other health journalists I respect were dealing with similar issues. And indeed, that struggle later became the subject of official pronouncements from the Centers for Disease Control and the World Health Organization, as well as long-form news articles by others who are not in my Tweetstream but who I read on the Internet and in hardcopy.

There are only so many hours in the day and only so many minutes I want to devote to Twitter. So my Twitter philosophy is to keep the number of tweets low and to follow only those who also keep their tweets low. If you pick the people you follow right, you will get a much more manageable stream.

I aggressively unfollow people who tweet too much. No matter how good they are, they drown out the others. And messages from high-volume tweeters still get into my tweetstream if the people I follow find them particularly important.

I unfollow people who retweet links without checking them out first.

I don’t mind following someone for a while and then unfollowing them only to refollow them later as my needs change.

If you find you have to follow someone who tweets a lot, follow them through an RSS feed or one of the programs (Tweetdeck, Twhirl, etc) that allow you to segregate their stream from your low-volume crowd. For now, I still access Twitter through the web because I am trying to keep the volume low, not increase it.

I often do not follow my friends if they tweet a lot because we are already on Facebook, I read their blog or we are in constant email contact.

I do not read every tweet. I do not reply to every @message. If you adopt a "river of news" approach to Twitter (similar to the one many of us have had to use with RSS feeds), the stream is much more manageable.

In essence, I think of the people I follow as my filter, a way of getting a sense of important ideas but NOT as a way of getting first-hand information. We are already flooded with facts (not to mention half-truths and outright lies). What we need are better filters.

As in so much of life, you have to take active steps if you really want to understand what is going on as opposed to just being distracted.

If you want to follow me on Twitter, I'm @cgorman.

Related Posts:
Wanted: A Social Network for Global Health News
Sharing and Global Health Blogging

Swine Flu: Stocking Up On Soup, Just In Case

2009-04-30T14:23:00.009-04:00

There are still a lot of unanswered questions about the new human swine flu that everyone has been talking—and sometimes obsessing—about. US government officials keep telling us to “hope for the best and prepare for the worst.” Here’s how I am taking that advice. At this point in time, I think it’s reasonable to stock up on canned soup, soap, hand sanitizer and Kleenex—which I have done. I plan to take a train this weekend. If I had to travel further, I would not hesitate to take an airplane. That could change tomorrow or next week. But for me, that’s reasonable for today.

Just finished talking with Lisa Mullins of PRI/WGBH/BBC’s The World. The other guest was Peter Sandman, a risk communications consultant who has been talking about preparing for pandemic flu for several years now. You can hear our segment on the radio at 3 PM on WNYCAM, which is 820 AM in New York. Here's the link to the podcast of the program.

I keep hoping, perhaps vainly, that adults ought to be able to sort through contradictory pieces of information at the same time. Yes, there is reason to be concerned about the new human swine flu. Even if it fizzles out in the next few days to weeks, there is still reason to be concerned. It’s not a bad idea to check your pantry and stock up on a few things that might have gotten low—in case you need to shelter in place. As anyone who has ever been in a hurricane knows, the time to buy extra diapers is not when the National Oceanic and Atmospheric Administration says the storm is going to hit your area in 24 hours. No, it does not make sense to close down the border between Mexico and the US.

Having extra food around the house or gas in the car are easy precautions to take now. There is not enough space in my tiny apartment for a two-week supply of stuff but we have seven days worth to cover my partner and myself. I’m also collecting a few phone numbers from my neighbors and have posted New York City’s flu hotline number (1-800-808-1987) in my kitchen. I have also noticed that I am not shaking people’s hands as much.

It helps to keep a sense of humor. I bought a box of crackers—one of my favorite things to eat whether sick or not—and marked it “IN CASE OF FLU.” I have a tendency to go overboard on crackers and don’t need the extra calories—unless I really am sick.

And after that, it’s kind of a waiting game—to see what will develop.

People who know me well say that I sometimes try too hard to fix things. Curiously, with reports of the new human swine flu, I have adopted a more fatalistic approach. No, I’m not throwing my hands up and doing nothing. I AM taking some precautions (outlined above). I may change my actions in the future. But I do NOT believe that I can 100% guarantee that I or my loved ones won’t get sick if a severe pandemic emerges. Flu is much too contagious for that.

The die is already cast as to whether this particular flu strain goes pandemic and how much illness and death it might cause. We will know soon enough.

For more information on preparing for a possible pandemic, you can go through the checklists at pandemicflu.gov.

Related post: Swine Flu: Getting the Facts Right

Swine Flu: Getting the Facts Right

2009-04-27T08:22:00.011-04:00

Is it me—or has there been more uninformed reporting than usual over the past few days about the developing outbreak of human swine flu? Could it be the wholesale exodus of experienced health reporters from many newspapers and magazines is having an effect on the quality of coverage? Flu is not a topic that general assignment reporters can easily get up to speed on overnight.

I have read news reports cautioning people not to get near pigs for fear of contracting swine flu.

Not true. The new human swine flu is transmitted from person to person. So you minimize your risk of getting it by keeping your distance from other people, washing hands, reminding folks to cover their nose and mouth when they sneeze.

A number of news articles ominously report that the new human swine flu is H1N1—the same subtype as was responsible for the 1918 pandemic. The implication—that a terrifying type of flu has come back after more than 90 years.

Yes, the 1918 flu was caused by an H1N1 strain. But the H1N1 subtype is now very common. Indeed, it has caused many seasonal flu outbreaks over the past 90 years. The current vaccine even includes a strain of H1N1, first identified in Brisbane in 2007.

So if the new flu is H1N1 and H1N1 subtypes have been around for years, why are health officials so worried? Because the arrangement of genetic components of the new flu have never been seen before—whether in pigs or people. And they are different enough from the recent strains that the body’s immune system may not be able to mount a quickly effective response.

Many news sites are also reporting as fact that the flu is killing more people under the age of 60 than the usual seasonal flu. We don’t actually know this for sure.

Yes, there have been lots of reports of middle-aged people dying from the flu in Mexico. That’s worrisome because it’s the same pattern of fatalities that was seen in the 1918 pandemic. But that is only part of the story. There are other possible explanations for the pattern of middle-aged deaths: maybe those were the folks who went to the hospital first. Maybe health officials haven’t paid as close attention to deaths among the elderly because they are so much more common. It could still be a true cluster of middle-aged deaths but we probably won’t know that for at least another couple of weeks.

Lots of headlines are also proclaiming that countries are racing to “prevent the pandemic.” Sorry, that horse is out of the barn. This flu has already been confirmed in Mexico, the U.S., Canada and cases are suspected in New Zealand, Israel and Western Europe. If there is going to be a pandemic, there will be a pandemic. That will depend on how virulent the virus is—something that we don’t know yet.

What people can do is mitigate the damage. Sort of like a hurricane. You can’t stop it from coming ashore but you can try to protect as many people as possible from drowning.

In addition to newsfeeds at the Centers for Disease Control and the World Health Organization, here are some of the folks I have come to trust for information on the current flu outbreak:

Anything written by Helen Branswell, Canadian medical reporter. Her coverage of flu and the potential for pandemic flu over the past several years has been stellar. She is also @diseasegeek on Twitter.

Tara Smith at Aetiology. Tara is an assistant professor of epidemiology, whose research focuses on pathogens that jump from animals to humans. Very readable and very smart.

The Reveres at Effect Measure. Anonymous, opinionated but well-informed, from public health professionals.

Crof at H5N1. Crof has been a smart aggregator about avian flu and potential pandemic news for years but is now including human swine flu.

The pandemic flu section of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.

Good, if technical overview on swineflu, also at CIDRAP.

And here are some web resources to understand flu and potential flu pandemics better. I’m chasing down links to some other tools and will add them as I learn them.

One-stop access to US government information on pandemic flu

The Nieman Reports special issue on preparing to cover pandemic flu

Association of Health Care Journalists ($60 per year). Members have access on the website to excellent content created specifically for journalists covering flu. (Update: AHCJ has now made its flu resources freely available.)

The basic science section of the Flu Wiki

WHO's excellent guide to risk communications in a pandemic

General overview on pandemic flu, with history, by US government's Health and Human Services.

Related blog post: Swine Flu: Stocking Up On Soup, Just In Case
(Updated April 30, 2009)

Killing River Blindness and Malaria With the Same Drug

2009-04-24T08:20:00.003-04:00

Researchers ponder whether a common drug that kills parasitic worms (helminths) might also prevent mosquitoes from transmitting malaria. The work is more preliminary than most in the field of malaria research, so don’t expect it to save any lives any time soon—if ever. But it is an interesting application of the old adage about trying “to kill two birds with one stone.”

In anticipation of World Malaria Day (which is tomorrow), the Bill and Melinda Gates Foundation held its first telephone briefing for bloggers who cover global health.

There were three researchers on the line—each of whom had won a $100,000 grant to explore an idea for fighting malaria that was a little unorthodox or “out of the box.” These are part of the Grand Challenges Exploration grants that the Gates Foundation has championed in recent years. Depending on the results, grantees are eligible for $1 million grants to further prove their concepts.

I focused most of my attention on Brian Foy, an assistant professor at Colorado State University.

Foy, who has previously done some work on malaria vaccines, started thinking about the life cycle of the malaria parasite inside the mosquito as an under-explored route of attack. It takes 10 to 14 days for the malaria parasite to mature in a mosquito’s body--from the time a mosquito bites an infected person (what entomologists call “taking a blood meal”) to the time that same mosquito can transmit the parasite to a different person. “If you could just make one of those blood meals toxic to the mosquito, you would basically kill it before it could transmit the parasite,” Foy says.

Enter ivermectin, a drug that targets parasitic worms, like heartworms in dogs or the worms that cause river blindness in people in West Africa. Ivermectin works by targeting certain neurotransmission channels in worms. It turns out those same channels exist in other invertebrates like mosquitoes.

So the idea is to give ivermectin to people, who then pass the drug along with their blood to the mosquito that bites them. To be most effective, the drug should kill only those mosquitoes infected with the parasite before it has a chance to fully mature. As an added bonus, you minimize the risk of resistance because you’re not killing all the mosquitoes, just the infected ones, so there is no selection pressure against the mosquitoes—at least in theory.

So far, the evidence from the field is encouraging. Foy reported data from Senegal that showed that mosquitoes died for up to a week after ivermectin was given in an anti-river blindness campaign. Now he is trying to determine if the effect is large enough so that if you expanded ivermectin treatment you could actually change the transmission of malaria.

You see, ivermectin is normally given only once or twice a year for the treatment of river blindness. To have any effect on mosquitoes, you would probably have to give ivermectin once a month.

But this is just a pilot test—a chance to see if the idea is worth pursuing further.

You’re talking about four very complicated organisms—humans, mosquitoes, malaria parasites and helminths. In 2007, there was a research paper that suggested that infection with helminths actually made malaria symptoms less severe and that treating the parasitic worms could actually make a co-infection with malaria worse. (TW Mwangi, et al. Annals of Tropical Medical Parasitology.)

So for now, the idea that ivermectin could make a dent in both river blindness and malaria at the same time is still just an intriguing idea that is being tested further.

The other two presenters on the Gates telebriefing were Szabolcs Marka, assistant professor at Columbia University and Pradipsinh Rathod, professor at University of Washington.

Marka is looking at the possibility of using laser light to interfere with a mosquito’s ability to find and bite people. Rathod is trying to see if genetic differences between Plasmodium falciparum parasites found in Asia and those in Africa might help develop more effective treatments.

You can hear a recording of the full teleconference until April 30th by calling (800) 475-6701 and entering access code # 997326.

Full disclosure: my 2008 Nieman Fellowship in Global Health Reporting was supported by a grant from the Gates Foundation. I believe I have no conflict of interest in this story because the Gates Foundation did not play an active role in my choice of study or of my field project on nurses in Malawi.

More Thoughts on Schools, Hospitals and Health

2009-04-21T11:01:00.005-04:00

Yesterday's writeup of my notes about social determinants of health from the annual conference of the Association of Health Care Journalists focused a lot on the graphical sin of using circles (which tend to show equality) in an area where equality does not exist.

Just as important is the realization that when it comes to developing a recipe for promoting health, you cannot leave any of the important ingredients out--no matter if it is just a quarter of a teaspoon (a small amount) or a pound of something (a large amount).

So, while schools/general education may be more important than hospitals/health services in coming up with a recipe for promoting the overall health of a population, you cannot ignore the contribution of health services.

I was first introduced to this idea of how various factors relate to each other in David Bloom's class at the Harvard School of Public Health--although, being a health economist, he didn't talk about cooking and recipes. He talked about addition and multiplication.

More specifically, he told the class of future public health experts that they would eventually have to decide whether to think of health as a multiplicative process or an additive one. If additive, then the various factors that contribute to the health of a population (however you rank them) simply add up to whatever sum--and if one of those factors is zero, well, that's not fatal because the others will make up for it.

On the other hand, if achieving health is a multiplicative process, then any factor along the line whose value is zero ends up negating the whole effect.

As in 2 + 1 + 3 + 2 = 8

But 2 x 0 x 3 x 2 = 0

Changing a single one of the factors to zero negates the contribution of every other factor.

Schools Are Better than Hospitals for Improving Health

2009-04-20T16:24:00.020-04:00

Education, social support and early childhood development play a more important role in determining the overall health of a country’s population than the condition of their hospitals and other health services, according to researchers who look at the social determinants of health.

Oh what a difference a choice of graphic makes!

If you think about it for just five minutes, you know that it’s not just doctors, nurses, hospitals and pills that determine how healthy we are. Those critical health services are part of an entire constellation that includes our genetic makeup, personal choices, the physical environment we live in (to overstate the obvious, it’s hard to stay healthy in a war zone), our social support, educational level and socioeconomic status.

Here is the way that Canadian public health officials visualize all these factors on an official government website—as spokes coming off a central hub.

The hub-and-spoke diagram makes it seem as if all these factors are playing equal roles in determining how healthy a given population is.

But what if you ranked those factors in order of importance?

That’s what Michael Hayes of Simon Fraser University in Vancouver, Canada and Stephen Bezruchka of the University of Washington did in a panel discussion at the annual meeting of the Association of Health Care Journalists in Seattle on Saturday, April 18, 2009. (Search twitter for #ahcj09 to get some of the raw tweets published during the conference.)

Hayes and Bezruchka placed health services (the doctors-nurses-hospitals-clinics-medications part of the equation) at the absolute bottom of the list in importance. At the top of the list are social determinants, like education (particularly of mothers) and socioeconomic standing.

The whole list goes something like this, in order of importance:

Most Important
Social determinants of health (education, socioeconomic status, social support, etc)
Early childhood
Personal behavior
Physical Environment
Biology
Health Care Services
Least Important

This ordering of the list, which is based on 25 years worth of data, Hayes and Bezruchka said, leads to some startling conclusions. First off, we in the press focus far too much attention on health services (the docs, nurses, new treatments and medications) as opposed to education, crime rates, poverty when talking about health. Second, dollar for dollar, you would probably actually get a better health benefit investing disproportionately more in schools than in hospitals. And perhaps, third, Canadian public health officials need a new graphics team.

To develop that last point a little further. Don’t use circles when describing the factors that lead to health disparities. It makes everything seem equal. Use ranked lists that tell you what the most important factors are—provided, as always, you have the data to back it up.

What is still unclear to me is just how widespread the consensus is that social determinants of health are more important than health services in determining the overall health of any country’s citizens. (Chime in on comments below if you can enlighten us.)

I asked Hayes about consensus in a quick follow-up at the panel table prior to the start of the next session. He says there is consensus that there are social gradients to health and even what the major influences are but not on how they play out. One camp favors the psychosocial view: people who are optimists tend to be healthier and live longer than pessimists. The other camp is more materialist: poverty is key.

The point, Hayes said, is to link biology to social being. Then he gave a quick example. We tend to focus on the fact that smoking cigarettes is clearly a matter of personal choice, he said. But we ignore the role that advertising plays.

In my mind, I was thinking well, we haven’t really ignored advertising—I mean smoking was banned from television ads. But I guess there are still plenty of billboards, sports sponsorships, etc.

Earlier in the session, either Hayes or Bezruchka threw out the statement that the relative risk of dying from smoking in Japan is much lower than in the USA. And then strongly implied that social determinants of health (a better social safety net in Japan, more family support, etc) explained the difference.

It was a memorable line but begs to be checked out further. What are the absolute risks in both cases? (Even though I knew about the importance of absolute risk before I knew journalism professor Gary Schwitzer, I can hardly think of one without the other anymore.) What ways do smokers compare/differ in the US and Japan? (Seems like you would have to compare Japanese-American smokers to Japanese national smokers to be truly thorough.)

Later, I was reminded of a conversation I had had with a woman, who was a physician, who had developed tuberculosis. She would not have survived, she said, had it not been for her own mother and sisters, who kept her on track. They made sure she took her medications over the course of many months, even after the pills made her violently sick.

She knew intellectually that she had to continue her treatment but that was not enough to keep her alive. She needed the pills but that was not enough to keep her alive. Her knowledge, the pills and her family’s willingness to make sure she took them every day—even when she begged them not to—is what allowed her to survive.

For further reading on social determinants of health:
"Toward a Healthy Future"
The 1999 Canadian report that studied and quantified social determinants of behavior.

Bezruchka's webpage of resources on social factors in health inequalities (hat tip: @HoltzReport)

"Spreading the News: Social Determinants of Health Reportage in Canadian Daily Newspapers"
Hayes' own research into how much Canadian journalists are aware of the research on social determinants of health.

NB: This post is based on my writeup of my notes from AHCJ09.

Panel: "The healthy environment: it's not just medicine"
Panelist: Michael Hayes, Ph.D., associate dean, Faculty of Health Sciences, Simon Fraser University
Panelist: Stephen A. Bezruchka, M.D., senior lecturer, Department of Global Health, University of Washington
Moderator: Andrew Holtz, M.P.H., independent journalist, Portland, Ore.

These notes are as accurate as I can make them but if you use any of this for a published piece, you should be sure to do your own reporting to double check it--as I will if I write it up for formal publication.

I'll post other notes from the AHCJ conference as I write them up.

Update (4/21/09): Here are a few more thoughts on how to think about the non-medical factors related to health and how they relate to health services and each other.

MSF Challenges Nutriset on Plumpy'Nut

2009-04-10T14:26:00.003-04:00

Reading between the lines of Medecins Sans Frontiere's letter to Nutriset, it seems to me that MSF is losing patience with Nutriset on both the patent issue and apparent continuing shortages of Plumpy'Nut. Special thanks to @bloodandmilk and @markarnoldy for bringing this to my attention.

Hardly a week goes by without someone emailing me privately about Plumpy'Nut these days. One of the most recent suggested that the American Peanut Council was looking into the issue (I have not confirmed this yet). So now, in addition to the moral/philosophical/legal issue about whether Plumpy'Nut should have been patented or whether the patent would withstand a challenge is the commercial pressure that major agro-businesses might want in on the action.

Will post more as I learn more.

In the meantime, here is MSF's letter to Nutriset:

Mr. Lescanne
Director General
Nutriset
BP 35 – Le Bois Ricard
76 770 Malaunay
France

Geneva, March 24, 2009

Dear Mr. Lescanne,

I am writing to you to reaffirm the position of MSF’s Campaign for Access to Essential Medicines with respect to Nutriset’s policy on intellectual property pertaining to nutritional pastes and issues concerning the production and export of such nutritional products.

Nutriset has played, and continues to play, a major role in the development and production of products used in the battle against malnutrition, which have made a large contribution to recent developments in the handling of this pathology. A growing number of international agencies and donor countries recognize the important role of ready-to-use foods. This results in an exponential increase in the consumption of these products, which can create serious stresses in the supply chain, as was the case in the second quarter of 2008. It is becoming urgent to increase and diversify the capacity to produce nutritional pastes.

In fact, the success of treatment of malnutrition with ready-to-use foods is arousing increasing interest among producers. This is good news and offers an opportunity to support the emergence of capacity to produce these nutritional products, especially in the countries of the South. Such a development would also create the conditions for better availability and a possible reduction in their prices, which would facilitate their supply in regions of the countries affected.

Currently, Nutriset allows NGOs, as well as several manufacturers under Nutriset franchise, to produce ready-to-use foods. However, agreements of this type include restrictions and limitations that can discourage other producers. At a meeting held in Rome in March 2007 that brought together a number of international agencies working in the field of nutrition, Nutriset made a proposal addressing this problem. Nutriset contemplated granting licences to producers in the South for the manufacture and export of ready-to-use foods in return for the payment of a fair royalty in the countries where patents are in force, in parallel to its franchise system. This proposal could indeed stimulate production on a larger scale and help to lower prices. We regret that this offer was not effectively followed up on a large scale and ask that you make it public and post it on your website so that any interested producer might benefit from it.

For reasons that are obvious, the intellectual property pertaining to nutritional products of a humanitarian nature must be handled differently from that pertaining to commercial products. As you know, we believe that, in the humanitarian field of nutrition, patents should be filed only on an exceptional basis, and when they exist, licencing agreements should be offered to third parties on flexible terms and conditions, so as to ensure the widest possible availability of nutritional products of a humanitarian nature.

This is also important with respect to supplements of ready-to-use products, such as Plumpy’doz®, which was developed with the participation of Médecins Sans Frontières. If such a product were recommended for young children by providers of food aid, the needs could be exponential. The supplies required for the delivery of such nutritional products adapted to young children would only be possible in the long term through the diversification of supply.

MSF, as well as other agencies working in the battle against malnutrition, can no longer continue to depend on a single source of supply for ready-to-use products. The current position of Nutriset in this regard is a source of concern to some of these agencies, as it is to MSF. We therefore encourage Nutriset to play a key and innovative role in the management of its intellectual property by offering humanitarian licencing agreements for the production and export of ready-to-use products.

I look forward to your reply.

Yours sincerely,

Tido v. Schön-Angerer

Executive Director

Médecins Sans Frontières International

Campaign for Access to Essential Medicines

Malawi Nurses' Project on WBAI Radio

2009-04-10T13:59:00.003-04:00

Just finished a half-hour interview on WBAI radio about my three-month reporting trip to Malawi last year. The host was Diana Mason, a registered nurse and the editor-in-chief of the American Journal of Nursing. Will update the link to the archived audio file as soon as it is posted.

In addition to sharing what I learned in Malawi, I was also able to talk about the idea of creating a social network for independent global health news.

Brand Loyalty and Global Health

2009-04-08T12:50:00.006-04:00

I have long been a fan of The Pump Handle, a self-described "water cooler for the public health crowd," with special expertise in mining and occupational safety. They also post on plenty of other public health topics, of course.

Many of the contributers have some tie to the George Washington University School of Public Health--although from the beginning that has seemed more incidental than anything else. They certainly do not act or blog like traditional institution boosters. And, in fact, lately, I have noticed that they are expanding their list of contributors well beyond Georgetown to academics at Boston and Tufts Universities, as well as a few well-chosen advocates and even one anonymous blogger.

I think that move to reach beyond institutional borders is particularly innovative--or should I say counter-cultural? Even if it seems like an obviously good idea, it does not happen that enough. Usually, the conventional wisdom is that in order to "get your message out," you need to focus on branding in general, and institutional branding in particular. Everyone is so worried about sharing credit that they don't realize how little credibility single-institution venues actually have.

Gorman Talk on Health and Human Rights

2009-04-06T09:26:00.008-04:00

As promised, here is my talk on health and human rights, which I gave this past Friday at the GlobeMed Global Health Summit at Northwestern University in Evanston, Il. I met a lot of bright, enthusiastic students at the event and learned a thing or two myself. Thanks to Jon, Divya, Hannah, Victor and others for inviting me and organizing everything.

"Health and Human Rights: One Journalist’s Perspective"
By Christine Gorman

GlobeMed Global Health Summit
Keynote Address

Friday, April 3, 2009
Northwestern University
Evanston, Illinois

I would like to thank GlobeMed and the other sponsors at Northwestern University for inviting me to this Summit today. In keeping with the theme of the conference, I have taken as the title to my talk “Health and Human Rights: One Journalist’s Perspective.”

My talk today has three parts. I want to tell you a story, share some observations and finally issue a warning. The story comes from the 1980s, from the first few years of the AIDS epidemic in the United States. The observations are my own and the warning, yes, about the warning. Well, I’ll leave that to the end.

The story takes place in 1987. The two main characters are Archie Harrison, a 32-year-old gay man, and myself, a still fairly new, young health reporter for TIME Magazine.

First, I need to set the stage for you a bit.

In 1987, the AIDS epidemic was officially six years old. That summer, the government reported that 40,000 people in the U.S. had so far developed AIDS. And of those 40,000 people with AIDS, more than 23,000—or nearly 60%—had died.

We didn’t know it at the time but 1987 was the beginning of a turning point. The amount of stigma and panic that permeated the earliest days was beginning, just beginning, after extraordinary effort and struggle, to subside. President Reagan spoke publicly about AIDS for the first time, in a speech at a fund-raising dinner. The Food and Drug Administration approved a new drug—called AZT—that prolonged life for a while. But the price was incredibly high—about $8000 for a year’s supply of capsules.

Many people did not have insurance and could not otherwise afford the medication.

Here was hope—after so few years packed with far too many funerals. But it was hope that came at a price tag that put it well out of reach.

The rage was palpable. I attended the legendary meeting in Greenwich Village in which playwright Larry Kramer told the assembled room that two-thirds of them would be dead in five years if they didn’t “Act Up.” They quickly organized a die-in on Wall Street to protest the high prices. That was just the beginning. I sometimes wonder how much more they might have done with Twitter or SMS messages or even cell phones.

As part of TIME’s ongoing coverage of the news, I made contact with Archie Harrison, who was 32, and had just finished a clinical trial with AZT. Archie had responded well to the drug. Our first contact was on the telephone. I got the quote I needed for the article, but there was this extraordinary quality, this sense of connection that came through in our conversation.

I decided that I wanted to meet Archie in person and so I set up a follow-up interview.

We met in the home that Archie shared with his partner in the West 50s of Manhattan. There are some interviews, some conversations you have as a journalist that just stand out—and that you know you will take with you the rest of your life. My conversation that afternoon with Archie was one of them.

For a short while, the masks of politeness and self-protection and the pressure of everyday busyness that keep us separated from each other fell away, at least a little.

I had recently lost both my grandmothers, with whom I had been particularly close. People my own age were dying in unprecedented numbers around me in New York City. Having grown up in the Antibiotic Age, that wasn’t something that I had ever expected to happen.

Before I knew it, I was asking Archie an incredibly direct and admittedly naïve question. “What’s it like to know that you are going to die?” I asked.

He paused a second and must have decided that I was sincere. “I know I’m going to die,” he said. “Just as I know that you’re going to die.”

In truth, I don’t remember what he said right after that because I was so surprised.

“What? I’m going to die? But I don’t have AIDS. How can you say that I am going to die?” Honest to goodness, although it embarrasses me to admit it, those were the first thoughts racing through my head.

Did I mention that I was very young?

But you see what Archie did—don’t you? He drew a circle that included me. He didn’t let me forget that we share the same human condition—a condition that includes illness and death.

I had asked Archie a very specific question—about his own mortality—and he answered with a deeper truth, one that was universal.

I had asked a question that assumed—without my even being aware of it—that we lived in two different circles. And he gave me an answer that showed me where the boundaries really stood.

That is where I believe we must look for the connection between health and human rights. In that bedrock of our common humanity.

And yet, so often, the language and the arguments that I hear about health as a human right sound to my ear as if they are not about the common human condition at all. Too often the arguments smack of noblesse oblige. That the human right to basic health care is something that one group with an abundance of rights is willing to bestow on the poor and the lame. Not because they are equal but precisely because they are different.

This may seem like a subtle point but we ignore it at our own peril.

A hundred years ago, Christian missionaries spread across the globe to bring the “Good News” to the heathen masses. They knew that what they were doing was right—just as those who believe in health as a human right are convinced that their cause is just.

You have got to admit, something in us—at least some of us—needs to save the world.

But until we get it, until we get that it is we ourselves who are the ones who need those rights, I think we are likely to miss the boat and compromise the dream.

Have you ever noticed how often the talk of human rights sounds like preaching to the converted? Even the language, the phrase—“human rights”—depends on an international legal framework that may resonate in the groves of academia or NGO-land but that, quite frankly, doesn’t motivate most of the world.

I say this not to stop the conversation but to broaden it.

How do you translate the goals of universal access to health care in language that resonates with everyone from the ordinary Muslim laborer to the anti-abortion activist to the libertarian atheist?

Doesn’t this demand many phrases and many languages and many partners in conversation—particularly among those who are not yet convinced?

When I was looking over the list of participants at the GlobeMed Summit, I was glad to see a few representatives from the religious world—namely the Reverend Dan Dale of Wellington Avenue United Church of Christ and John Neafsey, a clinical psychologist and senior lecturer in the department of theology at Loyola. It is probably not that hard for most human rights activists to find common points of understanding with Dale’s and Neafsy’s social justice theology.

But I challenge you to find and make contact as well with those thinkers and believers of a more conservative brand of religion—such as those Christians whose focus on sin and opposition to condoms so often drive the rest of us to distraction.

Make sure you use language and engage in conversations that allow you to cast a wide net. Reach out to folks who are more genuinely motivated by an appeal to the Bible, the Koran or the Hindu examples of Rama and Sita than to the Universal Declaration of Human Rights.

Yes, there is a risk of unsatisfactory compromises and visions diluted by weak coalitions. Yes, you will find people who are not at all interested in engaging in conversation, only in shutting you down.

But if you don’t discover that circle in which you and the other both exist, then health as a human right becomes just another pretty ideal that you can feel really good about holding but that doesn’t make a difference in the lives of real people.

Finally, don’t be so GLOBAL in your focus on GLOBAL HEALTH that you lose sight of what is going on here in the U.S.

For decades, access to health care in the U.S. has been a group privilege—won by right of hard work and a prosperous employer. Follow the rules and you will reap the benefits. And, after all, don’t we deserve those rewards?

But the bargain is changing—isn’t it? Hard work and a college degree are no longer guarantees.

That has opened a few more eyes. It has taken the incredible cataclysmic forces of our current financial crisis to draw the circle wider, to see that we can no longer maintain our distance. Much to our surprise, we’re there, too, inside a desperate circle.

The upheaval has not yet been great enough for the majority of the middle class to throw in its lot with the poor, but, who knows, that may yet occur. People in a position to change the system don’t really think about doing so until the system stops working for them.

So much for the story and for my observations.

Now for the warning. For years, global health visionaries like Jim Kim and Paul Farmer have talked about AIDS as the wedge issue—the tool for mobilizing people from all walks of life around access to healthcare.

As a wedge issue, AIDS works better than some others—like malaria—because it crosses so many economic lines. You don’t have to work so hard at drawing the circle—at getting people to see themselves in the circle.

But I fear that window of opportunity is drawing to a close. As AIDS increasingly becomes a disease of the poor, its power to rally people from all walks of life around access to health care diminishes.

It’s human nature. Once I get my treatment, then I’m not in the same boat as you are. Once my husband, brother, lover, wife, sister, mother, father, son, daughter, best friend gets treatment, the lines of the circle begin to disappear.

If you don’t believe me, just think for a bit about tuberculosis. For centuries it afflicted rich and poor alike—okay maybe more poor people than rich ones. But still it afflicted enough folks in the corridors of power to finance the many sanitoria of Switzerland.

And then along comes streptomycin, which--along with better food and living conditions--does such a wonderful job that the sanitoria have to convert themselves into ski resorts or risk going out of business altogether.

In just a few decades tuberculosis becomes so completely identified with the poor that there is no market pressure to develop new medications beyond the first handful that scored the greatest success—albeit over a treatment course of many months.

No one now would ever think of using TB—or the fear of TB or sympathy about TB—as the wedge issue for folks from all walks of life to rally around access to effective health care.

How much longer until our perceptions of AIDS fall into the same pattern? It was recently reported that 3% of the residents of Washington, D.C. have HIV--a rate that is now higher than New York City's or San Francisco's. Yes, there was news coverage of the study but not to the extent there would have been 20 years ago.

So, that’s my warning: as wedge issues go, AIDS may have opened the door, but it cannot keep the door open forever.

The struggle to recognize health as a human right is about what is fair in a world that is demonstrably unfair, in which progress is never guaranteed and even the best of intentions can, and far too regularly actually do, prove harmful.

And yet . . . and yet . . . the words of the late Jonathan Mann, which you have quoted in the conference schedule, still ring true. Mann said, and I quote, “People say there is no use trying to change the world. But if we don’t try, will it change?”

Thank you very much.

GlobeMed Summit in Chicago

2009-04-02T06:02:00.003-04:00

On my way to the 2009 GlobeMed Global Health Summit in Chicago, where I will be giving one of two keynote speeches. (The other one is being given by Stephen Lewis, the former UN special envoy for HIV/AIDS in Africa.)

The title for my talk is "Health and Human Rights: One Journalist's Perspective" and I will post it on the blog after I give it on Friday evening.

Wanted: A Social Network for Global Health News

2009-03-12T07:42:00.012-04:00

Towards building a social network for real global health news on the cheap.

The promise: the Web allows anyone to have a voice.

The reality: the Web is actually narrowing the bounds of conversation. We’re recreating in the digital world the same categories and divisions that exist in the real world—only stronger. (See James Evans' recent analysis in Science for supporting evidence in scientific publishing online. On a related note, check out this study about "the winner's curse.")

Case in point: global health news coverage. This topic always falls between the cracks in the mainstream press—somewhere between “world news” and “health news.” Those offline categories are simply getting stronger in the online world. News categories are not yet miscellaneous enough, as David Weinberger describes.

In my experience, most global health news is actually promotional, not journalistic in nature.

A possible solution and the reason for this message: organizing the folks who are already writing about global health news online for free. Note: this is not going to pay anybody’s bills but since we are doing it anyway (as a way of keeping online notes for a book, learning, self-promotion, etc.), why not make it as powerful as it can be?

Some background: the fact that we were able to cover global health news at all was a happy result of the inefficiencies in the advertising model that financed most of the news business until very recently. Yes, most of the health advertising in TIME Magazine, for example, came from pharmaceutical companies but the firewall between edit and the publishing side, my own interests and those of several colleagues plus the fact that drug companies were okay with the fact that their ads reached both people who wanted their medications as well as those who did not, allowed us to write about global health and other less obviously remunerative articles. Keyword-based advertising has changed all that but that’s a topic for another post. (See Ethan Zuckerman for a really clear introduction to the value of advertising inefficiency, especially the part about how Bloomingdales underwrites the New York Time's Africa coverage)

After spending a lot of time thinking about this and talking to lots of people, I’m starting to accept that foundations are NOT going to pay for global health news coverage. And there probably is not a very good business model for it either. Oh yes, certain sections will get peeled off—anything having to do with mobile phones, pharmaceuticals or risk management. Plenty of opportunities for targeted advertising, subscriptions or commercial contracts there.

But the same market failures that have hobbled the development of new TB drugs over the past 50 years also affect the production and coverage of in-depth global health news.

Note, I am not talking about creating an educational service—like Kaiser’s globalhealthreporting.org. Nor am I envisioning a PR newswire for global health—like globalhealthtv.com (which was developed by a PR company for the Global Health Council).

Both are necessary but not sufficient to what I would like to see, which is an independent editorial voice in global health news.

The news industry as we know it is undergoing radical transformation. It is too busy focusing on survival to care what happens to global health news. The Knight Foundation and others are focusing on local community news and investigative journalism. The foundations that fund global health are taking some baby steps—like the Gates Foundation funding NPR, PRI and the Jim Lehrer show—but they won’t do something bigger, I think, because they don’t want to give up control of the message.

So that leaves the people who are doing it for little or no money, out of passion or as an adjunct to other paying projects. (Heaven help us.)

Meanwhile, how do we get the values, the best of what we aspire to as journalists, as global citizens, baked into whatever the new systems are? I'm going to try buttonholing as many of my fellow participants at the meeting of the Association of Health Care Journalists in Seattle April 16-19 about this as I can. This is not something anyone can do on their own. But is there a critical mass willing to try? That's what I would like to know.

I welcome your thoughts.

Related posts:
Sharing and Global Health Blogging
Update on the Global Health Blogging Experiment
Community Organizing Meets Global Health Blogging
Looking for Context in Global Health Reporting

Can You Improve Wikipedia's Entry on Global Health?

2009-03-06T06:06:00.001-05:00

After 27 months, Wikipedia's entry on "global health" is finally starting to take shape. I look at this as yet another lesson on the need to wait for (or build) a critical mass.

Not all conversations on the Web happen so fast and include so many partners that it makes your head spin. Some are so long and laborious that you might think the participants were Treebeard and the rest of Tolkien's Ents. Case in point: the 27-month long conversation behind Wikipedia's entry on "global health."

Back in June of 2005, a volunteer Wikipedia editor who went by the name "Drgregmartin" wrote a short entry on Wikipedia about "global health." A few months later, I came along and did a little copy-editing, added some historical context and a few external links.

By the fall of 2006, this short, not-great entry had morphed into something completely overgrown and unreadable. A number of anonymous users from several universities clearly decided to do a little self-promotion while others added several giant tangents or pet peeves. Eventually, the entry got flagged as "needing clean up."

So far, I have described the natural history of countless Wikipedia entries. An earnest soul writes a short piece, others discover it and soon so many editors have a hand in it that it morphs into something that is far worse than whatever it started off as. In the best circumstances, this chaotic phase settles down and editing becomes much more stable--and the writing and the rigor improve.

Trying to be a good Wikipedian, I started a conversation on the global_health talk page about how to fix the entry and get to the next, more stable phase of Wiki writing. My proposal was met with deafening silence.

Meanwhile, the entry was getting longer and less readable. I contemplated fixing things myself but figured I would be out-revised by the self-promoters. Every once in a while I would come back to check on things. The entry kept getting woolier and woolier. I chalked it up as a reality-check on how Wikipedia works: popular articles are more likely to be better.

But, every now and then, someone would add a comment on the talk page. In more than two years, there have in fact been seven responses--all fairly substantial. And here's the most intriguing thing: they actually can be read as a conversation with genuine give and take.

Gradually, a Wikipedian by the name of Useknowledge came along and edited the entry back to a form that is more manageable.

It is still not perfect, but it is an improvement over the original post. The next step, as someone who may be Evelyne de Leeuw from Australia wrote, is to try to make the focus more health-oriented and less disease-oriented.

So, what do you think? Will a community arise organically to do this or is going to take concerted effort by a few people to create that community?

Some of the more utopian aspects of the web have enchanted many of us into giving credence to an "if you build it, they will come" mindset.

For me, the history of the "global health" entry on Wikipedia so far shows the limitations of that ideal (especially since already there is a new, more sophisticated round of self-promotion happening with external links to a number of academic centers). But I was heartened by the improvements that did happen. I suspect, however, that I may need the lifespan of an Ent to see the full flowering of the global health entry.

Or you could prove me wrong by taking a crack at en.wikipedia.org/wiki/Global_health.

Links: Hidden Good News, Plumpy'Nut, Malaria

2009-03-05T08:10:00.006-05:00

Nigerian sisters tell of African good news odyssey
The BBC reports that "Nigerian sisters, Chioma and Oluchi Ogwuegbu, have got fed up with all the bad news out of Africa. So much so that they've embarked on a journey right across Africa to try to draw attention to the good news which doesn't get reported." Go to the Ogwuegbu sisters' website at celebrateafrica.net

Paul Farmer mocks Nutriset patent on Plumpy'Nut
Ha! Farmer told me the same story a year and a half ago. It's the anecdote that got me looking into intellectual property rights and ready-to-use therapeutic foods (RUTFs). According to the Charlotte Observer's account of a recent Farmer talk, "when Partners in Health built a factory and began making its own peanut butter product, Farmer said he got "cease and desist” letters from the makers of Plumpy'nut. “It sounds crazy to argue over peanut butter,” he said. “But patenting some things goes a little too far.” " See my previous Plumpy'Nut posts for more background.

WHO cracks down on new malaria resistance
Scidev.net reports that the World Health Organization "has confirmed resistance to the malaria drug artemisinin at the Thai-Cambodia border, prompting urgent action."

Jim Kim Goes to Dartmouth

2009-03-03T08:31:00.004-05:00

Like others in the global health community, I was surprised to learn Jim Kim is going to be the new president of Dartmouth College. But now an email exchange Jim and I had back in January makes more sense. I was reading it as his thinking through the pros and cons of taking a position in the Obama Administration, if asked. I should have read it as an indication that he was even considering leaving Harvard at all.

Kim clearly sees this as a chance to broaden the reach and influence of the global health movement. He told Tamar Lewin of the New York Times, ". . . what I want to do is train an army of leaders to engage with the problems of the world, who will believe the possibilities are limitless, that there’s nothing they can’t do. Being the president of an Ivy League university is an amazing opportunity.” Kim reiterated that view in his first address to Dartmouth.

But as Alanna Shaikh points out, there is a lot about being a college president that has nothing to do with energizing global movements--especially in an era of global financial turmoil and falling endowments.

Speculation alert: You also have to wonder if the Harvard School of Public Health had become too crowded for Kim--now that it has a new dean, Julio Frenck, the very impressive former health minister of Mexico and a onetime candidate to head the World Health Organization. Was the deanship a position Kim had wanted for himself?

Wonder now what will become of Kim's partnership with Michael Porter at the Harvard Business School. Kim was very enthusiastic about applying some of the tools that business has developed to the challenges of implementation in global health.

Nothing yet about the new appointment on the Partners in Health website. Had to smile at the way Lewin described Kim's career as having been "entwined" with that of Paul Farmer. It has been an incredibly productive partnership with twinges of sibling rivalry at times.

Anyway, it will be interesting to see whether Jim Kim turns the presidency of Dartmouth into a bully pulpit for global health.

Don’t Bury Failures. Share Them

2009-02-23T08:41:00.018-05:00

Computer science students from the U.S. and Senegal designed a mobile phone application especially for fisherwomen in Senegal and yet, the Senegalese women could not use it because of a single flawed assumption.

I promised myself I would share at least one story from the MobileTech for Social Change Barcamp I attended at Hunter College in New York City on Saturday (Feb. 21, 2008). Barcamp, for those who may not know, is an approach to organizing and running conferences that tries to capture the hidden value of most meetings—the conversations that happen between sessions in the hallways—and bring it front and center. Barcamps are also supposed to be free, or nearly so, for participants to attend.

A computer science group from the State University of New York at Stonybrook presented three applications or “apps,” that is to say mini-computer programs, that they had designed for use on no-frills mobile phones owned by women working in the informal Senegalese economy. The pilot tests for two of the apps—a dictionary and a book-keeping calculator—were deemed successes. The third app—for measuring profit and loss—was judged a failure.

Since most people—myself included—don’t like to publish their failures, I was impressed by the Stonybrook group’s willingness to do so. Indeed, they were almost as enthusiastic about the failure as the two successes. “You often learn more from failure than success,” says Jennifer Wong, one of the two Stonybrook professors who, along with two students, came to present their findings. Sure, we all say it. But who really embraces the idea? Brava!

The National Collegiate Inventors and Innovators Alliance is giving the Stonybrook group and its co-investigators at Pace University and Thies Univeristy nearly $50,000 over two years to design mobile phone apps for use in the informal Senegalese economy.

What the mobile app group did right: they built local capacity. They recruited 20 Senegalese computer science students and taught a one-week crash course in Senegal on how to write and load mobile phone applications. These students in turn interviewed the local fisherwomen in Wolof (one of Senegal’s most common local languages) to customize the profit-and-loss application for their phones.

The fisherwomen are actually fish sellers. They buy fresh fish and then dry it to sell on the market. The women often sell the dried fish at a loss, which is why a simple profit-and-loss calculator on their mobile phones might help them decide when and at what price to buy the fresh fish so they could come out ahead.

The pilot was a failure because the fish sellers found the mobile phone profit-and-loss calculator useless. The computer science group did not learn why the app was useless, however, until a second round of testing in which one of the Senegalese computer science students happened to have a grandmother who was a fish seller. After talking with the fish sellers, he discovered that all the prices for both fresh fish and dried fish are fixed. Since everyone charges the same price for fish (one for dried, the other for fresh) on any given day, there is no way for the women to wait until the price is right.

One wonders why anyone would sell dried fish at all under these conditions? There is bound to be more to this story. Please enlighten us if you can, using the comments section.

Lesson learned: you have to be very specific when seeking local expertise.

Another way of looking at it: just because something looks to you like irrational economic behavior doesn't necessarily mean that it is, or that you know why it is irrational.

To find out more about applications for mobile phones in the informal economy, contact Anita Wasilewska or Jennifer Wong at SUNY Stonybrook or Christelle Scharff at Pace University in New York City or Prof. Ibrahima Ndiaye, Director of the Economic and Social Sciences Education and Research Unit, Thiès University, Senegal. See also their wiki about mobile apps in Senegal.

To learn more about what else went on at MobileTech For Social Change (New York):

• Search for #m4change on Twitter from 2/21/09 to about 2/23/09
• Read the Morningside Post stories once they come online
• Read Patrick Meier’s summary post on iRevolution
• Check out some #m4change photos on Flickr (cool search for events after 20090201)
• Read Persephone Miel at Media Re:public on why mobiles are not the future; they are right now.

(updated on 2/24/2009 to add Christelle Scharf and Ibrahima Ndiaye and Pace and Thies Universities.)

Looking for Context in Global Health Reporting

2009-02-18T08:43:00.005-05:00

To me, the most satisfying news stories are the ones that provide a context that continues to inform long after the news has turned old. That kind of deeper context is often what I look for in global health stories but do not usually find. Something to think about if you are hoping to improve the routine coverage of global health news.

I am thinking about this now for several reasons. Sharon Schmickle’s amazing article today in the Washington Post on the growing global threat of wheat rust—she provides plenty of context—finally got me to write these thoughts down.

When Josh Benton of the Nieman Foundation was in New York a couple weeks ago, we had a long chat about what constitutes context in news stories. (That's the kind of stuff we enjoy talking about.) He told me about Matt Johnson’s project at the University of Missouri’s Reynolds Journalism Institute.

As I understand it, Matt’s key insight came when he read decades worth of stories about commercial development in and around Columbia, Missouri. He realized he didn’t feel any better informed about the major factors, developers and politicians involved after reading one or 100 stories. Each story had to be taken on its own—separate from the others. The long-term context did not emerge from reading all those stories. It was all information overload with no meaning.

Johnson’s project is to see if there is a way to make that context more explicit, so that each news item about development either contributes to the context or benefits from it. What Matt Johnson says about the search for more context in the news makes a lot of sense to me.

In January, Jeb Sharp of PRI’s The World launched a new history podcast called “How We Got Here.” It looks at the history that continues to shape current events. Her inaugural piece was about Iran—because of all the talk about the incoming Obama Administration’s possible diplomatic outreach to that country.

But Sharp’s reporting on the three weeks in 1953 in which CIA agent Kermit Roosevelt nearly single-handedly engineered a coup in Iran provided some of the missing context that I was looking for in an entirely different story. Namely, it helped me understand a little better why the Iranian government recently tried and convicted a pair of Iranian AIDS doctors for conspiring to foment a “velvet revolution” by attending international medical conferences.

Earlier this month, Ethan Zuckerman, co-founder of Global Voices, wrote a very good piece that provides the missing context around the recent unrest in Madagascar. I have actually been following this in the news—in the New York Times and on the web. But nothing explained WHY this was happening NOW in the way that Ethan’s blog post did.

It makes me think of David Pogue’s Missing Manuals enterprise. You know, computer software doesn’t ship with printed instructional material any more. You have to either go online or screen through an electronic manual. But a lot of us still find a book a useful way to organize information—to get the broader view. So when software companies stopped supplying physical manuals, Pogue stepped into the gap with his Missing Manual series.

Supplying the missing context turned out to be a good business model for Pogue. Makes me wonder if that case is transferable to reporting about global health?

What's New in Health and Human Rights?

2009-02-13T06:04:00.003-05:00

I am giving one of two keynote speeches at the 2009 GlobeMed Global Health Summit in Chicago April 2-4. The theme for the gathering is "From Idea to Implementation: Securing Health as a Human Right," so I chose as the working title for my talk "Health and Human Rights: A Journalist's Perspective."

Kind of as a lark, I threw that phrase "Health and Human Rights: A Journalist's Perspective" into a Google search and much to my surprise got an exact hit. Television producer Rory O'Conner chose that as the title for a blog post that has some vintage video of the late Jonathan Mann talking about health and human rights.

So I changed my working title to "Health and Human Rights: One Journalist's Perspective," which isn't much of a distinction I admit. I also watched the interviews with Mann and others. They have held up quite well--even after ten years.

And they remind me how much AIDS, like the Holocaust before it, has taught us about human rights.

Update on the Global Health Blogging Experiment

2009-01-30T11:26:00.006-05:00

Thank you to all who participated in our little "global health blogging experiment." Nine posts on "prevention vs. treatment" were published--out of an expected 12. Respectable numbers for an all-volunteer effort.

I do not have much time to write today, alas, but wanted to leave you with at least one thought. I was particularly intrigued that Liz Borkowski pointed us to a larger story--the gradual abandonment of anti-tobacco/anti-smoking programs in the U.S. That's the kind of piece--big and slow-moving--that can be very hard to get a grip on in the traditional media. And precisely the sort of thing that can thrive on the web.

An example comes to mind from well outside the global health sphere--how the folks at Talking Points Memo aggregated their own reporting with that of disparate professional journalists to tell the story of the number of US attorneys who had been fired under the Bush Administration for not toeing the line politically. (The TPM, incidentally, also won a George Polk Award for Journalism for its work.)

Anyway, I hope folks look at the other entries and post their own responses/analyses/constructive critiques. So, without further ado, here are the other global health posts on "prevention vs. treatment."

Healthtwine: Prevention vs. Treatment
On why "we tend to value current health more than future health."

Superbug: Prevention v. treatment (1st Global Health Blog Carnival!)
On the need for a vaccine against methicillin resistant staph aureus.

Perspectives: Prevention vs. Treatment
On why prevention vs. treatment is the wrong way to think about drug resistance to malaria.

Karen Grepin's Blog: Prevention vs. Treament in HIV: Have we given prevention a chance to shine?
Proving prevention works is a lot harder than you might think. Maybe that is another reason why there are so few studies on the effectiveness of prevention.

The Pump Handle: For Whom Prevention Pays
On one of the bigger, overlooked stories of public health in the U.S.--the faltering anti-tobacco struggle, another victim of the economic crisis.

HIV Information for Myanmar: Two Quotes from Bogyoke
A few words on the greater good from the late Bogyoke (General) Aung San, who led the fight for Burmese independence after World War II.

Health Reform Watch: Health Care, "Common Sense" and a Global Health Blogging Experiment
A bit off-topic and somewhat rambling (the French revolution?), but a look at whether concerns over health reform in the U.S. will crowd out discussion of global health.

Global Health at Change.org: Prevention vs. Treatment--an Eternal Debate?
On why good decisions in public health "are about balance, and looking for long-term systemic solutions instead of the quick fix."

And from a public relations perspective:

Ruder Finn's DotOrg (U.K.): The Lazarus Effect
Lucy asks "Are there are any differences between ’selling-in’ stories that have a prevention angle over those that emphasise treatment."

Prevention vs. Treatment: A False Choice

2009-01-29T08:08:00.016-05:00

The long-running debate over the relative importance of prevention or treatment is the theme that at least a dozen global health bloggers are exploring today. In many ways, the debate represents a false choice; a well-functioning health system requires both prevention and treatment. But how do you strike the right balance? Is the measuring stick simply the one provided by economics? Or do equity and fairness also play a role?

“An ounce of prevention is worth a pound of cure,” or so the old saying goes. But we don’t always practice what our folk wisdom preaches.

The U.S. medical system, as currently set up, rewards cardiac surgeons at a much greater rate than it does programs for avoiding weight gain or controlling high blood pressure.

About 5% or less of the U.S. budget on health care is spent on prevention, according to Don Wright of the U.S. Department of Health and Human Services. Most of the rest is spent on treatment—and, I would venture to guess, paper work.

And yet, you can bet that if I ever experience a gripping pain in my chest or back, accompanied by nausea and perhaps an overwhelming sense of anxiety—classic signs of a heart attack in women—I am going to get myself to an emergency room right away to get treated and be mighty thankful if the specialists at the cardiac catheterization lab can open up any blocked arteries.

The year I spent at Harvard taught me a lot about how academics argue the prevention vs. treatment debate. Indeed, just a few years ago there was that rare thing in public health—a big public debate between some folks at the Gates Foundation on one side and some at Harvard on the other about whether prevention or treatment was the better—read more “cost-effective”—approach to tackling HIV/AIDS in sub-Saharan Africa. Eventually the Harvard side won the argument—especially once the cost of anti-retroviral therapy dropped dramatically. What made the difference was the fairness issue: How could you withhold treatment when so many were dying?

A few months in rural Malawi gave me a whole other perspective. There I learned that tremendous strides have been made in decreasing maternal death rates at the Embangweni Mission Hospital through a variety of efforts—not least of which was an emphasis on both prevention and treatment.

It did not happen by accident and it did not happen overnight. When the effort began, several years ago, there was only a single sink in the labor and delivery room. So improving the physical plant was a priority in terms of providing better treatment. Embangweni Hospital also worked really hard to get the right people in the ward—namely more nurses and clinical officers—and keep up their training. Alas, hard experience also taught them they had to make the ward off-limits to many of the grandmothers or “gogos,” who would slip their daughters and daughters-in-law a powerful herbal concoction to induce labor but that also increased the risk of potentially fatal uterine rupture.

On the prevention side, community health nurses have been working throughout the South Mzimbe region for the past ten years to provide prenatal care to pregnant women. To give just one example, the community health workers I met, like Joyce Ngoma and Tamala Chirwa, work hard to identify women who may have trouble delivering—because they are carrying twins or the fetus is not positioned properly. The nurses advise those women to go to the hospital early so that they can be watched more closely and scheduled for a caesarean operation, if need be.

Each side—prevention and treatment—benefits from the other. With fewer pregnant women showing up at the hospital in crisis, the clinical officers and nurses there are able to save more mothers' lives. The nurses in the field can see that their efforts have saved lives and are encouraged to do more prevention work.

Today's posts on Prevention vs. Treatment from other global health blogs (as I learn of them):

Healthtwine: Prevention vs. Treatment
On why "we tend to value current health more than future health."

Superbug: Prevention v. treatment (1st Global Health Blog Carnival!)
On the need for a vaccine against methicillin resistant staph aureus.

Perspectives: Prevention vs. Treatment
On why prevention vs. treatment is the wrong way to think about drug resistance to malaria.

Karen Grepin's Blog: Prevention vs. Treament in HIV: Have we given prevention a chance to shine?
Proving prevention works is a lot harder than you might think. Maybe that is another reason why there are so few studies on the effectiveness of prevention.

The Pump Handle: For Whom Prevention Pays
On one of the bigger, overlooked stories of public health in the U.S.--the faltering anti-tobacco struggle, another victim of the economic crisis.

HIV Information for Myanmar: Two Quotes from Bogyoke
A few words on the greater good from the late Bogyoke (General) Aung San, who led the fight for Burmese independence after World War II.

Health Reform Watch: Health Care, "Common Sense" and a Global Health Blogging Experiment
A bit off-topic and somewhat rambling (the French revolution?), but a look at whether concerns over health reform in the U.S. will crowd out discussion of global health.

Global Health at Change.org: Prevention vs. Treatment--an Eternal Debate?
On why good decisions in public health "are about balance, and looking for long-term systemic solutions instead of the quick fix."

And from a public relations perspective:

Ruder Finn's DotOrg (U.K.): The Lazarus Effect
Lucy asks "Are there are any differences between ’selling-in’ stories that have a prevention angle over those that emphasise treatment."

Community Organizing Meets Global Health Blogging

2009-01-27T09:24:00.008-05:00

Towards building a social network around global health news.

At least a dozen global health bloggers have publicly said they will be posting on the broad theme of "prevention vs. treatment" this Thursday, January 29, 2009. (Feel free to join in!) This is part of an experiment that grew out of a Twitter conversation to see if we can coordinate posts in a kind of "global health blog carnival" to increase awareness of global health issues. I'll be posting about my experience in Malawi and reflecting on whether the prevention vs. treatment debate is really a false choice.

But there are some larger questions here that I would like to explore: Is a social network around global health news starting to emerge organically on the web? What can we do to nurture it? Do economic realities dictate that this will have to be a volunteer led endeavor, at least for a while?

Or, another way of putting that last question: Is news about global health subject to the same market failures that afflict products for global health (e.g. free-market forces alone will not lead to new tuberculosis medications and other drugs that affect mostly the poorest people in the world)?

Some preliminary thoughts on the first question: Is a social network around global health news starting to emerge organically on the web?

Although blogging has been around for a while, we haven't really had the critical mass of bloggers interested in global health issues until recently.

International news coverage has suffered terribly in the retrenchment affecting the journalism industry. There are efforts to do something about that. The Gates Foundation is funding more coverage of global health issues at National Public Radio, Public Radio International and on television's The NewsHour with Jim Lehrer. The new kid on the block is Global Post, which I am happy to say, has a global health correspondent in South Africa. And let's not forget Global Voices Online, whose international health reporting is growing.

The British newspaper The Guardian is partnering with AMREF, an NGO dedicated to medical relief in Africa, to report development news from the Ugandan village of Katine. (See Laura Oliver's post on a UK journalism blog for news on the project's growing pains. Larry Hollon also has thoughts at Perspectives.)

I suspect we have only scratched the surface. In my view, a true social network for global health news would go far beyond encouraging comments, cross-linking, blog carnivals and re-tweeting. But those are the first steps.

Note to self and others: the news innovation barcamp for entrepreneurial journalists at the University of Missouri last week may give us some ideas for how to share ideas, organize efforts. They have created an online site for collaboration among groups of like-minded people (journalists and non-journalists) who want to explore new ideas for news coverage but have low or no budgets for experimentation.

Links: Journalism, Development, Antibiotic Resistance

2009-01-26T08:51:00.008-05:00

Two important news items that should be getting more attention. The first is on a "midnight rule" change from the former Bush Administration that is just coming to light. The other is on a unique partnership between a journalistic outfit and a global development organization.

Well, this is bad news
Maryn McKenna tells us "the FDA has quietly reversed a decision it took last summer, and will allow cephalosporins, a human medicine, to be used without restriction in food animals." McKenna takes the time to put the news in context and add some of her own reporting--good journalistic habits. About that headline . . .

Media and Development
Excellent post from Larry Hollon at Perspectives about an "agreement between the African Medical and Research Foundation (AMREF) and the Guardian, the London-based daily newspaper, to document a development program in Katine, Uganda." I was most struck by Larry's concise summary of the high expectations and journalistic conflicts that accompany such projects.

Links: Ebola, Toilets and Corruption, Iodized Salt

2009-01-23T08:29:00.006-05:00

Filipino tests positive for Ebola
From Reuters in Manila: "At least one person has tested positive for the Ebola-Reston virus in the Philippines, where the disease has broken out in pigs at two farms north of the capital, the government said on Friday."

Are Working Toilets A Good Anti-Corruption Indicator?
From the BBC's Mark Doyle: Reading official reports about corruption can be so boring. Doyle's lighthearted look at whether working toilets indicate progress against corruption in Sierra Leone.

The Challenge of Iodized Salt
From Alanna Shaikh, who just moved to ~~Uzbekistan~~ Tajikistan: A quick look at why it is so hard to make iodized salt universally available.

Broken Links at DotGov Sites

2009-01-22T10:33:00.007-05:00

Are broken web links at U.S. government sites going to be a feature of all future changes in Administration? I'm having trouble finding some of the links I had saved on a couple of global health issues from official U.S. government sites. Shouldn't we have some web continuity between Bush and Obama Administrations?

I can no longer get at a press release about human rights from Dec. 10, 2008 that was on the whitehouse.gov site. I get redirected to the Obama briefing room, not even a "page has been moved" message. Very Ministry of Truth.

Yesterday, Maryn McKenna found a broken link to whitehouse.gov that used to tell about the President's Malaria Initiative. No refer pages to where the pages are archived (although the Malaria Initiative itself is still available at fightingmalaria.gov).

I thought, okay, that is the White House--a very political place. But then in writing up my post about the Iranian AIDS doctors who were just sentenced to prison terms for trying to foment a velvet revolution via international HIV meetings (you can't make this stuff up, unfortunately), I realized that a link to an official statement from U.S. State department about the Alaei case was broken. The error message read "We're sorry. That page can't be found and may have been moved."

Since the statement was made by the Bush Administration, the contents had been moved to an archive site. Okay, fine, but at least give me the refer. I had to go and search by eyeball (keyword search Alaei brought up nothing) to find the archived statement.

That's when I started to worry. What about all the press releases at the Centers for Disease Control? Are all those links broken, too? Fortunately, as of Jan. 22, 2008, the CDC's RSS feed for press releases about vaccinations, mortality data, etc. is intact.

I used to think saving links to U.S. government web sites was a safe thing to do because, well, it's the government, they have to preserve those web pages--right? It is a matter of public record. And press releases are part of the public record. But what if the government webmasters preserve the pages and destroy the links? Makes keeping track of things mighty difficult.

It's a different kind of way of politicizing the record--every bit as Orwellian as deleting the word "abortion" as a search term from the Popline database last spring. Fortunately, that was fixed.

Is there a technological fix for broken links, too? Can the new Administration put up their stuff without losing the links to the old information? It is the same government of the same country, after all--just different temporary leaders.

Do you have any other examples of broken government links about global health post-Obama transition?

Iranian AIDS Docs Get 3 and 6 Years in Prison

2009-01-22T07:46:00.007-05:00

While the rest of the world was focused on the peaceful transition of power in the U.S., Iranian AIDS doctors Kamiar and Arash Alaei learned on January 20 that they had been sentenced to three years and six years, respectively, in prison, according to Physicians for Human Rights.

The Alaei brothers' case is one of several recently in which professionals and religious minorities have been falsely accused of fomenting revolution. Lawyer and Nobel Laureate Shirin Ebadi's Human Rights Defenders Center was raided and shut down by police in December (Los Angeles Times). Her former secretary was arrested earlier this month in a roundup of six B'hai women (B'hai News).

(Update: The LA Times says Sylvia Hartounian, 33, a reproductive medicine specialist, was sentenced along with the Alaei brothers.)

Radio Free Europe has a good summary article that ties all these moves to internal Iranian politics--trying to sow fear among the Iranian electorate ahead of presidential elections in June.

The Washington Post quotes an unnamed Iranian official as saying the brothers' treatment is part of a "full-fledged intelligence war" between the U.S. and Iran. "A soft revolution has been programmed against our country and carried out in some instances, but it was suffocated in the cradle," the Iranian official was quoted as saying.

Further update (1/29/2009): For deep context, listen to Jeb Sharp's excellent podcast on Public Radio International's "The World" about the long-term damage to US-Iranian relations caused by the 1953 coup engineered by the CIA.

Related posts:
Jailed Iranian Docs
Jailed AIDS Docs Tried in Secret
Sentences Expected for Iranian AIDS Docs

Who Hears a Prayer About Gays, Malaria and AIDS?

2009-01-19T11:41:00.006-05:00

The decision to censor Gene Robinson's prayer at yesterday's pre-inaugural concert in Washington, D.C. meant HBO's television audience also did not hear his call to do more about "women [who are] raped because they want an education" and the "thousands [who] die daily from malnutrition, malaria and AIDS." Interestingly, the openly-gay bishop also reminded folks of something that many conservatives have been saying lately, too--sometimes more crudely than other times--that Obama is not the Messiah.

AfterElton.com reports that HBO says it was only following the Inaugural Committee's wishes not to air the pre-concert show.

Christianity Today posted a video of Robinson's prayer on Youtube. (Episcopalcafe has text of the prayer.)

My two cents: I believe all prayers are heard by God. Whether or not the rest of us pay attention is another story.

Proposed: Global Health Blogging Experiment

2009-01-15T08:27:00.005-05:00

Reading Jon Shaffer's post on three top debates in global health gave me an idea. What if we organized a bunch of global health bloggers to coordinate their posts around a single topic and then picked a day where we agreed to post them all? It might increase the visibility of some of the deeper issues in global health.

Each blogger would take the part of the debate that had the most resonance to them. Say, for example, the topic were "prevention vs. treatment." Maryn McKenna might write about it in the case of antibiotic resistance. I might write about it in the community health vs hospital context. Alanna Shaikh might write about it based on her experiences in Central Asia. Then we would update our individual posts with links to what the others had to say.

You might think of it as a blog carnival (defined as "a rotating showcase of interesting writing from around the blogosphere within a particular discipline"), although that may be too organized for our first effort. The most exciting part is that we're starting to get enough of a critical mass of global health bloggers that this is even possible. What do you think?

Who Reads the Global Health Report?

2009-01-15T06:09:00.009-05:00

Based on your comments, I would have to say you are all intelligent and thoughtful, if still a little bit shy. (To keep things civil, I delete the comments from trolls and hucksters.) Thanks to some basic web analytics software, here is what else I know about the people who visit The Global Health Report.

Just over 1500 unique visitors come to the site in December 2008, a monthly rate that has quadrupled in the past year. (Is that good or bad? You tell me.)

If I'm reading the charts right,

97% used a fast connection
2% used dialup
fewer than 1% accessed the blog from a mobile phone.

In the past year, visitors have come from 140 countries, with the following breakdown for the top five:

United States 71%
United Kingdom 6%
Canada 4%
South Africa 2%

If you have simple ideas on how to increase the international readership of the blog, please let me know.

11% of visitors accessed the site using computers on university or college networks, with the top five being:

Harvard University
Northwestern University
George Washington University
Bowdoin College
University of Washington

1% of visitors accessed the site using computers at U.S. government agencies, with the top five being:

The United States Centers for Disease Control and Prevention
The U.S. Department of State
The U.S. Department of Health and Human Services
The U.S. Agency for International Development
The U.S. Department of Veterans Affairs

Employees who use computer networks at the following press organizations (top 5):

BBC
Seattle Times
New York Times
Time Inc.
National Public Radio

Plus, a smattering of non-U.S. national and international agencies, several public relations agencies, some foundations and lots and lots of folks who I assume must be logging in from home on RoadRunner, Comcast, BellSouth, etc.

Related post:
Top 5 Blog Posts for 2008

Opposition to Gupta as Surgeon General

2009-01-13T08:05:00.009-05:00

Opposition to the possible nomination of Sanjay Gupta as Surgeon General is building.

"CNN journalist lacks independent voice to be surgeon general," says Peter Canellos today in the Boston Globe. Representative John Conyers of Michigan is pushing a different candidate, Dr. Herb Smitherman, a public health advocate from Detroit.

I still find it hard to believe Gupta will take the position. He will have a much smaller staff and much tinier budget than he is used to at CNN. Sanjay looks good on television because he is talented but he also has some very capable producers helping him.

If the Surgeon General were just a health educator, then Gupta, who I like very much (for one thing, he never gave me grief when I edited his columns at TIME), would be a surprising but logical step. But there are also policy issues. The SG is supposed to lead the 6,000-person U.S. Public Health Service Commissioned Corps. (Per comments on one of my earlier posts, morale there seems very low.) There is also talk Gupta will play a role in the Office of Health Reform (Washington Post), perhaps as salesman for whatever national health care reform the Obama Administration offers?

I would also like to know a lot more about Gupta's relationship to the pharmaceutical industry. This is a question I would ask of any doctor or health journalist who is being considered for government office--and Gupta is both.

We all know that advertising and corporate sponsorship make mainstream media possible. That is why you need to look at the firewalls between the sponsors/advertisers and editorial side in any specialized field, but especially in health, to make sure they are solid.

This is especially true when there is a single sponsor for a television program or print column. Anyone who cared to flip through the pages of TIME Magazine from a few years ago would see that Gupta's column always ran next to ads from Pfizer. The New Republic has written about the pharmaceutical industry's sponsorship of CNN's AccentHealth.

In addition, the practice of accepting speaking fees from pharmaceutical companies is very controversial, to say the least, among health journalists. I have written about why I do not do it. Just last November, we learned that psychiatrist Fred Goodwin, host of NPR's Infinite Mind, received more than a million dollars in consulting fees from drug companies (New York Times). That little conflict of interest left a huge black eye on NPR.

So, I would also like to know a lot more about the speaking fees that Gupta has received over the years from pharmaceutical companies.

This is more than I had planned to write about Sanjay Gupta as Surgeon General. But this is something new for health journalism--a health journalist being tapped for a high government position.

The revolving door between government and politics is a lot more common for my colleagues in political journalism--where the potential conflicts there have been looked at in greater depth.

If Gupta and the Obama Administration are serious about the Surgeon General's position, then we need to examine this possible nomination more closely.

Related posts:
AIDS Docs, Gupta, Measles

Questions About Gupta for Surgeon General

Update: See also Gary Schwitzer's extensive critique of Gupta's journalism. Schwitzer used to be head of the medical news unit at CNN.

Global Health News Feeds, Part Three

2009-01-12T08:19:00.007-05:00

In the spirit of sharing what you are already doing, I have made my Google reader subscriptions to the global health blogs I regularly follow publicly available. Most of these bloggers post once or fewer times a day so having all their posts collected in once place is incredibly convenient and no single voice (or small group of voices) drowns out all the others--something to cherish on the Internet and in life. No editing is involved--the posts are all generated automatically, although there is a delay between when the posts are published and when they appear in the feed but that is usually not a problem.

Separately, I am still maintaining a Global Health Mini-blog with my own picks of five interesting news and blog posts per day. In this case, I comb all my general news feeds looking for topics that have some bearing on global health issues.

I find this dual approach to feeds--one automated and one touched by human hands or "curated" in the new journalism lingo--necessary because we still do not have a semantic web that understands that items about malaria AND girl's education AND sanitation, etc. all fall under the rubric of "global health."

The next step would be to have a kind of Slashdot or Digg approach to global health news--where lots of folks post their own RSS collections of global health-specific items and then the group votes on the submissions. But there again, you would need some kind of mechanism to make sure that a few voices don't drown out all the others.

Of course, neither Slashdot or Digg even has a global health channel in the first place--another example of how the web often actually narrows the global conversation instead of broadening it. By the way, the Boston Globe had a great piece by Rebecca Tuhus-Dubrow in November 2008 about how the web drives out diversity.

Also, per John Wilpers' comment on January 8, I have agreed to share the Global Health Report's RSS feeds through Global Post, the new international news website, which is launching today.

Related posts:
How to Build Your Own Global Health News Feed
Global Health News Feeds, Part Two

AIDS Docs, Sanjay Gupta, Measles

2009-01-08T07:51:00.005-05:00

Iranian AIDS Docs. Revere at Effect Measure and Declan Butler at Nature both have items up about the 6-month detention, trial and expected sentencing of Arash and Kamiar Alaei, who were accused of trying to overthrow the government by going to international AIDS meetings.

Sanjay Gupta for U.S. Surgeon General. Several public health types seem disappointed but hopeful while many of the journalists I follow on Twitter and in list-servs are far more skeptical. Interestingly, the public health types emphasize Gupta's demonstrable communication skills while the journalists focus on his lack of public health experience (which, of course, is not the same as medical experience). I'll have more to say on this later when I have time to write a more thoughtful piece.

Other interesting posts on the Surgeon General at Paul Krugman's blog (see especially the early comments) and a much more positive analysis at Technology Health and Development.

Measles cases up in Europe. A Lancet study found measles cases were on track to double, from 3,909 in in 2007 to 6,269 cases in the first nine months of 2008. (Click here for full text of Lancet study on measles.)

Who is on Your Global Health List?

2009-01-07T08:07:00.005-05:00

Belated thanks to Change.org for listing The Global Health Report as one of eleven essential global health resources. RadiationTechnicanSchools has GHR down as one of six top global health blogs (scroll down). I was also cited by USPharmD+ for writing one of 100 blogs that "will open your eyes."

Sentences Expected for Iranian AIDS Docs

2009-01-06T19:23:00.006-05:00

Physicians for Human Rights expects Drs. Kamiar and Arash Alaei to be sentenced any day now on bogus treason charges in Iran. The brothers, who have been treating AIDS in Iran for many years, apparently became targets of the Iranian government after daring to attend a few international conferences.

PHR is requesting immediate help in their latest action alert on the situation. They think the more people protest, even electronically, the more likely the brothers will get a lighter sentence, or even have the charges dropped. Read more at iranfreethedocs.org.

Related posts:
Jailed Iranian Docs
Jailed AIDS Docs Tried in Secret

Questions About Gupta for Surgeon General

2009-01-06T19:11:00.011-05:00

Years ago, when I was a cub health reporter, I remember the political reporters assuring me that the U.S. Surgeon General's position was a largely ceremonial one that political Washington didn't take too seriously.

This surprised me at the time--shows you what I know about politics. It seemed to me the Surgeon General's report of 1964 about smoking was an incredibly important public health policy. And I think Surgeon General Koop opened the door somewhat in a very closed Reagan Administration on AIDS policy.

Obviously, the reason I'm reminded of this is the floating of Sanjay Gupta's name as possible surgeon general nominee. Full disclosure: I worked with Sanjay at TIME and think he's very nice, an excellent neurosurgeon and obviously very telegenic.

But that's the question: is the SG position all about being a good communicator--in which case, Sanjay is a surprising but logical choice. Or is there more to the Surgeon General's position--like actually setting public health policy? If the latter, then--much as I like Sanjay--I remain unconvinced that there aren't people with better public health credentials to take the job.

I am asking about this on Twitter and in private emails and conversations I have been having with fellow journalists and public health types.

Will let you know if I learn anything good, including any interesting posts--as opposed to the many, many me-too posts that merely repeat what has already been said in the mainstream media.

Also, please point me in the direction of good information about whether the Surgeon General's position is largely ceremonial or not.

Update: See Opposition to Gupta as Surgeon General

Questions About Third-Hand Smoke

2009-01-06T07:51:00.008-05:00

I missed this study from Pediatrics over the New Year's holiday. Researchers say "third hand smoke," which is smoking residue that lingers in people's hair or clothing, can damage the health of babies. A new survey shows that most people are unaware of the danger. So, even stepping outside to smoke does NOT protect infants from third-hand smoke. (Discover Magazine)

Obviously, no one in this day and age should be smoking--whether it is cigarettes, pipes, cigars. And yet, I have a question. Is third-hand smoking less harmful than second-hand smoking? Given the addictive nature of smoking, we don't want current smokers to just throw up their hands and decide to come into the room and smoke near the baby because they are "damned if they do and damned if they don't."

Read an abstract of the Pediatrics' study on attitudes about second-hand and third-hand smoke here.

Jailed AIDS Docs Tried in Secret

2009-01-02T07:20:00.006-05:00

Two internationally known AIDS doctors were tried in secret in Iran on Dec. 31, 2008, according to reports received by Physicians for Human Rights. Drs. Arash and Kamiar Alaei were arrested back in June, apparently on suspicion of traveling to international AIDS conferences as a cover for spreading revolution in Iran.

Their plight has not received anywhere near as much attention as that of Iranian-American academic Haleh Esfandiari, who was detained under similar charges in 2007 before being released after 110 days in prison.

The U.S. State department released a statement (updated link here: apparently with the change from Bush to Obama Administrations, all the press releases were archived to a different place in the ether) about the Alaei brothers' situation in Iran on Tuesday, Dec. 23. In the statement, the State department also condemned the closing of the Center for the Defense of Human Rights, which was founded by Iranian lawyer and Nobel Peace Prize winner Shirin Ebadi.

Here's an excerpt from the latest press release from Physicians for Human Rights:

The doctors have been held in Tehran's notorious Evin prison since late June 2008. They were indicted in December on charges of communicating with an "enemy government" according to their attorney, Masoud Shafie.

On December 31, the Iranian prosecutor tried the brothers in Tehran's Revolutionary Court on these charges, and also informed the court of additional, secret charges which the brothers' attorney had no opportunity to refute, because the prosecutor did not disclose either the charges or the evidence on which they are based.

ProPublica and Conflicts-of-Interest

2008-12-30T05:18:00.007-05:00

Hmmm. In a lengthy piece that was otherwise mostly about Herb and Marion Sandler, the New York Times reported last week that Paul Steiger, the editor-in-chief of ProPublica, contacted Lorne Michaels at NBC to protest an utterly tasteless, wickedly funny and potentially libelous skit on Saturday Night Light. The skit depicted the Sandlers, who are the major funders of ProPublica, as corrupt peddlers of predatory mortgages and "people who should be shot."

Okay, so SNL clearly went too far with the "people who should be shot" bit. But the New York Times piece by Michael Moss and Geraldine Fabrikant does make you wonder if maybe the Sandlers should go to jail.

At any rate, NBC pulled the full video from its site and substituted a redacted version that leaves out the Sandler segment entirely--not just the offensive "should be shot" title--but the whole thing. The conservative blogosphere had a field day with this when the flap first occurred in October. But Steiger's role, as far as I can tell, did not come out until last week.

And that's the part that interests me the most at the moment. I'm also teaching a class next May and June on journalistic judgment, although it's about science, health and environment reporting.

Every form of journalism has to deal with conflicts of interest--no matter where the money comes from to pay for it. There is nothing about being a nonprofit organization that earns you a free pass.

This was very clear to me last spring while I was researching and developing a business plan for launching a global health news service. And yet, I was surprised at how much pushback I got on this issue.

This is not rocket science. I am sure that ProPublica has a conflict-of-interest policy for its individual news staff. They should also come up with a policy for its coverage and comments about the Sandlers. Then, they should post their conflict of interest policies on their web site (that section on "privacy policy and other terms" looks about right) and move on.

Ditto for news organizations that take Gates Foundation money to cover global health.

Oh yeah, and as more advocacy groups engage in journalism, they are going to have to come up with their own policies on conflicts of interest.

As for my own potential conflicts: I am a freelancer and former TIME Magazine writer who is passionate about global health and would like to be paid for what she writes. (Believe me, AdSense is not the way to make money in this business.)

Although advertising paid for my salary at TIME, my contacts with the business side were severely limited. In addition, I do not directly own any pharmaceutical or biotech stock. I do not take consulting fees from same. My Nieman Fellowship was paid for by the Gates Foundation but they had no say in my Malawi project.

Writing it down like that is a good reminder.

Video: Mapping NYC's Rats

2008-12-29T13:32:00.007-05:00

Back in November when I saw that New York City had turned to computerized mapping software in its renewed fight against rodents, I knew I wasn't going to be satisfied with just a quick blog post. I had to learn more.

After 19 hours of work, including a wonderful but very cold expedition to the Bronx to see Bobby Corrigan and Mike Mills at work, I produced a written piece on rat mapping for Time.com and did the voiceover for the video, which was shot and edited by Ed Robbins.

It's kind of fun to compare the two projects. Text is great for information--and there's plenty of it in my text piece. Audio is ideal for emotion and I recorded several versions of the voiceover--some that sounded a lot more menacing than the one the editors ultimately used. And the video did a much better job of giving you a sense of Bobby's and Mike's personalities than my written piece did.

The written piece was picked up by CNN earlier this month and was one of the most popular pieces on Time.com for a while.

But enough with the media commentary: more importantly, the rat map has helped drive the number of rat problems in the Bronx down 40% in the past year.

Below is a screengrab from NYC's rat map of the abandoned house (upper left corner) where Bobby and Mike introduced Ed and me to their work. (You may need to click on the photo to see the detail.) The official rat map interface is a bit clunky but it yields an utterly fascinating view of New York City.

AIDS Denialists at Change.org

2008-12-29T08:19:00.006-05:00

Looks like the AIDS denialists have made a run at change.org--which, I hasten to add, is not affiliated with change.gov, the Obama transition team website. Questioning whether HIV is the cause of AIDS is now the second most popular item in the global health category of change.org.

It's not enough that AIDS denialists have killed at least 330,000 people in South Africa alone. It makes my blood boil to think their juvenile antics, like flooding the simplistic popularity contests at change.org, will keep even a single person with HIV from getting the treatment that she or he needs.

Some valiant commenters have taken up the fight and taken on the denialists at change.org. The guy who originally posted the idea is a total lurker. As of this morning his profile shows he supports no non-profits, has taken no actions, raised no money or recruited anyone to any cause.

Memo to change.org folks: you have been punked.

Wanted: A Brief History of Ideas

2008-12-22T16:30:00.001-05:00

Journalists are often told to skip the history when writing the news. Contemporary context is okay. Extended history is out. In rethinking that advice, I offer up Tina Rosenberg’s masterful article on poverty in the Sunday Magazine of the New York Times.

In a few paragraphs, Rosenberg covers nearly half a century of thinking about “the culture of poverty”—at least as far as U.S. intellectuals have described it.

Summary and synthesis, the history of ideas.

That’s increasingly what I am looking for—whether in old media or on the web. And what I find missing in so many discussions about global health.

From Rosenberg’s NYT article:

FORTY-NINE YEARS AGO, the anthropologist Oscar Lewis published a book called “Five Families: Mexican Case Studies in the Culture of Poverty,” detailing a single day in these families’ lives. One family, headed by Jesús Sánchez, a food buyer for a restaurant, continued to tell its story in a second Lewis book, the widely read “Children of Sánchez.” Lewis singled out elements of a culture that, he argued, keep those socialized in it mired in poverty: machismo, authoritarianism, marginalization from organized civic life, high rates of abandonment of illegitimate children, alcoholism, disdain for education, fatalism, passivity, inability to defer gratification and a time orientation fixed firmly on the present.

We still call this the culture of poverty today. But the idea has taken on a life far beyond the world of Mexican peasants. And although the concept originated with Lewis, it has come to mean almost the opposite of what Lewis intended.

Lewis was a man of the left. He saw the culture of poverty as a defense mechanism adapted by the poor in response to capitalist inequality. For a while, the culture of poverty remained a leftist idea: Michael Harrington used it throughout his hugely influential 1962 book, “The Other America,” which laid the foundation for President Johnson’s War on Poverty. But Lewis soon lost control of the concept. With the publication of Daniel Patrick Moynihan’s 1965 report “The Negro Family,” the “culture of poverty” became a shorthand for black ghetto culture, a defect of the poor. Then Edward Banfield, a conservative political scientist, introduced the notion that the culture of poverty was immutable; his 1970 book, “The Unheavenly City,” attacked the key assumption of the War on Poverty — the idea that government can help. Banfield argued that poverty was a product of the poor’s lack of future-orientation, and that nothing government could feasibly do would change that orientation or stop parents from transmitting it to their children.

Banfield’s book is widely seen as retrograde today, but he still seems to own the culture of poverty. Lewis had used the phrase to describe habits acquired in response to structural factors — the standard left-wing argument that people are poor because of low wages, discrimination and bad schools. But the phrase has essentially become shorthand for the right-wing argument that poverty stems from the limitations of the poor and is largely impervious to outside intervention.

Persistent poverty has retreated from the political debate in the United States. But outside the headlines there has been a gentle evolution in thinking about the causes and cures for poverty, one that moves away from blaming capitalism and blaming the poor alike. Today, the most interesting development in that evolution — one with implications for fighting poverty around the world, including in the United States — is coming once again from Mexico, this time from the grandchildren of the children of Sánchez.

Links: Flu, Abortion, Google Data and TB

2008-12-22T08:59:00.003-05:00

Seasonal flu. Health experts announce that this year nearly all H1N1 viruses are resistant to oseltamivir (sold as Tamiflu) and responsive to adamantane, amantadine and rimantadine. The opposite is true for H3N2 viruses. (Toronto Sun)

Abortion. Blogger roundup about abortion and women's rights from Brazil (Global Voices Online)

Science Commons. Google shutters its science data service before it is even launched (Wired)

TB. How evolution and human migration make controlling drug-resistant tuberculosis even harder than you think (PLoS Biology)

Jailed Iranian AIDS Docs

2008-12-19T14:13:00.008-05:00

Looking ahead to Monday.

The folks at Physicians for Human Rights expect the U.S. State Department to release a statement on the 6-month anniversary of the detention of two AIDS doctors in Iran.

Kamiar and Arash Alaei are internationally known for their work with AIDS and with heroin addicts. Iranian authorities accuse the brothers of trying to promote a "velvet revolution" under the guise of fighting AIDS. (Sounds a lot like the Haleh Esfandiari case to me.)

A quick Google News search shows the Alaeis' detention has so far garnered more mainstream press interest in Europe than the U.S., especially in French-language press.

I learned about the story in an e-mail from Physicians for Human Rights. Read more about their campaign to free the brothers here. (Note to PHR, you need to update the background page on the website. Kamiar Alaei has obviously not returned to his doctoral program at the SUNY Albany School of Public Health.)

The BBC profiled Kamiar and Arash Alaei for their AIDS work back in 2004 as did the Washington Post in 2006.

If you know about this story, please add to the comments below. I will give the comments that provide the most context a full-on post of their own.

Update: the State Department released its statement on the Alaei brothers on Tuesday, Dec. 23, 2008. It reads, in part:

The United States is also deeply concerned by the continued detention of internationally known Iranian HIV/AIDS physicians Dr. Arash Alaei and Dr. Kamiar Alaei. December 22 marked six months since the physicians were arbitrarily arrested by Iranian authorities and detained in Tehran’s Evin Prison. As a party to the International Covenant on Civil and Political Rights, Iran has the obligation to afford due process rights to anyone detained. The two have been active in various international exchange programs and academic research, helping to involve Iranians in the international academic and scientific community.
In November 2006, because of their work on HIV/AIDS, the Alaei brothers were participants in the first professional exchange program for Iranians in almost three decades, sponsored by the U.S. Department of State’s Bureau of Educational and Cultural Affairs. The program, which focused on public health, led to collaboration between American and Iranian medical professionals that could benefit the global fight against HIV-AIDS. Similar programs have brought citizens from over 165 countries to the United States.

The Iranian people have consistently expressed their desire to be connected to the global community. The actions of the Iranian Government against the Alaei brothers, Ms. Ebadi, and other human rights activists only serve to isolate further the Iranian people. With our friends and allies in the region, we stand by the brave people of Iran, who are trying peacefully to exercise their universal human rights, and call upon the Government of Iran to abide by its international obligations.

Twitter and Global Health

2008-12-18T01:07:00.006-05:00

I finally gave in and created a Twitter account back on November 4 so I could participate in the #votereport project. It reminded me somewhat of the way mobile phone or SMS texting has shaped elections in Africa, starting with the 2000 election in Ghana and continuing on to the more recent 2008 election in Zimbabwe. It also got me thinking about how such democracy-movement techniques could be adapted to global health. Perhaps to introduce some much-needed transparency in pharmaceutical supply chains?

Votereport was a volunteer-led project that called on U.S. voters to characterize their election experience by providing three major pieces of information: where they voted, how long they waited to vote and whether the experience was a good one or a bad one. If yours was a bad experience, then you were supposed to give a brief description why, e.g. mismatch of your name compared to driver’s license records caused an official to doubt your right to vote.

From a technical point of view, we’re talking about structured-data.

I messed up my first attempt at tweeting my own vote but fortunately someone named ZekeSaysSo showed me how to do it: “#votereport. #10019 #good #wait:40 at 6 AM. longest lines I have ever seen at this polling place at this hour.”

Each specific piece of information was preceded by a # sign or hashtag, also known as a pound sign, to make the information more easily sortable by computer.

People like Adrian Holovaty have convinced a lot of us reporters that one major path to a future for journalism lies through structured data. As Holovaty defined it in 2006, structured data is “the type of information that can be sliced-and-diced, in an automated fashion, by computers.”

Holovaty’s breakthrough example in 2005: using the structured data from Chicago crime statistics mashed up with Google maps to automatically generate geographical pictures of a neighborhood’s character. You can see the latest iteration of his efforts at Everyblock.com

The new wrinkle about Votereport, the Ghanian and Zimabwean elections is that “we the people” provided the structured data—in real time with tangible results. Mobile texting plus radio coverage stopped voting irregularities in Ghana in 2000 and prevented Robert Mugabe from being able to fudge electoral results in Zimbabwe earlier this year—although it didn’t stop him from hanging on to power.

Nothing quite so impressive in the U.S. but Votereport did help a number of individuals cast regular ballots instead of provisional ballots after minor misspellings of their name threatened their franchise rights. Because anyone who tweeted #bad and provided information as to why they couldn’t vote was automatically put into contact with an election protection lawyer. In many cases, simple misunderstandings were resolved before the voting booths closed.

See also Ethan Zuckerman’s thoughtful look at the pros and cons of twittering vs. texting elections.

Seems like you could adapt this type of technology to other uses. I’m thinking specifically about the government’s drug-supply chain in Malawi.

Many, many people I talked to complained about how they can’t get the drugs they need for hospitals and clinics from the Malawi government’s Central Medical Stores. Even the taxi drivers in Lilongwe know that a lot of the pharmaceuticals get diverted from the public sector to the private sector—despite periodic purges of the employees involved.

What if every hospital administrator, clinical officer and nurse used their mobile phone to text every encounter they had with Malawi’s CMS, giving information about the number and kind of drugs that were missing? And you compared that to the number and kind of drugs they started off with—many made available through international agreements?

How long would it take before CMS employees retaliated? Could you get enough people to participate so that no one individual would be targeted for retribution?

Just wondering. What do you think?

See also this Slideshare presentation on Twitter for Health by PF Anderson at the University of Michigan.

Can There Be Too Much Training?

2008-12-15T06:29:00.001-05:00

There are many moments from my three-month Malawi trip that I just had to store away for later reflection. I recognized a ring of truth even if I did not quite understand what it meant or how it fit into the larger picture. What a number of people said to me about the role of training—which theoretically seems like a good thing—was just one of these moments that set my head spinning.

A number of managers I interviewed griped that excessive training sessions were distorting the health care system in Malawi. Too many nurses in a country with precious few nurses in the first place were out of their clinic or hospital for various two-week training sessions, often every other month. Several health care workers—particularly in government hospitals—said they depended on the extra pay they got from those training sessions. A couple of Malawians I met who did trainings admitted they could not get anyone to come unless they offered financial incentives.

Now I learn these were not just a few isolated cases. Training and sustainability have turned into perverse incentives in numerous HIV programs in Malawi, according to a new study by Ann Swidler (UC Berkeley) and Susan Cotts Watkins (UPenn and UCLA). I am trying to get a hold of the full paper but this excerpt, provided by Bill Savedoff at the Center for Global Development, is electrifying:

Swidler and Watkins follow the logic of the “sustainability” mantra [Savedoff writes] to show how incentives at every level – from the international donors to the national elites, interstitial elites and local population – make funding for training (and training of trainers) the dysfunctional outcome of an otherwise well-meaning effort. The donors can claim they are “teaching the population to fish,” the national elites get income and status from managing and negotiating the programs, the interstitial elites (usually young high-school-educated volunteers) get contacts and opportunities to rise socially and economically, and the local population gets .. well, relatively little.

[snip]

Swidler and Watkins make the case for what is really needed quite clearly in their final remarks:

"It is hard to say precisely what constructive recommendations follow from the perspective we have offered here, but we do have several suggestions. First, the ideal of sustainability is a convenient self-delusion for funders and they would do much better if they could systematically and rigorously determine what projects are effective and then sustain them by paying local workers to actually do good—provide health care, sell discounted seeds and fertilizers, treat STIs, provide ARVs, supply children with books and school uniforms, or care for the ill and elderly (Kremer & Miguel, 2007).

Second, since few of the approaches to AIDS prevention currently in vogue have shown any measurable effect (Potts et al, 2008), we encourage funding that responds to Malawians’ desire to take care of the vulnerable in their communities, provide for their children’s futures, and build economic security, independent of the issue of HIV and AIDS. Indeed, reading the proposals that Malawian villagers submitted in their usually vain attempts to gain access to AIDS funding convinces us that villagers do know what they want, but little of it is training in how to prevent, mitigate, or treat AIDS. The first two they already know how to do as well as the experts who try to advise them (Watkins, 2004), and treating AIDS has to be done through the health-care system.

"Finally, we suggest that donors consider the “hidden curriculum” their procedures teach. Requirements for elaborate proposals, bank accounts, and monitoring and evaluation might better be replaced by simple procedures that would funnel more resources to villagers and less to monitors. Such resources would create continuing projects that both villagers and employees (perhaps the brighter, more successful of the villagers’ children) might rely upon. Rather than projecting a social imaginary that they find morally gratifying, donors and NGOs might provide opportunities that could sustain the realistic aspirations of those they claim to help."

Hat-tips to Alanna Shaikh and Bill Savedoff for the study.

Links: Varmus, Rape, Methadone

2008-12-15T06:04:00.005-05:00

A few worthwhile links on U.S. policy, rape, to start off the workweek.

Harold Varmus speaks on the U.S. commitment to global health on on Tuesday, Dec. 16, 2008 at 11:30 AM Eastern time (U.S.). Videocast will be available at videocast.nih.gov (NIH)

Update: Read the report on global health priorities from the Institute of Medicine on which Varmus bases his recommendations.

Journalist Pushpa Jamieson reports that even asking general questions about rape in a Malawi police station is stigmatizing. (The Chronicle)

Methadone project in Ukraine faces tough sell with public. (Global Voices Online)

Vaccines: Careful What You Pay For

2008-12-12T09:58:00.007-05:00

Paying poor countries to vaccinate kids sounds like a good idea—as long as no one games the system. A new study from the Institute for Health Metrics Evaluation in Seattle shows that dozens of countries exaggerated their vaccination statistics in order to benefit from financial incentives. As the Seattle Times points out, the Gates Foundation paid for both the vaccine incentive program and the study that criticized it.

The larger issue: what role should financial incentives play in health care? The IHME study, which was published in the Lancet, is not the final word on this debate.

The idea that financial incentives can backfire is nothing new—look at the U.S. tax code for multiple examples. Or the Israeli day-care study by Gneezy and Rustichini (instituting a fine on parents who were late in picking up their kids at daycare resulted in an increase, not a decrease, of late arrivals). You have to pay close attention to how these deals are set up. See the cash transfer programs Julio Frenk championed in Mexico for examples of how to do things right.

Here’s a question for anyone who wants to dig deeper into the IHME study: the program was aimed at kids who wouldn't otherwise have gotten vaccinated. So, did more kids get vaccinated, despite the exaggeration, than would have otherwise? Did their health improve? And if so, is it okay to tolerate a little distortion? How much distortion--5 percentage points or 10, or in this case 16 (74% actual rate vs. 90% reported rate)? On the other hand, if you can't trust the numbers . . .

Update: See Ruth Levine's post at Global Health Policy for a more in-depth analysis of the IHME study.

Spotted Fever Caused Death in Brazil

2008-12-10T22:11:00.004-05:00

Whew. It wasn't arenavirus after all. ProMed-Mail has the followup.

Related post: Mystery killer in Brazil.

Daulaire and Gayle for Obama Administration?

2008-12-10T21:30:00.006-05:00

Catching up to the news. Helene Gayle, currently leading CARE, is being rumored as a possible pick to head up USAID, according to Al Kamen at the Washington Post. Nils Daulaire may be tapped for HIV/AIDS coordinator, displacing Mark Dybul. If true, I wonder where Dybul will go?

Repeating rumors is precarious business. The way the game is played in Washington, you can't help but feel you're being used by someone--you just never know by whom. (See Valerie Plame.) Maybe it's a trial balloon. Maybe it's wishful thinking. We'll know soon enough.

Related Post: US Food Policy Needs to Change (Editorial)

Update (Jan. 13, 2009) Looks like Dybul is staying on at Pepfar for now. Wonder how he gets along with Hillary Clinton, who as Secretary of State, would presumably be his boss?

Sharing and Global Health Blogging

2008-12-08T10:09:00.005-05:00

How can we get more coverage of global health news when old media doesn’t seem to want to do it without outside support and new media (blogs, texting, sharedmedia) still seems a scattershot affair?

This is the fourth post in a series that began with “Rethinking Why I Blog.” The others are “What Plumpy’Nut Taught Me” and “Authentic Sharing vs. Selfish Sharing.”

One of my goals for my Nieman fellowship year was to develop a business plan for a web-based global health news service. I know, I know, “news service” is such a quaint phrase, reminiscent of teletype, telegraphs and Morse code. But it is descriptive. If it’s too old-fashioned for you, think “content platform.”

The idea was to aggregate posts from around the globe as well as to provide funding for original reporting. I further focused the goal by targeting transparency issues in global health funding by eight major organizations. I developed the plan as part of a class on non-profits that I took at the Kennedy School and pitched it to the Open Society and Ashoka folks. Both decided to pass.

Nowadays, though, I’m wondering if maybe I was just trying too hard or too soon? After all, I keep seeing efforts by individuals to write about what they find interesting or newsworthy in global health. The ones I find most interesting are not promotional or advocacy-oriented but rather add context and highlight overlooked news.

In addition to established blogs from academics in the field, e.g. Effect Measure, The Pump Handle, Aetiology, there are a few more student blogs, like these efforts from Karen Grepin at Harvard, GlobeMed at Northwestern University and Unacceptable from Brigham Young University. See others on my blogroll at right.

(Mostly US-generated, I know. Send me your recommendations for global health blogs from other countries using the comment section below!! I haven't been bowled over by what I have read in the health section of Global Voices Online. )

The development community is farther along in self-publishing. See especially blogs from organizations like DFID and the Center for Global Development as well as DFID-funded Scidev.net. While trolling Twitter, I found “Blood and Milk,” a clear-eyed view by Alanna Shaikh of just how ethically challenged anti-poverty work can be despite good intentions.

Now that the Gates Foundation is investing in mainstream news organizations so they can cover global health news, you might say we don’t need individual efforts at reporting and commenting any more. Who needs amateurs, who post between bouts of norovirus or grant applications, when you can hire professionals [irony alert]?

And yet they write.

Update: PharmD+'s list of 100 global health blogs--three of mine are included, one of which is no longer active. But others on the list haven't been updated for quite a while either, e.g. BrownforGlobalHealth (last post Sept. 2007) and Don Burke's Global Health Blog (last post Jan. 2008).

Mystery Killer in Brazil

2008-12-07T21:58:00.008-05:00

Note to self: watch ProMed-mail for results of blood tests of South African man who fell ill and died in Brazil last week. Early reports suggested it might have been highly contagious arenavirus--and linked to earlier case in Johannesburg clinic. Two days later, health authorities from South Africa said that scenario was unlikely. The blood tests should say for sure. Unclear if results will be out this week.

Another reason to control rat populations in cities: arenaviruses are closely associated with rodents.

Update: Word from Brazil is that it's spotted fever, not arenavirus.

Story-Telling Makes Sense

2008-12-04T14:34:00.003-05:00

Making the obvious difficult. We tell stories to deal with information overload (http://is.gd/af7f) and understand complexity (http://is.gd/af7j).

New Gates Grant for Global Health News

2008-12-01T11:03:00.006-05:00

An announcement is due later today from The NewsHour with Jim Lehrer that the Bill & Melinda Gates Foundation is giving WETA, co-producer of The NewsHour, a $3.5 million grant over the next three years to cover global health issues. Foundation-funding of publicly funded news programs like The NewsHour is becoming more and more important as other sources of money, like corporate-funding, dry up.

Other recent investments in global health news coverage by the Gates Foundation include:

1. A nearly $1 million, three-year grant for National Public Radio in 2006.

2. A $5 million, three-year grant for Public Radio International in 2007.

This latest move suggests the Gates Foundation has made a strategic decision to fund news-coverage directly, as opposed to, say, training for journalists in global health issues. In 2007, the Gates Foundation gave the Knight Foundation $1.7 million over three years for health fellowships for journalists in sub-Saharan Africa. Earlier this year, however, the Gates Foundation chose not to renew its three-year grant to the Nieman Foundation for Journalism at Harvard.

The Nieman Foundation is continuing its global health program—although it will award two fellowships next year instead of three.

I’m very interested to see how the Gates-funded NewsHour navigates the challenge of reporting on global health programs that are funded by the Gates Foundation and of interviewing experts who are also receiving funding from the Gates Foundation.

Full disclosure: I received a 2008 Nieman Fellowship for Global Health Reporting. The Gates Foundation had no say in the choice of my field project. And I dealt with even the potential appearance of a conflict-of-interest issue by focusing on the nursing brain drain in Malawi—an issue that, as far as I can tell, has received no Gates funding.

Updated to add Knight Foundation information.

Help Needed on US Labor Rule Change

2008-11-25T10:55:00.003-05:00

Celeste Montforton suspects that the U.S. Department of Labor might be engaged in midnight rule-making in the NEXT FOUR DAYS to weaken workplace safety protections. She is asking for help to determined whether Labor has "decided that the risk assessment rule does not require OMB review?" and plans to "publish a final rule on OSHA’s and MSHA’s risk assessment procedures ASAP, despite the load of comments they received and could not possibly have addressed in a final rule?"

Authentic Sharing vs. Selfish Sharing

2008-11-20T13:34:00.006-05:00

By all means, share what you are doing on the web. Just make it authentic.

Previous posts in the series: "Rethinking why I blog" and "What Plumpy'Nut taught me."

When Richard Lalleman of the Netherlands asked me to share my delicious feeds about development with his Focuss.info initiative, I came back at him with some questions to make sure I knew just what kind of sharing he was talking about. I wanted to make sure that he wasn’t going to use my freely available feeds for a commercial project and that it would NOT require any extra effort on my part.

That got me thinking about the nature of sharing on the web. And whether it’s any different from sharing in the real world.

My church, like many community organizations whether faith-based or not, collects cash and canned goods for our local food pantry. Every year, we need to explain to the youngest crop of Sunday Schoolers what sorts of items are worth sharing. Usually, one or two discover the brilliant strategy of sharing something they don’t like—like canned peas. It’s a two-fer. They get rid of something they don’t want and they get points—in case anyone is keeping score—for sharing.

And so every year we explain again that the point of sharing is not to share what you don’t like but to share your love, in this case something that you find tasty or that you would want to receive yourself.

That first impulse—to selfish sharing—is totally human and not something that we necessarily grow out of. Think about how many folks donate clothes that they would never wear. There’s the satisfaction of sharing, not to mention a tax deduction. We won’t even go into the harm that free clothing has done to struggling textile industries around the globe.

A lot of the potential of the web comes from what’s called the “gift economy” or the benefits of collaboration.

The more you look, the more you realize there are different levels of sharing, with differing levels of authenticity.

Here’s a list, with examples, that I am playing around with. Some of the layers overlap, of course. Feel free to play along, whether here or on your preferred social media.

Selfish-sharing: (see above)

Reciprocal sharing: You watch the kids on Tuesday and I’ll watch them on Wednesday.

Self-interested sharing (or enlightened self-interest): I’ll tweet my voting experience as a way of improving democracy.

Convenient sharing: I’ll share the idle time on my computer to help model new ways to control malaria parasites.

Sharing from abundance: I can’t eat all these tomatoes from my garden; would you like some?

Coincidental sharing: I had to do this anyway, but I don’t mind sharing what I learned about getting a cell phone in Malawi.

Catalytic sharing: let’s all get together and write the code for [insert favorite open-source program here] and watch it change the world when we’re done. Or let's share what we know about treating drug-resistant tuberculosis.

Sacrificial sharing: the stranger who dives into icy waters to rescue a child trapped in a sinking car. A soldier’s ultimate sacrifice.

Next: Sharing and Global Health Blogging

What Plumpy’Nut Taught Me

2008-11-19T10:22:00.009-05:00

Online collaboration may be the wave of the future but it’s not so easy to convince people to do it. As I learned last year, lots of public health folks were willing to talk to me about the Plumpy’ Nut patent but most were reluctant to act as journalists themselves, to help dig for the story, pull the various threads together.

Many were intrigued by the patent issue but didn’t want to join in publicly because they didn’t think they were expert enough. A few, no doubt, also felt the need to play it safe. After all, who knows what future employers (or donors) might think? As always, the people who knew the most were often the least interested in going on the record—in whatever format.

This is the second post in a series that started with “Rethinking Why I Blog.”

I learned about the Plumpy’Nut patent in October of 2007. I was attending a nutrition conference in which I picked up some hallway grousing from a humanitarian group that had been told it could not whip up its own version of Plumpy’nut, a carefully fortified peanut butter that has done wonders in the fight against severe malnutrition.

There was a patent on Plumpy’Nut, taken out by its manufacturer Nutriset (and the French government, I later learned.) Even though the recipe is widely available and easy to follow, making a batch on your own in many countries would land you in plenty of legal hot water.

Fascinating case. Before then the only reports I had heard or seen about Plumpy’Nut were glowing accounts about its proven qualities to save young children’s lives.

My first impulse was to dig deeper and write a freelance piece. But here I hit a snag. The rule was no freelance while on a Nieman fellowship.

So then I thought about it a bit and rather than ask for an exception, I decided to use this as an experiment in online collaboration. Normally I would hoard the information until I could come out with a fully-fledged piece. Otherwise, I would risk being scooped.

Instead, I decided to share it all, from the beginning, starting with the first disgruntled vibes I picked up at that conference. I envisioned a group blog where a bunch of interested folks could pursue the story—each contributing a different piece. And so launched what I hoped would be a group blog at Patents and Peanut Butter.

Talked to a number of students at Harvard’s School for Public Health. All were unfailingly polite, many offered suggestions, a number were intimidated by the blogging software. Most found it easier just to talk to me and let me write whatever I wanted on the blog.

Talked to several faculty members, including Richard Cash, who helped develop oral rehydration therapy back in the 1960s. Like Plumpy’Nut, ORT is a dead-simple recipe that saves lives. Unlike Plumpy’Nut, ORT is not patented. Anyone can make it. Many manufacturers do, but so do folks at home.

Several legal types thought the Plumpy’Nut patent wouldn’t stand up to legal challenge. I learned about “prior art” and “non-obvious” innovations.

Once again, the old habit—of journalist interviewing source as opposed to source commenting directly on a web site—was hard to break. I was perfectly willing to break it. But most people I talked to were not.

And so the blog sputtered along. I continued adding notes as time and opportunity allowed. But the hoped-for group blog did not materialize.

And yet, after a few months on the Internet, I did start getting inquiries and a few people from around the world added their two cents—some of them anonymously (which brings up all sorts of other issues.). Most of the interaction was still via e-mail. Most people didn’t feel comfortable posting comments on the Internet—despite repeated encouragement on my part. A few got into the spirit.

This was not the instantaneous burst of community magic that I had hoped for. But a kind of long-amplitude wave eventually did materialize. My old Plumpy’Nut posts kept getting traffic. Maybe I had brought a fast-food mentality to a slow-cooking world.

And indeed, a year after the blog went up (and many months after I stopped posting anything new), I received an e-mail from Martin Enserink at Science, who was working on a story about Plumpy’Nut and wanted to include a sidebar on the patent controversy.

We exchanged some information—though I couldn’t tell him much more than what I had already posted on the Internet. And Enserink's article—a piece of real journalism—has advanced the story. That’s where I learned, for example, that the real sticking point in the patent controversy may be the French government—and not Nutriset.

On balance, I learned more by sharing the Plumpy’Nut information when I did than if I had hoarded the information. And other people—whom I would never have known about otherwise—learned a few things through our exchanges or just by lurking on the blog.

As for news gathering, this felt kind of like a disorganized (or is it self-organized) relay race. Sometimes I was the leader passing the baton, sometimes I was receiving the baton. And sometimes, much to my surprise, I was just one of the bystanders (formerly known as the audience) cheering the race on.

Next: Authentic Sharing vs. Selfish Sharing

What to Tell the Global Health Fellows?

2008-11-18T15:13:00.002-05:00

Going to Cambridge, Mass. this weekend to impart whatever wisdom I can to the current global health fellows about the academic year at Harvard, the field project and life after the Nieman year. Looking forward to hearing what they’re doing and to catching up with David Kohn and Andrew Quinn, who will also be there.

But what to say that they don’t already know? All three of the current global health fellows have extensive experience in developing countries—Vietnam, Nigeria and India.

And how to prioritize? I still have trouble talking about the Malawi trip in anything less than treatise form. And so when friends ask, I often just say it was great and leave it at that.

If I had to focus on just three things what would they be?

1. Importance of sharing what you’re doing. e.g. Plumpy’Nut patent, putting Malawi proposal on the web. Solicit feedback but don’t be discouraged if you don’t get it or it doesn’t come as fast as you’d like it to.

2. Plan, plan, plan. Thinking of the field project as three distinct phases: pre-production, production and post-production. My own struggles with post-production. Don’t forget to bring the Malawi planning book I created. Also the laminated contact cards.

3. Bite off more than you can chew. But not too much more. Then let it happen.

Check with David and Andrew to see what they're thinking.

Rethinking Why I Blog

2008-11-18T14:23:00.007-05:00

My journey from live-blogging to beat-blogging to transition-blogging to a new state of grace that you might call emergent-blogging. This is going to take a few posts.

I’m still not sure emergent-blogging is the right catchphrase but it will have to do for now. What I mean is that I am now using this blog more and more to grapple with the ideas, projects, etc. I am already working on. I find that writing things out often helps me figure out what I think, what I should be doing next. You just have to be careful not to force a conclusion or a takeaway message.

The Global Health Update was one of the first blogs at Time.com. My co-workers and I launched it as a way of live-blogging TIME’s Global Health Summit in the fall of 2005. I was so taken with the medium that after the conference was over I convinced the powers-that-be to continue the blog because I wanted a place to cover global health news more often and in greater depth that we were able to in the limited real estate of the print magazine.

I quickly learned that blogging was a great way to keep up with global health news—and after TIME’s lawyers finally okayed the comment feed, we even managed to get some great conversations going. Nerd that I am, I loved checking out the web analytics software to see which .edu’s and .br’s and .mw’s were checking out the site. Traffic never grew to Swampland proportions but it grew nonetheless.

And after all, isn't that the point? That you don't need the mass audiences that make traditional media possible? It turned out there was an audience for global health issues and they didn’t all work for the same three NGOs. Also, it didn't hurt that I broadened my reputation as a global health journalist. A win-win, as the B-school folks like to say.

After I left my staff position at TIME and headed up to Harvard for a Nieman fellowship, I didn’t really know what I wanted to do with the blog—other than the fact that I wanted to continue blogging about global health. So I turned to Blogger, believing what folks said that the most important ingredient for success in blogging (whatever that means) was to be passionate about something—and I had plenty of passion.

I struggled a bit with how much I should write about what was happening in classes and often played it safe by posting about public lectures (by Ira Magaziner or Tim Wirth or Agnes Binagwaho) and other events. Or I’d post my reactions to some of the ideas and concepts I was picking up (like why the phrase “maternal mortality” just drains you of the desire to do anything whereas a book like Monique and Mango Rains fires your soul.)

Then in October of 2007, I learned about a brewing controversy over Plumpy’Nut, the nutritional supplement that saves starving kids' lives, and the decision by Nutriset (and, I later learned, the French government) to protect the incredibly straightforward recipe with a patent.

My first reaction was to write a freelance piece. But that wasn’t allowed under the terms of my Nieman fellowship. (The laudable idea being that a fellowship is supposed to get you away from the grind of deadline journalism.)

That's when I really started to grapple with the ins and outs of sharing on the Internet.

Next: What Plumpy'Nut taught me.

Friday Links: India, Bush Regs, Ignoring Systems

2008-11-14T11:28:00.007-05:00

IBM researches information-web based on cell phones for the millions who cannot read in India. (SciDevNet)

Celeste Montforton says how you undo Bush-era regulations is just as important as what you undo. (The Pump Handle)

Karen Grepin on why so much debate over cost-effectiveness or even whether it's more important to fund AIDS or maternal and child health programs misses the point. Have to think about education, human capacity, health systems, she says. Makes me wonder if the latest Lancet piece that charges that too much money is going to infectious disease is also off base for the same reason. (Karen Grepin's blog)

Social Networks for Global Health and Development

2008-11-14T03:53:00.013-05:00

Just last week I was thinking once again that the global health community has been slow to the digital social networking party. Then I received an e-mail from Richard Lalleman asking me to join a world-wide effort to build up a collaborative database of public bookmarks on global development.

Actually, Lalleman doesn’t want me, per se. He wants the RSS feed of my delicious tags (e.g. development, globalhealth, poverty.) After checking out Lalleman's web trail (LinkedIn, Twitter, blog, Foccuss.info) and asking for some clarification, it seemed like a good idea.

At first I was a bit confused—partly because Lalleman’s main site—Foccuss.info—is full of Dutch-inflected English and a fair amount of academic jargon. Lalleman is an information and knowledge management expert—which is to say the 21st century model of what we used to call librarians—a group of people I revere. So, I was willing to slog through all the abstractions and theory.

But here’s the essence: if more people in the development world would share their favorite sites on the web, it would make searching for credible information easier than what’s currently possible with generic search engines from Google or Yahoo.

Since I already make my bookmarks publicly available on delicious, Lalleman isn’t asking me to do anything extra. Just using what I’m already doing. He doesn’t even care if I use delicious or some other social bookmarking site.

And that’s key. A lot of idealistic types who think social networking is going to save the world seem to have a “if we build it, they will come” attitude. This typically requires a lot of work for not a lot of payoff. Example: Aaron Wallace’s global health social networking site at swala.org. Looked great when he launched it a year ago. Still doesn’t have that critical mass needed to make a social networking site work.

Instead, social networkers have to figure out what folks are already working on and simply convince them to share that publicly.

Most social networks for global health are still toiling in the list-serv phase of global collaboration. Critically important—especially in areas where e-mail is more easily accessible than the web. ProMED-mail, for example, works incredibly well on this model and on a shoestring budget with a lot of volunteer labor.

But the web-based systems offer advantages in greater interactivity and facilitating many-to-many conversations. You have to get beyond thinking of blogging for its promotional value (that idea could really use a post of its own) and really start thinking of platforms. You also have to get beyond thinking about social networking for its fund-raising value (another theme worthy of many more posts; see especially Beth Kanter on fund-raising in Second Life).

In the meantime, I’ll keep my eye on Focuss.info.

The other web-based social networking site for global health that I’m aware of is Global Health Delivery Online, an initiative out of Harvard and affiliated partners that’s trying to create online communities of practice around tuberculosis, AIDS and a few other targeted areas.

One of the big questions I have about Global Health Delivery Online is whether they can go beyond the Harvard brand? In other words, will folks from Columbia, Johns Hopkins, the Pasteur Institute, World Health Organization, the Novartis Institute for Tropical Diseases join the conversation?

But that’s enough about social networking for one entry.

Related posts:
Web 2.0 Comes to Public Health
Where are the Global Health Blogs?

Logging More Malawi Video

2008-11-13T16:16:00.003-05:00

Oh thank goodness. This past weekend I discovered that just about everyone finds logging video tedious. I was at the Nieman Foundation’s 70th Anniversary convocation and telling my tale of woe about logging the video I had shot in Malawi to friends who are television producers and documentary makers.

Here I was afraid that I was doing something wrong—that something about my print journalism training had messed me up forever for dealing with video. What other explanation could there be if logging video was taking me so long and seemed so excruciating?

All the TV and video folks assured me that what I was feeling was absolutely normal. And that that sense of being overwhelmed by all the material I had gathered would eventually go away as I got better at planning my shots, producing and editing on the fly.

It is a situation that’s very akin to the kind of ruthless editing you have to do when you write. My friend Lorie Conway urged me to focus on just two stories out of the gigabytes and gigabytes of video, audio and digital stills I have—at least for now. Log to those stories (leaving out the bits that don’t support those pieces). I can always return to the original material later as time allows.

This may be easier said than done. Every time I go through the material I see more avenues to explore. Plus I feel such a sense of responsibility to the folks who shared so much of their lives with me. But you can’t do everything at once.

So I have been back at logging video with renewed vigor and once again combing through the photos Eileen took. Have also hired a journalism student for help with logging some of the audio. Will probably focus on a story about malaria and another about nurses’ daily challenges and successes at just one of the several hospitals I visited in Malawi.

One thing is for sure, the pregnant woman's lament has got to find a home in there somewhere.

Friday Links: Twitter, Aspirin, Chinese Teflon

2008-11-07T07:14:00.004-05:00

Twittering and micro-blogging for public health. (University of Michigan Libraries)

Soon all aspirin will be made in China. Acetaminophen, too. (NY Times)

High levels of toxic Teflon precursor found in Chinese workers at a factory that had been open only one year. (Charleston Gazette via the Pump Handle)

Voting in USA

2008-11-04T08:39:00.005-05:00

Everything points to an historic voter turnout. Just over 60% of eligible voters went to the polls in 2004--the highest number since 1968. News reports show we're on track to beat that figure.

I showed up at my voting place in New York City this morning at 6:08 AM and didn't leave until 40 minutes later. That's me in the picture getting ready to step behind the curtain to vote.

Mapping New York's Rats

2008-11-03T10:55:00.003-05:00

High-tech approach to an age-old problem. New York City has just launched an interactive rat map online.

Update: A reader has pointed me to this book by Robert Sullivan, which has a cover of a map of Manhattan in the shape of a rat.

Further update: My story about GIS-mapping of NYC's rats and going on rat patrol in the Bronx is up on Time.com.

And now the rat map video is up as well. You can read some behind-the-scenes stuff here.

A Trio of Aid Scandals in the News

2008-11-03T09:10:00.003-05:00

There has been a trio of aid scandals in the news the past few days:

The Global Fund to Fight AIDS, Tuberculosis and Malaria accuses Robert Mugabe's government of diverting $7.3 million in money meant to fight disease in Zimbabwe.

The W.K. Kellogg Foundation of Michigan says several hundred thousand dollars is missing from its programs in southern Africa and is now suspending operations there, pending an investigation and restructuring by former U.S. Ambassador to South Africa James A. Joseph.

The bribery trial of a former Costa Rican president begins today. Rafael Ángel Calderón Fournier (1990-1994) and eight others are accused of taking bribes as a part of a $39.5 million Finnish deal to sell medical equipment to the Costa Rican health services. For an English language summary of the Costa Rican scandal, click here.

I'm told the scandal first came to light after reporters from the Costa Rican daily newspaper La Nacion noticed one of the key players was living way above the modest means his government salary would normally afford.

Pharma Boom in Emerging Markets

2008-10-30T09:19:00.005-04:00

While the pharmaceutical market for the US stagnates, IMS Health forecasts 14% to 15% growth in the so-called emerging markets, or what they call pharmerging markets. I think they need some help coming up with a better buzzword--something that rolls off the tongue more easily. Which syllable do you stress most? FAR-merging? How far is that merger? Who said anything about mergers? But I digress. The larger point still stands:

Rapid Expansion of "Pharmerging" Markets. The pharmerging markets of China, Brazil, India, South Korea, Mexico, Turkey and Russia are forecast to grow at a combined 14 - 15 percent pace to $105 - $115 billion. Along with the pharmaceutical industry's increased focus on these high-growth markets, these countries are benefiting from greater government spending on healthcare and broader public and private healthcare funding – which is driving greater access to, and demand for, innovative medicines.

Related Post: Growing market for malaria drugs

Kaiser Foundation Launches News Service

2008-10-29T16:46:00.001-04:00

Kaiser Family Foundation to start non-profit news service - San Francisco Business Times:: "The Kaiser Family Foundation, a Menlo Park-based nonprofit, said Wednesday it plans to start an independent news service to report on the U.S. health-care system and “the increasingly urgent political and policy debates surrounding it.”

Lancet Series on China's Health

2008-10-24T08:02:00.007-04:00

The special series in the Lancet on health system reform in China is fully available online, after free registration. See also Lancet's special online focus on China here.

Lancet is being a good global citizen in providing this material free of charge but navigating their web site continues to be something of a challenge.

Also, reading between the lines, it seems the rivalry between Harvard's Lincoln Chen and Bill Hsiao continues apace. Chen is co-author of four articles in the series while Hsiao does not appear at all.

Both men are experts on health care systems in general and China in particular. Chen often starts the conversation by focusing on health care workers while Hsiao begins with entire systems. Seems like you might want both views.

Logging Malawi Video

2008-10-23T17:05:00.002-04:00

They say logging your own video helps you understand better how to shoot video in the first place. I sure hope that’s true. I’ve been logging my video of Malawi nurses for days on end now and find myself yelling at the computer screen every now and then “Hold the shot! Hold the shot!” Fortunately, I seem to slow down and hold my shots better in the later videos.

Logging video means you write down a description of the action in different sequences, what people are saying and the time code from the video so you can easily jump to it if you need it.

Today I finished a whole series on Nurse Grace Nyirongo as she gives malaria medication and checks temperatures on the pediatric ward at Embangweni Mission Hospital and talks about her life and work.

It’s all in preparation for writing scripts that will combine different video sequences with photos and audio. It’s time-consuming work and, frankly, a bit tedious. But it’s allowing me to relive the trip to Malawi and revisit my deep respect and admiration for the men and women who work in the hospitals I visited.

Pandemic Flu Ethics at Seton Hall

2008-10-22T15:33:00.004-04:00

Seton Hall Law School in Newark, New Jersey will be hosting a symposium on October 23-24, 2008, to examine the legal, ethical, and public policy issues related to developing a pharmaceutical response to an influenza pandemic. Panels will explore issues related to the development and approval of vaccines and antiviral drugs, both before and during a pandemic; the allocation of vaccines and antiviral drugs in situations of scarcity; and issues related to international equity.

Wonder if they will take up the ethics of withholding flu vaccine from North Korea, Iran and other countries the U.S. considers rogue states?

Meanwhile in Niger

2008-10-22T12:39:00.004-04:00

Still haven't heard from an independent source about yesterday's post on malnutrition in Maradi, Niger. But the video below gives you a sense of conditions in Niger. It's from a new series on global health called ‘Survival’ that is currently airing on BBC World News.

The focus in the Niger piece is on what's going right in the battle against various neglected tropical diseases. And it features local villages distributing medications in places where there aren't enough nurses and doctors to do so.

What's Really Going On in Niger?

2008-10-21T11:58:00.007-04:00

There's malnutrition in Niger and then there are the arguments about malnutrition in Niger, which is turning into a "he-said, she-said" fight between Issa Lamine, the health minister of Niger, and Marie-Pierre Allié, President of Médecins Sans Frontières (MSF)France.

Yesterday, Lamine accused MSF of exaggerating ongoing malnutrition problems in the Maradi region. Today Allié said in a press teleconference that the situation is worse than the government is willing to admit. "Despite all their efforts, the health care staff in the hospitals and health centers I visited cannot respond to the influx of malnourished children," Allié said, after returning from a visit to the Maradi region of Niger.

The government of Niger suspended MSF's operations back in July. Allié says another group, Action Contre la Faim, was given the boot in August.

The stakes are particularly high this time of year when food stocks are traditionally low before the harvest begins.

Allié took pains to say the MSF has worked with the Niger government before and she praised the government's past successes against malnutrition. But she was baffled by the latest setback and particularly worried to hear a government leader saying, "If MSF is not present, then there is no malnutrition in the area. MSF is creating malnutrition.”

Actually, Lamine's anti-aid agency stance sounds a lot like what I've gleaned from the Internet about a Norwegian documentary called "Sultbløffen" (or "The Hunger Bluff") that aired in March of 2008. The gist of the documentary is that aid agencies undermine local agricultural efforts and exaggerated the extent of the Niger famine in 2005 to justify their own existence. I hesitate to mention it since I haven't seen it, don't speak Norwegian and all the references to it I can find are suspiciously identical as well as identically vague as to who was behind the documentary.

If you've been to Niger recently, please share your thoughts on what's behind this unusual standoff.

Related post: Meanwhile in Niger

Science Looks at Plumpy'Nut Patent

2008-10-20T13:56:00.003-04:00

As part of a larger piece in Science on whether Plumpy' Nut should be used to prevent malnutrition as well as to treat it, Martin Enserink takes a separate look at the patent controversy. I wish the piece was longer (and suspect Enserink does too) but it's a great introduction to the topic--well worth reading if you have access to Science online or a good library.

As regular readers know, I've followed this controversy for almost exactly a year now. (See two key posts here and here.) I even started a separate blog devoted just to Plumpy'Nut and patents while at Harvard when the parameters of my fellowship did not allow me to write freelance pieces. (I quickly learned public health experts don't want to become journalists in their own right.) So I applaud any attention this issue gets from traditional media.

Two data points I want to remember from Enserink's excellent article:

". . . Nutriset and the French Institute of Research for Development obtained patents for Plumpy’nut that last until 2018 and are valid in Europe, North America, and about 30 African countries. Nutriset has threatened lawsuits to keep others—including Compact in Norway and MSI in Germany—from selling similar pastes. . . ."

and

". . . the patent [IS NOT] valid in many malnutrition hot spots, including India . . . "

As I learned in my own reporting, Enserink says it's unclear the Plumpy' Nut patent could withstand a challenge.

But I was most intrigued by what Michael Golden, the developer of an older non-patented nutritional supplement, had to say. Golden told Enserink that

"the pressure should not be on Nutriset but on the French government; [Golden] hopes that France’s foreign minister, Bernard Kouchner, a physician who helped found MSF in 1971, will intervene."

Back to the Usual Suspects?

2008-10-20T13:46:00.000-04:00

The great promise of the web is that it can take you beyond your usual circle of friends or sources of information. That ability, along with a few other things, is what really drew me to the web as a way of covering global health news. If most big media outlets treated international news as completely separate from health news, at least there was an alternative.

But it looks like we're swinging back toward centralization of media sources. In a story that's mostly about the declining popularity of Technorati and Bloglines, Nick Carr has some very trenchant insights into the growing centripetality of the web.

Investing in Africa's Private Health-Care Biz

2008-10-17T14:50:00.005-04:00

Big meeting in Washington, D.C. on Nov. 20-21 to see how US companies can make money investing in the health care systems of African countries.

According to conference organizers, "Over the next decade, $25 to $30 billion in new investments will be needed in health care assets, including hospitals, clinics, and distribution warehouses, to meet the growing health care demands of sub-Saharan Africa. It is estimated that the market for health care will more than double by 2016. With a total health expenditure of $16.7 billion in 2005, roughly 60 percent—predominately out-of-pocket payments by individuals—was financed by private parties, and about 50 percent was captured by private providers."

Read more about the US-Africa Private Health Sector Forum at the Corporate Council on Africa website.

Update: CGdev.org has a good Dec. 9 post, with worthy links, on the public-private debate (via Jon at GlobeMed, in the comment feed)

Keeping Science a Secret

2008-10-17T10:12:00.004-04:00

Two new transparency issues in global health news, on pandemic flu vaccine and scientific candor at US government agencies. For an example of how lack of transparency in one small area (say credit swaps) can spread around the world, see the current financial crisis.

Discouraging News on Infant Mortality in US

2008-10-16T13:14:00.005-04:00

When staying in place means falling behind. The Centers for Disease Control releases new statistics on infant mortality in the U.S.

Key point: "Increases in preterm birth and preterm-related infant mortality account for much of the lack of decline in the United States′ infant mortality rate from 2000 to 2005."

Look East, Young Idealist

2008-10-14T09:26:00.004-04:00

Polymeme is fast becoming my new favorite source for news beyond the echo chamber. Today's gem, from the Financial Times: "Crisis marks out a new geopolitical order."

There's no doubt economic power is shifting eastwards, as Philip Stephens says. And, I would argue, along with that shift goes the power to set the agenda in global health.