Crooked Timber

A kind reader alerted me to an article in last Sunday’s Guardian, on the proposal by the Conservative Party to introduce the Dutch system of Kraamzorg in the UK. As I briefly mentioned in an earlier post, under this system a qualified maternity nurse cares for mother and the newborn child at home in the first week after the birth.

The article gives a fair account of what these nurses do, and of the advantages of this system. Yet I’m surprised by the claim that the system would be too expensive to be introduced. Of course the question is ‘expensive in comparison with what’. In the Netherlands, one reason why mothers who give birth leave the hospital so quickly after the delivery (if they go to the hospital at all, that is), is the cost; a maternity nurse at home is much cheaper than the cost of keeping mother and child in hospital (as is the case in Belgium, for example). I don’t know what the kind of care is that is currently provided to newborns and their mothers in the UK - yet it is self-evident that if the comparison is made with no care for the newborn and mother at all, then the system is relatively expensive. But how under a system of no care at all the mothers can take the rest that they need is a mystery to me. The days that this could be provided by family members are, for most of us, long gone. Hence not a bad plan from the Tories, if you ask me.

There’s a long-standing urban legend about where you meet an attractive person in a bar, they buy you a drink, and the next thing you know you wake up in a bath of ice with a pain in your lower back and a note telling you to get to a hospital. One of the reasons this story is just a story is that in order to usefully extract someone’s kidney for transplant, a whole lot of stuff has to be organized beforehand, and you need to have a lot of skilled people working together against a hard time constraint—too many, really, to quietly and reliably pull something like this off.

On the other hand:

Mr. Mohammed was the last of about 500 Indians whose kidneys were removed by a team of doctors running an illegal transplant operation, supplying kidneys to rich Indians and foreigners, police officials said. A few hours after his operation last Thursday, the police raided the clinic and moved him to a government hospital. … Many of the donors were day laborers, like Mr. Mohammed, picked up from the streets with the offer of work, driven to a well-equipped private clinic, and duped or forced at gunpoint to undergo operations. Others were bicycle rickshaw drivers and impoverished farmers who were persuaded to sell their organs, which is illegal in India.

Although several kidney rings have been exposed in India in recent years, the police said the scale of this one was unprecedented. Four doctors, five nurses, 20 paramedics, three private hospitals, 10 pathology clinics and five diagnostic centers were involved, Mohinder Lal, the police officer in charge of the investigation, said. “We suspect around 400 or 500 kidney transplants were done by these doctors over the last nine years,” said Mr. Lal, the Gurgaon police commissioner.

I’d be interested to see how many suppliers were straightforwardly lied to about what they were getting into, or otherwise forced to undergo operations, and how many were offered money first (and paid afterwards). Unlike some other documented cases of organ sales, this seems less like an illegal but functioning market and more like a criminal racket founded on fraud.

I got an email today from Phillip Coticelli at Africa Fighting Malaria pointing to a study by Donald Roberts (PDF), showing that DDT has a repellent effect in addition to its toxicity. The key finding is that that three out of five DDT-resistant Aedes aegypti mosquitoes avoid huts sprayed with DDT. Roberts argues that this is a reason for preferring DDT to alternative pesticides such as dieldrin. A few points about this are worth making

• First, it’s good to see AFM acknowledging the fact of pesticide resistance, which primarily accounts for the abandonment of large-scale attempts to eradicate malaria-carrying mosquitoes with pesticides. The libel put out by people like Steven Milloy and AFM founder Roger Bate[1], in which it is suggested that the failure of the eradication program was due to a mythical ban on DDT imposed at the behest of environmentalists, who callously caused millions of deaths, depends critically on ignoring resistance.
• Second, although the study is new, the claim is not. Roberts has been arguing the importance of repellent and irritant effects for a long time. And while the reporting of this study suggests that these benefits are unique to DDT, other work by Roberts has found that permethrin and deltamethrin are just as effective in this respect.

How does this relate to the general debate over the use of hut spraying as a strategy to fight malaria?

Continue reading “DDT as a repellent”

Chris Uggen posted this video a few days ago:

I added a link to it on my daily links list where Liz Losh saw it and then included it in a blog post “Just Say Know” discussing all sorts of parody videos and sites related to drug use including the artist-created fictional drug Web site Havidol, and this video:

These are some great parodies. Work in the field of health communication looks at the effects of health campaigns, but tends to focus on serious ones. I wonder what type of work may be going on in the domain of parody viral videos online for similar purposes.

David Denby didn’t like “Sicko” very much. In the New Yorker, he writes:

“Hauling off seriously ill people to a military base where they won’t receive treatment is a dumb prank.”

Okay – I’m not the biggest Michael Moore fan in the world, and I can see how this might rub some people the wrong way.

“Why not tell us what really happened on the trip – for instance, what part Cuban officials played in receiving the American patients?”

Actually, that might not be a bad idea.

“Moore winds up treating the audience the same way that, he says, powerful people treat the weak in America – as dopes easily satisfied with fairy tales and bland reassurances.”

Seems harsh – this is clearly supposed to be a piece of entertaining propaganda – but, again, I can see the point.

“A shift to the left, or, at least, to the center, has overtaken Michael Moore, yielding an irony more striking than any he turns up: the changes in political consciousness that Moore himself has helped produce have rendered his latest film almost superfluous.”

Er, how’s that again? In polls, a majority are in favor of universal health care, so there’s no need to build grass-roots pressure anymore? Same for getting out of Iraq, I suppose.

I am reduced to nicking stuff from Harry Hutton . Oh well. But I couldn’t resist the two quotes from Mark Steyn that he links to. The evils caused by socialized medicine have limits :

Does government health care inevitably lead to homicidal doctors who can’t wait to leap into a flaming SUV and drive it through the check-in counter? No.

That’s a relief. But we shouldn’t get complacent :

… the unloveliness of any British city after six in the evening – the dolly birds staggering around paralytic, the pools of “pavement pizza”, the baying yobboes gagging for a shag and hurling bollards through the bus shelters to impress the crumpet – is a natural consequence of what happens when the state relieves the citizen of primal responsibilities.

As of yesterday, Indonesia has suffered more confirmed human deaths (72) from the avian flu than any other country. (Here are World Health Organization statistics.) In February, Indonesia stopped sending samples of the flu to the WHO. They wanted to prevent drug companies from developing and patenting vaccines that they (and other poor countries) could not afford. In a February story (that I missed at the time), the NY Times reported:

Dr. David L. Heymann, chief of communicable diseases at the [WHO], who negotiated in Jakarta, the Indonesian capital, with the health minister, thanked Indonesia for drawing attention to the problem and said he had been assured that it “would not hold the W.H.O. hostage to the virus,” wire service reports from Indonesia said.
…
Dr. Heymann said that a fund to buy vaccine for poor countries could be discussed at the March meeting and that his agency would help Indonesia eventually develop its own vaccine factories.

At the end of March, Indonesia and the WHO reached an agreement according to which Indonesia would resume sharing samples with the WHO, on the condition that “not share virus samples with commercial vaccine makers without permission from the source country”.

Now, news comes that

GlaxoSmithKline (GSK), Britain’s largest drugs company, is in talks with the World Health Organisation (WHO) about a proposal for a subsidised mass vaccination programme against avian flu for developing countries, The Times has learnt.

Hopefully these negotiations will be fruitful. It seems as though Indonesia has played the game successfully – but what a dangerous game they were forced to play.

Last June I wrote about my friend Havi Carel and her battle with the lung disease Lymphangioleiomyomatosis (LAM). Havi has an article in today’s Independent about LAM and about what it is like to live with a terminal illness and how that changes your relationship to others, indeed, to everything.

Last time I wrote I invited you to sponsor Havi on a bike-ride to raise money for LAM Action which supports patients and raises money for research. This time Kate Gamez and Becky Tunstall are running the London Marathon for LAM Action – so please click on one of their names if you want to sponsor them.

I used to give blood, less often than I probably should have done, but willingly, and without much personal cost. Needles don’t bother me (as long as I am the victim) and whereas I’d feel tired at the end of the day, that was about it. There’s nothing special about my blood, and I’m sure it’s a drop in the ocean, but a recent conversation about why I no longer give blood has prompted me to wonder whether I should start again.

Why don’t I give any longer?

Continue reading “Very Nearly an Armful”

Today is World Aids Day, and UN AIDS reports that another 14.000 children, women and men will become infected with HIV today. This year is 25 years ago that the first case was reported. In those 25 years, there has been a gigantic difference in the impact of HIV/AIDS on the affluent societies versus the poor societies, especially in sub-Saharan African. The life expectancy in some African countries such as Botswana and Swaziland is now well below 35 years. And even these statistics do not reveal the grim reality of children who are growing up without adults, in what social scientists now call ‘childheaded households’. How can a 12 year old girl feed her younger siblings? If there are no neighbours or organisations supporting them, it is likely that her only short-term survival option is prostitution. Long-term survival is something these children simply cannot contemplate.

The theme of this World Aids Day is accountability – not only of individuals who are having unsafe sex (especially those who are infecting others through unwanted sex), but also of religious leaders discouraging the use and promotion of condoms, political leaders of rich societies who don’t give enough money to fight the epidemic, and political leaders in severely HIV/AIDS-affected countries, such as Doctor Beetroot, who are misinforming the population. But World Aids Day is also the day when we should thank the many men and women who are fighting this ugly disease, from grassroots awareness activities up to diplomatic action at the highest level, often in difficult circumstances.

Over at Marginal Revolution, Tyler Cowen has responded to my claim that, once societies have achieved a certain threshold level, continued growth in output doesn’t matter that much (and that inequalities among such societies matter little, certainly when set beside the absolute poverty of the global poor). Tyler writes:

Just as the present appears remarkable from the vantage point of the past, our future may offer comparable advances in benefits. Continued progress might bring greater life expectancies, cures for debilitating diseases, and cognitive enhancements. Millions or billions of people will have much better and longer lives. Many features of modern life might someday seem as backward as we now regard the large number of women who died in childbirth for lack of proper care. Most of all, economic growth limits and mitigates tragedies. It is a simple failure of imagination to believe that human progress has run its course.

I think what is most striking about what Tyler writes here is the way in which he runs together human progress and economic growth, as if they were the same thing. I’ll leave to one side any moralized or perfectionist thoughts about human progress and just notice that there’s a basic distinction to be made between scientific and technological development and economic growth in the sense of increased per capita GDP. Capitalism’s advocates have always had a tendency to equate progress with increased output, but there are other possibilities, chief among them being that output remains constant and people become progressively freed from burdensome toil. Jerry Cohen has some trenchant observations about Max Weber’s enslavement to a Tyler-like view towards the end of his Karl Marx’s Theory of History (p. 321 and thereabouts). If the passage were online, I’d link. But you should all own a copy anyway.

The other thing to note is the way Tyler holds out the carrot of the benefits of medical technology, including “cognitive enhancements”. If scientific progress can come apart from growth in GDP I could just suggest that giving up on growth in one sense doesn’t necessarily require us to forgo such future benefits. (And I could also point to a list of societies that have innovated in medical technology despite not being at the front of economic development: the British invention of MRI scanning in the 1970s being a case in point.) But it is worth noting that the really great advances in longevity (so far) have mainly come from improvements in diet and public health and rather less from hi-tech. Maybe Tyler thinks that all this will change in the future and that we need to incentivize innovators now so that the benefits of “cognitive enhancements” trickle down to ordinary Westerners and then to the global poor. I’m unconvinced.

Review: Jacob Hacker, The Great Risk Shift: The Assault on American Jobs, Families, Health Care, and Retirement and How You Can Fight Back. Available from Powells , from Amazon .

In his ethnography (PDF) of Grover Norquist’s weekly breakfast meetings, Thomas Medved tells us how Newt Gingrich sold reluctant conservatives attending the meeting on Medicare reform. Continue reading “Review: Jacob Hacker – The Great Risk Shift”