Tuesday, September 26, 2006

Financing the global village’s healthcare. Are we doing enough?

Health economist Ruth Levine (a member of the think tank Center for Global Development) makes an interesting analogy in a recent essay entitled, “A Cure for the Asian Flu.” In the article Ms. Levine notes the global response to economic crises in third world and emerging nations. In this world economy, when Asia sneezes. Wall Street can quickly get a cold.
When these situations arise the US, World Bank, IMF and other entities are there to lend financial support. Ms. Levine’s premise is that such interventions are not charity, but preventive medicines to isolate and ‘cure’ an ailing economy before the red ink washes upon our shores.
The essay proposes that we treat global health problems as we do global financial problems and drastically increase aid. Ms. Levine suggests that spending more on health care for developing nations will act as an investment that keeps such problems away from us.
Agreed. Better healthcare in China equals better healthcare in the West–remember SARS? But redistributing wealth on a grand scale to achieve this goal is not the sole answer. Let’s look at AIDS as a global health problem.
AIDS awareness spending is higher than ever. Few Americans (3% in a recent poll) know that the Bush administration has pledged $15 billion to fight HIV over a five year period ($8.4 billion has already been spent). AIDS is not a new issue, and it must be assumed that most people in the world are aware of what it is and how to prevent it. The good news is that with increased spending we’ve seen HIV infection rates decrease or stabilize for the most part. But despite all the awareness and spending, 40,000 Americans become infected with HIV each year. World wide 14,000 new HIV infections happen everyday, totaling 5 million new HIV infections each year. Money is part of the solution, but not the only solution for this problem.
Sometimes aid is ineffective, and it is not because the donor countries are not giving enough. Economics Professor William Easterly discusses the issue in his book, The White Man’s Burden; Why the West’s Efforts to Aid the Rest have Done So Much Ill and so Little Good, (Penguin Press, 2006), NY Times book review here.

[A tragedy of the world’s poor has been that] the West spent $2.3 trillion on foreign aid over the last five decades and still had not managed to get twelve-cent medicines to children to prevent half of all malaria deaths. The West spent $2.3 trillion and still had not managed to get four-dollar bed nets to poor families. The West spent $2.3 trillion and still had not managed to get three dollars to each new mother to prevent five million child deaths.

… It is heart-breaking that global society has evolved a highly efficient way to get entertainment to rich adults and children, while it can’t get twelve-cent medicine to dying poor children.
Rational people can agree that more should be done to better the healthcare of all who inhabit this interconnected planet. For altruistic or self-centered reasons, those who are blessed with more should share with those who have less. But it is unfair to characterize the developed world in general and the US in particular as uncaring, short sighted and cheap. In a world of limited resources and seemingly unlimited need it is reasonable that donor countries seed money where it is effectively spent. It is incumbent upon recipient nations to make the most of the funding. Frequently governments and individuals, for political and personal reasons, corrupt the process. If Ms. Levine wants healthcare aid to have the same stipulations (e.g. insistance on positive outcomes) as other aid, then I'm all for it. But it should be done intelligently.
In fighting global health issues donor countries can supply some meager tools. It is up to the recipient countries to build the best systems that they can with those tools. Yes more needs to be done, but it is not from a lack of trying by more developed nations.
As Professor Easterly says in his book, judging the success of aid programs by the amount of money spent is like reviewing hollywood movies based on their budgets.

Monday, September 25, 2006


Extensively Drug Resistant TB (XDR-TB) is an emerging killer that is virtually untreatable. World wide, 9 million people contract TB each year, and 1.7 million of them die. Typically TB is treated with first and second line drugs. XDR-TB is resistant to the first line drugs as well as most of the second line drugs. There are no third line drugs for TB at this time. This new strain is found in many countries, including the US. Right now it is preying upon HIV positive patients in South Africa. In one South African ward, 52 of 53 patients infected with XDR-TB died. And they died quickly, within 25 days of diagnosis.

Part of the problem is the nature of South Africa's inadequate health care. 50% of South Africans treated for TB will find themselves back at the hospital again because their treatment failed. The longer these people stay in the hospital, the more likely they are to come in contact with, and contract, XDR-TB. In essesnce, the South African situation appears to be an instance of Hospital Acquired Infection. That's where Ultraviolet Germicidal Irradiation could play a role.

UVGI was a regular method of TB control in the US for many years. Upper room UV deactivates TB and prevents the virulent bacteria from infecting people via the air. As effective drugs were developed, UV fell out of vogue. But UVGI plays a unique role in fighting infectious disease. Virulent viruses and bacteria are programmed to find ways to adapt to medicines that stop them. Over time, drugs lose their effectiveness and contribute to creation of drug resistant microorganisms.

UVGI is a prophylactic barrier. The use of UV radiation to prevent DNA and RNA from being able to replicate is not something that a microorganism can adapt to and circumvent. Of course, certain organisms are more resistant to UV and take a larger dose for inactivation (e.g. spores). However, an organism's suseptibility to UV doesn't change or grow more resistant. Once engineers know the dose needed to inactivate a microorganism, UV systems can be designed with sufficient exposure to get the job done.

So far we are unable to find any reports of the use of UV in South Africa to fight XDR-TB. Given that doctors involved in this crisis say XDR-TB is a nosocomial phenomenon, it would appear that UVGI could help contain a threat that is more immediate and more deadly than exisitng strains of H5N1.

Wednesday, September 13, 2006

Old Flu News is New Again

How did Americans deal with the ‘Spanish Influenza’ outbreak during WW I? The following is taken from a memo by the US Army Surgeon General. It appears as if some of these suggestions remain valid to this day:

Memorandum, Surgeon General’s Office, for camp and division surgeons, September 27, 1918. Personal Defense Against Spanish Influenza. It is desired that the following 12 suggestions for avoiding influenza be given all possible publicity in your camp, by placarding and other proper means of bringing it to the attention of the command.

  1. Avoid needless crowding; influenza is a crowd disease.
  2. Smother your coughs and sneezes; others do not want the germs which you would throw away.
  3. Your nose, not your mouth, was made to breathe through; get the habit.
  4. Remember the three C’s—a clean mouth, clean skin, and clean clothes.
  5. Try to keep cool when you walk and warm when you ride and sleep.
  6. Open the windows—always at home at night; at the office when practicable.
  7. Food will win the war if you give it a chance; help by choosing and chewing your food well.
  8. Your fate may be in your own hands; wash your hands before eating.
  9. Don’t let the waste products of digestion accumulate; drink a glass or two of water on getting up.
  10. Don’t use a napkin, towel, spoon, fork, glass, or cup which has been used by another person and not washed.
  11. Avoid tight clothes, tight shoes, tight gloves; seek to make nature your ally not your prisoner.
  12. When the air is pure, breathe all of it you can; breathe deeply.
If anyone can tell me the link between infection and tight clothes, please do so. The material above is from Office of the Army Surgeon General, Public Affairs, and the Directorate of Information Management, Fort Detrick, Md. Their web site is quite informative.
Image info: Emergency hospital during influenza epidemic, Camp Funston, Kansas.
Source: National Museum of Health and Medicine

Thursday, September 07, 2006

Avian Flu Fighters use GPS for Wild Swan Chase

This is tangential to our normal topics, but it's cool to see how man evolves and adapts to evolving threats from nature--namely H5N1. If you think the first image looks like people putting a backpack on a bird, you are correct. Researchers are carefully attaching tiny solar powered GPS sending units to 10 Whooping Swans.
The swans are migrating now from their homes in Mongolia, to their wintering grounds in Europe. The swans' journeys will be mapped by the researchers who are tracking the GPS information transmitted by the tiny GPS units. The hope is that this information will help is better understand the role that migratory birds play in the spread of bird flu.
These swans were chosen for two reasons:
  1. Highly Pathogenic Avian Influenza has alreadybeen found in this bird, so it could be an infection spreader
  2. Thousands of the swans mysteriously died in Mongolia and China in 2005 and 2006 in areas where few chickens are present.
Check out complete information from the scientists involved in the study by clicking here.
The second image shows a swan heading back into the wild with its tiny GPS backpack. The units are designed to eventually fall off the birds after the migration season.
Let's hope that our knowledge continues evolving just as pandemic threats evovle in the world.

Wednesday, September 06, 2006

Hygiene Expert: Reduce Harmful Bacteria by Changing Your Culture!

A novel idea is proposed by Virologist Dr. John Oxford of the Royal London Hospital. Dr. Oxford suggests that governments can change public hygiene behavior by changing public perception. In other words, let’s treat hygiene issues the same way we’ve attacked smoking and seatbelt use.

A coordinated public PR campaign taught in schools and broadcast as PSA’s could change the way people think about hand washing, house keeping and other hygiene issues. Dr. Oxford chairs the Hygiene Council, a think tank that promotes better understanding of the role microorganisms play in infectious disease. The Hygiene Council is funded by Reckitt Benckiser marketers of such brands as Calgon, Lysol, Woolite and Spray-N-Wash.

The Hygiene Council has just conducted a survey of Canadian hygiene practices that found:
  • 36% of respondents did not properly wash hands after sneezing
  • 37% of respondents didn’t wash hands after petting animals
  • 9% of respondents failed to wash their hands after using the restroom

Back to the war on germs. Oxford’s recommendations are an excellent start to reduce infections such as colds and flu. I see it as an important part of disrupting the chain of transmission, an idea that recognizes infectious disease is an environmental issue which includes all modes of transmission.