MAN, MONEY AND MALARIA

Wait, wait, wait!” I told myself,“You are not going to drive out your readership by talking about malaria, of all things, are you? Write on things you know well, like the bathroom habits of boozed-out businessmen and sober socialites. Write on how bad other doctors are, compared to you. Etcetera.”

wjs-pic.jpg

A recent paper published in the World Journal of Surgery interested me. First of all, the author’s name was familiar. In fact, I had written a blog post on one of his publications and scoffed at his pretentiousness.
This time, however, I wondered what his beef was. What was a surgeon trying to do by publishing an edit piece in the World Journal of Surgery on a very old medical disease like malaria?
My twisted mind told me that this was no scholarly treatise on the disease. Rather, underneath the medical jargon, there was a scathing indictment of Governments and world bodies like the WHO, and a hot story involving money, politics, global warming, the environment, and sex. Okay, not the last, but I thought I should raise your hopes a bit before I proceed.

A global perspective on malaria reveals that:
* It affects around 40% of the world’s population.
* Around 500 million cases of malaria occur every year (about 10 cases per second).
* 1 to 3 million children die of this disease annually. One could translate that to a death of one child every 30 seconds. Most deaths occur among young children in tropical Africa.

The author, perhaps, felt a need to justify writing on this topic:

……why do Third World surgeons and internists care so much for what, after all, is another ‘‘bug’’ for which cures have been discovered and Nobel Prizes long conferred? The question is answered by looking from the past to the future of malaria.
Malaria has defied all the predictions and plans of organizations such as the World Health Organization (WHO) by staging a massive comeback from the brink of extinction during the 1960s and 1970s. According to many public health experts, environmentalists must bear a significant burden of guilt for this owing to their campaign against the pesticide DDT. This agent removed malaria from endemic areas such as the United States (in 1951) before its use was almost banned a decade later for suspected (though unproven) damage to animals and humans. The use of DDT led to massive drops in the number of malaria cases, and the end of its use led to a massive resurgence.

Damn, damn, damn! Someone was actually attacking environmentalists?! WTF?
Actually, DDT was banned after Rachel Carson, in Silent Spring (1962), accused it of a range of dangers to human health (notably cancer), to the ecosystem and to thinning the eggshells of bald eagles. Ted Lapkin claims that “no scientific peer-reviewed study has ever replicated any case of negative human health impacts from DDT”.
He asserts that of all Carson’s charges “the only contention that has been scientifically proved is the thinning effect DDT has on the eggshells of predatory birds”. Several others have trashed Carson’s contention.


Bjorn Lomborg (The Skeptical Environmentalist)
:

Our intake of coffee is about 50 times more carcinogenic than our intake of DDT before it was banned…the cancer risk for DDT is about 0.00008 per cent.

Ted Lapkin:

(DDT is) still widely regarded as the single most powerful weapon at our disposal in the war against malaria and its disuse has been a scandal of public policy.

Author Michael Crichton:

Banning DDT is one of the most disgraceful episodes in the 20th century history of America.

It has even been speculated that the DDT ban (with the resultant deaths from resurgence of malaria) has been a Western ploy to control the population growth of the developing countries.

The environmentalists scoff disdainfully at the opposition, arguing that there are better alternatives to DDT, and that resistance of the malaria parasite to DDT was the main reason the world chose to ban DDT.

Crichton indicts the West, and especially the environmentalists. Take this quote from an article:

For Crichton, the most imperative of contemporary challenges is to retrieve responsible environmentalism from the clutches of those zealots for whom it has become a substitute faith….
“I am thoroughly sick of politicised so-called facts that simply aren’t true. It isn’t that these ‘facts’ are exaggerations of an underlying truth. Nor is it that certain organisations are spinning their case… in the strongest way. Not at all — what more and more groups are doing is putting out lies, pure and simple. Falsehoods that they know to be false. This trend began with the DDT campaign and persists to this day.”

Crichton estimates that between 10 and 30 million poor people of Asia and Africa have died because of aggressive environmentalism.

According to the WJS article, the return of malaria stems from several issues that, in turn, stem from interventionist Government business policies. Weak drug patency laws in Asian (including China, Thailand, and Cambodia) and African countries led to spurious chloroquine (the curative drug for malaria at the time) flooding the markets. The malaria parasite quickly became resistant to the drug. In spite of this, for long years, the WHO continued to push the drug as the main weapon against the bug.

So how much money is needed to fight malaria? The Bill Gates Foundation is at it, as is the WHO with its Roll Back Malaria program.

According to the WHO, around $2 billion per year is
required to halve the disease burden by 2010.

The WJS article quotes studies that trash the premise of this assessment:

Critics assert that public health spending and injection of foreign capital do not result in desired results. Filmer and Pritchett (1999) showed that although mortality in very young children could be massively reduced in the poorest countries by spending only $10 per child, the actual amount spent by governments to spare one child death is an incredible US $50,000 to $100,000. Among the several reasons for this, a couple are worth mentioning.
Public health agencies are inefficient and corrupt, with only a fraction (30–70%) of funds ending up in the community, and aid-financed drugs are sold in the black market. In addition, the presence of free public health
services drives out the private sector, resulting in a slothful monopoly in the health services
, a fact known to the people of Africa and Asia.

So, if pouring tax money on malaria prevention and control is not going to work, what is?
The article ends off lamely by saying:

Malaria, a disease that has survived a million years,
cannot be eliminated unless humankind eradicates what the
American playwright Eugene O’Neill called ‘‘the most
deadly and prevalent of all diseases’’—poverty.

There are very cogent arguments in scholarly studies that espouse a free market society as the ultimate solution to curb the ravage of malaria. The most wretchedly poor and socialist countries are the ones most affected by malaria.

Capitalism (as the most successful wealth-creating system) as malaria vaccine. Some concept, isn’t it?

58 responses to “MAN, MONEY AND MALARIA

  1. I wouldn’t be surprised if this journal guy makes it to the next Shekhar Suman – Siddhu comedy show.
    They used to sprinkle DDT in the water puddles covered with green-green slimy vegetation near my school. DDT, the other day I heard it say, “Mosskutto mai tera khoon pee jaungaa…”

    Priyank,
    Hahaha!

  2. The problem with DDT was overuse, not proper use. Massive spraying led to ecological turmoil. Case in point: Very common here to spray _lots_ of pesticides and fertilizers on Christmas trees. Many wells are contaminated as a result.
    Agricultural education outreach efforts encourage the farmers here to use lower quantities of pesticides and fertilizers. “Weeds” were allowed to grow between the rows of trees, providing cover and food for Christmas tree crop predators.
    I agree that throwing money at the problem does not help dysfunctional, highly corrupt countries. All the money, NGOs, and other do-good efforts have had limited success for decades.
    Based on my understanding, I would support:
    Judicious use of DDT
    Treatment of patients via Directly Observed Therapy (DOTS), as is done for TB, using appropriate combination therapies.
    Pray for local buy-in and political will, so locals can help themselves, rather than waiting for rescuers.
    Signed,
    Crunchy granola tree hugging, but practical, enviro gadfly.

    Jackie,
    The ecological turmoil was the red rag, but was never proven. People died as a result of that scare mongering.

  3. What about polio in India? You think we should leave it to free market capitalists to take out campaigns and go to every village and administer polio vaccine?

    Anand,
    I think Shefaly and Ergo have answered your question. If you notice, the Government has failed to provide potable water to the villages, but Coke has its bottled water even there. Says something.

  4. Doc,

    I’ve known of this for a while. The Ayn Rand Institute has published numerous commentaries and articles attacking this wretched environmentalist ban on the DDT; on the death (or anniversary, I can’t remember) of that evil woman who wrote Silent Spring, the ARI and other pro-reason bodies produced celebratory articles while calling for a reversal of this deadly ban. I would like to say that among the best things to happen to this world was her death, but that would be giving that obscure woman too much importance.

    Ofcourse, ARI is not concerned about the poor or the disease-stricken. Afterall, Ayn Rand–as people claimed–advocated eating babies and exhorted humanity to “Go to the gas chambers, Go!”

    Ridiculous.

    To Anand,

    Yes.

    Ergo,
    Thanks for the comment.

  5. The latest I heard was that they were coming out with a malaria vaccine.

  6. I fail to understand where the $2 billion have been put to use. The number of Malaria cases is as high as ever in the wards. Complications (including death) due to ineffective treatment isn’t anything new. And us students refuse to even present cases of Malaria/Tropical Splenomegaly Syndrome these days, having done it a hundred times already.
    All that aside, the one question that stays is, just where is the money going? I know the obvious answer is red tape and politicians, but there has got to be something more than meets the eye.

    Stopping DDT usage was silly beyond explanation, but last I heard the mosquitoes now have an enzyme that renders DDT useless. Better sewage systems, a stronger civic sense and Guppee fish are the way to combat Malaria, I feel. But when we know how much rot the municipalities are filled with, it’s hard to expect anything more from them.

    Spunky Monkey,
    What you are saying is precisely the issue. Where does the money go?

  7. Very insightful indeed. Thanks to studying about DDT (and its alleged effects) in the late 80s and 90s in my bio text books, I was completely brainwashed into believing all they said, and faithfully mugged up words like Eutrophication for my exams.

    Will definitely do my reading more carefully before I get on my next eco-trip.

    Signed
    Total tree hugger, reva-driver.

    Thanks, Total Tree Hugger! What’s Eutrophication?

  8. Rambodoc: Your fears are unfounded. Writing about malaria has brought new readers and commenters, out of the woodwork 😉

    Evidence suggests that the mosquito net, sometimes impregnated with mosquito sprays, remains the most effective preventative against malaria. However the logistics of distribution are complex and nobody gets to go rah-rah over the several millions being donated because it is a piddly product, requiring unglamorous solutions in logistics…

    DDT I feel is the new thalidomide. Both enjoying a rising tide in their popularity as if everyone has forgotten the past problems with both.

    The buck does stop at the governments in this case, who will be happy of course if capitalistic solutions are proposed because they absolve governments of any responsibility. Poor sanitation (see link on World Toilet conference on the Privy Prop post, for instance), poor planning, poor literacy all contribute.

    A systems approach is needed and DDT being scapegoated is just one aspect.

    @ Anand:

    Same applies to polio. The reasons for its return are manifold. The incidence is concentrated in certain communities (religious, economic).

    The design of vaccines can also cause inadvertent damage – prime boost vaccinations, which require the patient to return to ensure compliance over several doses, almost always lead to lower compliance.

    So in an odd way, capitalism – if it is keen to innovate in the vaccine technology area – may provide the answer.

    @ Nita: You have rightly noted the news about the vaccine.

    For profit making firms, the ownership of patents in case of diseases, where national governments can declare national emergencies and appropriate ownership, is potentially very unprofitable. The Doha Round agreed compulsory licensing provisos very early on. So developing vaccines knowing there is a need but no purchasing power – the definition of market in marketing terms is need backed by purchasing power – is a fool’s adventure.

    Complex partnerships are therefore required to develop such vaccines.

    Prevention ultimately is cheaper, but there being no money-multiplier effect (remember the cubicles post over on my blog?) and garners no headlines. It is also difficult to say before a long time has passed, exactly how many lives were saved.

    Science like all else is enamoured of glamour and headlines…C’est la vie.

    Shefaly,
    Thanks for the commentary. Seriously.
    The funny thing about the insecticide-treated mosquito nets is that they are not feasible to use at the local level. Many Africans have been using them as fishing nets. DDT was cost-effective and was shunned, and Africa suffered.
    BTW, the Government will not be happy to allow capital markets from taking responsibility for all this, because of several reasons:
    1. It goes against their dogma/belief/religion.
    2. It may help them lose elections.
    3. Few Governments like to lose control over anything.

  9. Rambodoc:

    “You are not going to drive out your readership by talking about malaria, of all things, are you?”

    This reminds me of an interesting dialogue from an old Hindi film. Prem Kahani, I think.

    The female lead, Mumtaz, marries Shashi Kapoor although she should have married Rajesh Khanna, who is some kind of activist or something. At one point, she says that she would rather have been Rajesh Khanna’s (character’s) widow than Shashi Kapoor’s (character’s) suhaagan.

    With us readers, it is similar with malaria and your blog. We would rather read your blogpost about malaria than not read your blog.. 🙂

    PS: It is, for some, a tenuous point and may isolate some of the readers who do not have cultural context on this. So please feel free to delete after you have read it. 🙂 Thanks.

    Now that is a compliment! Thank you. I won’t ever delete anything you say!
    🙂

  10. I read your blog mainly because of the health issues you talk about. It’s always very informative.

    So, Marc, that means you miss out on most of the fun topics, eh?
    🙂

  11. I think the issue is quite a bit more complicated than “environmental hysteria kills people.” DDT was largely discontinued because it no longer works against many of the world’s major species of mosquitoes, which have become resistant to DDT. It still works as a powerful repellant and can be effective in places where bites tend to occur indoors (by using DDT to keep insects from entering buildings). But where malarial infection is spread primarily by bites out of doors (as in India and some parts of Africa), DDT offers significantly less benefit because the mosquito populations are resistant to it.

    It can still be very effective, but mainly as a repellant rather than an insecticide.

    Brendan,
    That (DDT resistance) may be true today, though why would the WHO come back to the DDT as one of its main weapons of mosquito control?
    The historic reason for the eradication of DDT was clearly the scare mongered at the time, when it was at its most potent.

  12. //We would rather read your blogpost about malaria than not read your blog.. :-)//
    Shefaly is right.
    what about Dengue rambodoc? Every year there are cases of resident doctors catching Dengue in AIIMS, not to mention the rest of Delhi.
    A couple of years back the Delhi govt started inspection of houses to detect any stagnant water in water coolers and open water tanks. The inspector visited our house and very innocently asked me if there was any stagnant water in the house. I said no and he walked away. If this sort of effort our govt departments make, the results are on expected lines. You need effort to spray DDT which our govt employees are not ready to put. DDT or no DDT you need honest intention to combat Malaria.

    Actually, Prerna, that is a pretty accurate depiction of the Health workers attitude towards spraying (of insecticides) and has been listed as an important cause of failure of the technique.

  13. Rambodoc:

    “The funny thing about the insecticide-treated mosquito nets is that they are not feasible to use at the local level. ”

    AFAIK, the nets are distributed several times a year by some “evil” petroleum companies in Africa. I have some references but I am trying to finish a post on auditory cortex so my brain with its limited resources is kind of stretched… 😦

  14. I thought Shefaly’s argument was ambiguous in its support for eliminating Govt out of the picture..

    In any case, as long as you are convinced that Govt has a vested interest in continuing diseases and Corporates making medicines and basing their profits on sales don’t have a vested interest, there can’t be much argument 🙂

    Anand,
    No company can force you to serve their vested interest by buying their drugs and vaccines. If you do, in spite of hating them for whatever reason, it just means that they have succeeded whilst others have failed. The government, clearly is an instrument of force, while you still have an alternative not to deal with the corporates.

  15. @ Anand:

    When I wrote “So in an odd way, capitalism – if it is keen to innovate in the vaccine technology area – may provide the answer”, it refers only to innovation. Not to delivery of healthcare. With its incipient payer-provider structures. As well as licensing issues related to deemed public health issues.

    I did not advocate a pro-market or pro-government position; I did however point out why certain disease areas are of little or no interest to profit making healthcare product and services firms.

    You can see it as ambiguous; in healthcare, they call it the realpolitik.

  16. Yeah Shefaly, I was just clarifying your ideas to doc. The word ‘ambiguous’ wasn’t used in a pejorative or aggressive way. I completely see your point. In fact, what you wrote would be my response to what doc has written.

    Today people working to bring about quick development see Govts as catalysts. Govt goes where private organs refuse to go for lack of incentive. In some areas, Govt incentivises private sector so they can take some load off our welfare state.

    BTW, doc, Corps also use force. Just see Microsoft. It bundles all sort of crap into a windows system and users have no choice.

    Anand,
    Users do have a choice. Its called a Mac!
    🙂

  17. Great post and I found your blog because you talked about malaria! Good stuff and well presented.

    Welcome, Adventure Doc, and thanks!

  18. I am undecided… dont have much knowledge about DDT or malaria…. I just remember tsomeone telling me that malaria vaccine has some side-effects… no idea how far thats true.

  19. @ Anand: Thanks for clarifying. 🙂

  20. Instead of believing everything in this post regarding DDT/malaria, it’s a good idea to also read the wiki page on DDT, which has a much more nuanced approach and detailed information on this complex issue, and doesn’t seem to view it through a simplistic ideological lens, or resorts to laughingly calling Rachel Carson “evil.” Another source is Tim Lambert’s blog.

    Here’s a quote from Rachel Carson (from wiki):
    It is more sensible in some cases to take a small amount of damage in preference to having none for a time but paying for it in the long run by losing the very means of fighting [is the advice given in Holland by Dr Briejer in his capacity as director of the Plant Protection Service]. Practical advice should be “Spray as little as you possibly can” rather than “Spray to the limit of your capacity.”

    Doesn’t seem to me that she is advocating for a ban – but rather cautious use of a powerful chemical, the long-term health effects of which are not fully known.

    Here’s another excerpt from wiki page:

    Many critics repeatedly asserted that she was calling for the elimination of all pesticides despite the fact that Carson had made it clear she was not advocating the banning or complete withdrawal of helpful pesticides, but was instead encouraging responsible and carefully managed use with an awareness of the chemicals’ impact on the entire ecosystem.[50] In fact, she concludes her section on DDT in Silent Spring not by urging a total ban, but with advice for spraying as little as possible to limit the development of resistance.

    So much for “rationality” from the COWRCC!!! 😉

    Amit,
    What’s COWRCC?
    Rachel Carson was the fountainhead of the environmental activism that started in the US around the ’60s. She has been phenomenally influential in generating the hype and hysteria surrounding DDT. I did not say that she alone physically banned DDT.
    It is important to have moral clarity at least on issues that have a bearing on fundamental issues of life and death.
    The US Government not only banned the use of DDT, but went hard at other countries to do the same. The torpedo effect led to its worldwide ban. India resisted this, and Greenpeace activists gave us a hard time to close down the one plant manufacturing the chemical.

    Regarding Tim Lambert’s blog, it seems he is talking of the current when he talks of Sri Lanka. The focus of the article has been the impact of the DDT ban of the 1960s that led to a resurgence of malaria. Today, mosquitoes may have got resistant, but DDT is only one drug. There will always evolve something else (and has).

  21. “”The ecological turmoil was the red rag, but was never proven. People died as a result of that scare mongering.” END QUOTE

    Perhaps true, but it was pointed out earlier in this thread that DDT resistance was due to _very heavy_ use of DDT – overkill.
    I do not believe our lives are more important than other life forms, and we cannot live without our ecosystems – nature’s capital, if you will (air, water, decomposition, natural resources, food). All provided free of charge.
    Every day, for millions, billions, of years, nature works out a beautiful economics . At the end of the day, the ledger is balanced. Mistakes are weeded out, although not in timeframes we understand. But we have introduced some serious changes in the last even 50 years, that few creatures can adapt to.
    I was not aware that there are people still questioning the DDT connection with the near extinction of birds of prey… and unfortunately, the folks mentioned in your blog have been discredited by their scientific peers. Umm, extinction is forever. There is no danger to the human race, but lots of peril for other creatures.

    One more comment please RE:
    “Capitalism (as the most successful wealth-creating system) as malaria vaccine. Some concept, isn’t it?”
    Agreed – imagine diseases of poverty being eradicated by anti-poverty vaccination! Capitalism works, but must be balanced with serious checks and balances.
    Thanks

    Jackie,
    The resistance was not much of a problem at that time in much of the world. The resistance came later. Why then would the ban lead to a spurt in malaria cases in many countries? The US had eradicated malaria ten or more years before the ban. We are talking of Africa and Asia, where DDT had (and still has) a significant role to play.
    You said, “I do not believe our lives are more important than other life forms”. I disagree. However, the issue is that while that may be a point of view of many, it surely cannot justifiably become public policy, can it? Many people may choose to believe that human lives are most important on this planet.
    As far as capitalism is concerned, I will say that I think (as do many economists) that the free market works better than a controlled one, though even your preferred version is far better than the statist societies that burden most countries.

  22. Doc, part of the reason I love your blog is because I always learn something new — in this case, a positive effect of DDT.

    This makes me wonder if we will ever rid the world of malaria, and just how long it will take. It seems from what you say here that the $2B the WHO claims it needs to halve the disease by 2010 is, realistically, more like something in the trillions. And with so much money and political focus on “worse” diseases like HIV and AIDS, I don’t think it’s at all possible to eradicate the disease within our lifetimes.

    Unfortunately, there’s a tiny gear in the framework of every human being that turns when money is mentioned, and it’s in our nature, however horrible, to extort the world’s health care.

  23. you were right about thinking that malaria would drive your readers away – I rise from the dead after more than a month, and what do I get?!! Malaria?!! 😦 Well, I have to agree it was very informative n all, but how ’bout just your ususal fun wordplay?

    you’re gonna kick me out, aren’t ya? ok, i’ll see myself out. 😉

    Priya,
    Naah! As a South Indian blogger says, “(Comment) pottundu poyeenday irru”, (meaning keep the comments comin’).
    🙂

  24. Pingback: Malaria-A joke,A Poem,A Post « Xntric pundits

  25. Doc, I am a Mac user too, but I still have to use the horrible Word Document, Power Point to read what others send. With its market share, it can pass on any BS as code. And the sad part is there are no elections to logoff Microsoft 🙂

    As a Mac user, its your earned right to despise Microsoft 🙂 It stole many ideas from the original Mac – drop-down menus, mouse organisation etc and won law suits because they were then deemed general items!! It now actively engages in monopolistic practises to kill Linux. If that is not force, what is?

  26. “That (DDT resistance) may be true today, though why would the WHO come back to the DDT as one of its main weapons of mosquito control?
    The historic reason for the eradication of DDT was clearly the scare mongered at the time, when it was at its most potent.”

    DDT resistance first starting appearing in India in 1959, decades before its use was scaled back. Recent studies show that DDT has a very limited and short-term effect on most mosquito populations because the resistance is now expressed very quickly to DDT as a pesticide.

    G. Chapin & R. Wasserstrom, “Agricultural production and malaria resurgence in Central America and India,” Nature, 293:181-185, (1981).

    However, DDT still has a powerful repellent effect, and its use for such is a large part of the reason WHO still endorses it. That use is substantially limited where marlarial problems are primarily due to transmissions that occur out-of-doors. In fact, some studies show that in regions of India where transmission occur outside, DDT use for its exito-repellent effects indoors may actually increase infections.

    Sharma, V. P. (10 Devember 2003). “DDT: The fallen angel”. Current Science 85 (11): 1532-1537. (http://www.ias.ac.in/currsci/dec102003/1532.pdf)
    and Agarwal, Ravi (May 2001). “No Future in DDT: A case study of India”. Pesticide Safety News.

    The “environmentalists suck” meme is a powerful one and I appreciate the appeal, but they aren’t the reason for the shortcomings of DDT.

  27. Anand:

    “If that is not force, what is?”

    Interesting to see that on the one hand you query why private sector does not participate in public health related provisioning and on the other hand you clearly despise a firm that did a better job of commercialising something better than the original nerds who created that something. 🙂

    Damned if they do, damned if they do not.

    Shefaly,
    Tooshay!
    🙂

  28. From the Sharma article I linked:

    “Slowly but steadily, rural mosquito populations (A. culicifacies) evolved to withstand or avoid the killing effect of DDT. That was the beginning of the decline of DDT. As resistance spread, a dramatic resurgence of malaria occurred in the second half of the 1960s and in the 1970s. Malaria in India basically had been a rural disease, and therefore NMEP was a rural malaria control programme. During the resurgence of the disease during the late 1960s onwards, malaria cases were multiplying in the urban
    areas, and the disease was seen diffusing from urban to rural areas that were in the maintenance phase.”

    And that was without a government ban in India on either the agricultural or malarial use of DDT. So environmental hysteria had nothing to do with it. DDT has only a very limited usefulness for combating malaria in many regions and is actually counterproductive in others.

  29. @ Shefaly,

    I never questioned why private sector doesn’t participate in providing healthcare. (In fact it does, right?). I was only saying that Govt. related efforts have a meaningful role today in healthcare (in polio, malaria etc)

    I do despise firms that use practises bordering on coercion though.

    But, I am the devil’s advocate most of the time. Like our ancient scholars said, “Spardhaya Vardhate Vidya”. Friction Brings Knowledge 🙂

  30. Brendan,
    The important reasons that led to the failure of malaria eradication in the 1960s are:
    1. Inadequate spraying by the malaria control workers (inadequate number of workers, low morale and populace being complacent and refusing spraying at their houses).
    2. The Indo-Pak war, with resultant disruption in spraying schedules.
    3. Rise in petro prices leading to shortage of insecticides.
    4. Inadequate treatment of malaria cases.
    5. Migrant laborers and soldiers spread the disease.
    6. Resistance of the mosquitoes to DDT (likely related to inadequate spraying and continued low level exposure- here I am speculating and extrapolating from other examples in medicine).

    So, what was blamed? DDT, an allegedly carcinogenic and toxic chemical. I don’t disagree with the fact that resistance is a factor. However, as you yourself have quoted, the resistance was most with An. culicifacies, which is a less effective transmitter of the disease. On the other hand, An. fluviatilis, which has a greater man-biting rate, is 100% susceptible to DDT. This alone should be reason enough to keep DDT in the NMEP program.
    Of course, this is not to say that other insecticides do not have a role, or did not have one in the past, though DDT is cheaper and more practical. The point is that the environmentalist-led political fight to ban DDT (and there is enough evidence to say this with confidence- please read the history of the process of DDT evaluation in the US Congress) led to the loss of a potent weapon in the fight against the disease, and of many, many lives.
    Another example of the continued role of DDT is underlined by the not very old malaria epidemic in the Kwa-Zulu and other parts of South Africa that appeared just after the Government withdrew DDT from its vector control program. The major vector there, An. arabiensis is totally resistant to the newer (pyrethroid) alternatives that were introduced. The reintroduction of DDT in 2000 (along with the newer artemesinin-based therapy) led to a drastic (80%) reduction in malaria cases, leading the South African Department of Health to identify DDT as the most important factor in the reduction of malaria cases.
    As far as India is concerned, the NMEP has officially had DDT as part of its vector control program. However, the increase has not been as much due to DDT failure as to the failure in using DDT in vast areas of the country. Please also note that DDT is off-limits to the private sector, which spends more on malaria prevention and cure than the Government (4-something billion versus 3-something billion). If the private sector were allowed to use DDT, it is likely that the mosquito control will be far more effective.

  31. “The important reasons that led to the failure of malaria eradication in the 1960s are:
    1. Inadequate spraying by the malaria control workers (inadequate number of workers, low morale and populace being complacent and refusing spraying at their houses).
    2. The Indo-Pak war, with resultant disruption in spraying schedules.
    3. Rise in petro prices leading to shortage of insecticides.
    4. Inadequate treatment of malaria cases.
    5. Migrant laborers and soldiers spread the disease.
    6. Resistance of the mosquitoes to DDT (likely related to inadequate spraying and continued low level exposure- here I am speculating and extrapolating from other examples in medicine).”

    Tellingly absent from your list is a “ban” on the use of DDT. For your argument to be true, the environmental hysteria led to the decline in use of DDT, one of these factors should have something to do with people not using it because of “environmental hysteria.” I don’t disagree that environmentalists widely publicized the notion that DDT was more dangerous that it probably is, but blaming environmentalists for malaria deaths seems like an incredible exaggeration of their role, given that none of the factors on your list that led to the resurgence of malaria in the 1960s and 1970s in India have anything to do with them.

    The three papers I cited all explain that the decline in DDT usage was primarily due to resistance to DDT in the mosquito populations and the resurgence of the disease while DDT was still being used.

    By the way, regarding the WHO’s endorsement of DDT for control of malaria vectors, it is only half-hearted because there is some reality to those environmental concerns. Under WHO guidelines, DDT is only recommended for control of malaria vectors when certain conditions are met: (i) It is used only for indoor spraying. (ii) It is effective. (iii) The material is manufactured to the specifications issued by WHO. (iv) The necessary safety precautions
    are taken in its use and disposal.

    Here are Sharma’s factors for the failure of DDT in India, they overlap with yours to some extent, but like yours, including nothing about environmental hysteria:

    “Summing up, three main factors have contributed to the ineffectiveness of DDT in India. First, the widespread phenomenon of resistance underscores why those launching
    the eradication programme more than four decades ago sensed they had only a few years to eradicate malaria before resistance set in. While in places like Madagascar and South Africa resistance is not a problem; there is overwhelming evidence that it is a problem in India.
    Second, NAMP has been unable to meet the minimum requirements for programme efficacy set out by WHO – the formulation (75% WP) and dosage of DDT (2 g/m2) to be applied in vector control. Indeed, evidence indicates that these factors have profoundly affected the useful life
    of DDT.
    Third, such social and cultural factors as widespread resistance to the spraying of homes reduced the coverage necessary to accomplish the goals of eradication and control.”

    Brendan,
    DDT ban was not in India, but in much of the world. You are talking of this country, while I have been talking about the world-wide picture, where the environmental hysteria was crucial. Not in India, though! I should have seen that we are talking of different things, in a way.

  32. rambodoc, you are a member of COWRCC and you don’t even know it? 🙂 🙂
    You’ll find it here.

    And Michael Crichton as an expert on DDT? You do have a sense of humor. 😉

    It is important to have moral clarity at least on issues that have a bearing on fundamental issues of life and death.
    And why would you assume that the moral clarity is the exclusive domain of “objectivists” alone and no one else in this world? It’s not as if moral clarity was absent in the world before Ayn Rand published her books. 🙂

    I do want to thank you because it made me do all the research on DDT and look up information, even though I may not always agree with your black-and-white take on certain issues. Cheers.

    Cheers, Amit!
    BTW, at this blog, I don’t usually choose to have the last word. Usually my ‘commenters’ do. That is not because their point or mine is stronger or weaker, but that I believe in presenting the issues from one’s perspective and leaving the reader to decide what to believe. I do hope you like that.

  33. Politics. I doubt that there is spending on the level of $50,000 per kid — but there is money available to act. Even with Environmental Defense calling for the Bush administration to allocate some funds for DDT for limited, Rachel-Carson-approved spraying, the Bush administration held on to funds appropriated to fight malaria. Why? Ask them. (Environmental Defense was the first group to challenge DDT use in court, and they won.)

    Bush officials argue that people will be more serious about using anti-malaria tactics, like bed nets, if they have to pay something for them. So, rather than give out the $5.00/net stuff free, they insisted African nations charge at least $1.00 for them. Trouble is, that is more than many of the beneficiary families make in a day. It’s too expensive. A couple of pilot projects under the aegis of the Gates Foundation passed out the nets for free, and saw a dramatic reduction in malaria infections.

    In some ways, curing poverty would help a lot. We eradicated malaria from the U.S. with the help of screens on windows, air conditioning, and draining of stagnant pools around homes. A paved road goes a long way to preventing malaria. If all Africans could afford concrete foundations on their homes, framed houses with windows with screens, and paved roads, it would help reduce malaria. How soon can we make that happen?

    Rachel Carson was right. She didn’t call for any ban on DDT due to human health effects. She pointed out that DDT abuse killed the things that prey on malaria vector mosquitoes. (Is it too much to ask critics of Rachel Carson to at least get right what it was she said?) Carson called instead for programs using integrated pest management, to reduce chemical killing and increase prevention.

    In short, environmentalists have been in the forefront of fighting malaria for more than 50 years. It’s nice of y’all to suddenly get interested, but overspraying of DDT screwed up the malaria control programs 40 years ago, and would do so again. There are many things that need to be done to reduce malaria: Foremost, we need better medical care in nations where malaria is endemic; this is expensive to do and may require retooling entire national economies, but curing people of the parasites is an essential step in breaking the links of transmission. Second, we need governments that are stable and can mount effective, national campaigns to prevent malaria. Having Idi Amin as the leader of Uganda did nothing to get rid of malaria — and it’s unfair to blame Rachel Carson for petty tyrants like Amin — she had nothing at all to do with that. Third, we need good education campaigns, to teach people to avoid mosquitoes, to teach people how to drain pools around their homes, and to teach them how to get the medical treatment they need if they become infected. Fourth, we need money for integrated programs, where DDT can play a small but very important role.

    Rachel Carson stood in favor of all of that, and against none of it.

    Blaming Rachel Carson is one more way of being amazingly ineffective. Is that a legacy we should leave?

    By the way, I am rereading Carson’s book now. I have not found a single study that was not later corroborated, nor a single study that was later proven wrong, in her 53 pages of citations to research and science journals. If anyone knows of one, I’d like to hear about it. I have a lot more on DDT and malaria over at Millard Fillmore’s Bathtub — c’mon over and see.

  34. Oooh. I see Amit beat me to referring to my own blog. How’s that for being shown up?

    Thanks, Amit.

  35. Ed,
    Thanks for commenting.
    I understand the four points you make that need to be done to curb malaria: education, treatment, political instability and money.
    All these are lacking in the malarial regions. I think it would be accurate to list malaria as an index of poverty: the poorer you are, the more you have malaria. The more malaria you have, the poorer you will get (proven studies on GDP and malaria).
    However, the money has always been spent. The educational programs of various States and the WHO has been on for a long while now. Where are the results, and the evidence that any of this approach actually works on a large scale?
    Insecticide-treated nets was always a loser because of the cost factor, as you rightly say. If cheaper options are available, why not go for it?
    As far as Rachel Carson’s Silent Spring is concerned, I have read that in a subsequent 1972 edition the back cover said that while the book was a landmark publication, “It makes no difference that some of the fears she expressed ten years ago have proved groundless or that here and there she may have been wrong in detail”.
    Doesn’t sound like great science to me.
    As far as she and DDT are concerned, are you aware of any case of human cancer due to DDT? Are DDT workers who have been spraying for years more likely to get cancers? I can tell you the answer is NO, but I am not an environmentalist.

  36. Rambodoc:

    “I understand the four points you make that need to be done to curb malaria: education, treatment, political instability and money.”

    How about just one factor – mosquitoes? 🙂

  37. However, the money has always been spent. The educational programs of various States and the WHO has been on for a long while now. Where are the results, and the evidence that any of this approach actually works on a large scale?

    My point was that the money has not always been spent, and surely not always wisely. Bush made a big show of calling for billions in aid for Africa, to fight diseases like malaria. Congress appropriated the money. Bush didn’t spend it. This is especially true of Bush’s pledge to fight HIV/AIDS in Africa, but it is also true of malaria. Politics, not faux science, not fear of science, nothing to do with environmentalism — unless you now argue that Bush is a greenie, in which case we’d know for certain you’ve gone around the bend.

    WHO rather got caught up in the false hopes that mosquitoes could be eradicated as vectors. It took a while to develop a more rational strategy that would work over the long term; the bigger problems have been getting governments stable enough and competent enough to mount anti-malaria campaigns, getting the medical care system up to snuff to treat the disease (remember, the parasites live in infected humans, too — that’s a reservoir for reinfection of the next generation of mosquitoes), and figuring out how to mount campaigns effective for specific areas of specific nations.

    By the way, the U.S. was helped a lot in the eradication of malaria by the fact that vector mosquitoes don’t do well in our temperate climates, nor even in our subtropical climates. This is changing (nothing to do with DDT again). Changing climate also significantly affects Africa, where vector mosquitoes have moved through Kenya provinces where they were previously unknown because of warming climate. Malaria vector mosquitoes are now found much higher up Kilimanjaro due to the warming. Malaria is working hard to reinvade Europe — hold on to your crystal balls.

    Insecticide-treated nets was always a loser because of the cost factor, as you rightly say. If cheaper options are available, why not go for it?

    There is nothing cheaper than the bed nets. Plus, recent studies in Africa show that the “loser” component in bed nets was the Bush administration’s insistence that people pay for them. A Gates Foundation test gave the nets away for free — 70%+ reduction in malaria. The key is to get people to use the nets, and the key to that seems to be to get the nets to them by any means possible. Charging for the nets reduces the effectiveness of the campaign by two-thirds. I have a couple of posts on this topic at my blog.

    DDT does not work without nets, by the way. Ineffectiveness is never cheaper in the long run, and in this case it’s even more expensive in the short run.

    As far as Rachel Carson’s Silent Spring is concerned, I have read that in a subsequent 1972 edition the back cover said that while the book was a landmark publication, “It makes no difference that some of the fears she expressed ten years ago have proved groundless or that here and there she may have been wrong in detail”. Doesn’t sound like great science to me.

    It must have been a pirated edition published by either JunkScience or the tobacco trusts. The claim is absolutely groundless. My challenge is to find one study she cites, out of dozens in the 53 pages of citations, that has been found false. I’m sure there is one at least, but I have not found it, and not even Steven Milloy has been able to cite one.

    In fact, I’m putting up a post shortly at Millard Fillmore’s Bathtub in which I point out how Milloy distorts the truth about studies he cites. Milloy complains Carson was wrong about hatch rates of birds affected by DDT — turns out she was citing fledgeling survival, not hatch rates; in the case Milloy cites, though hatch rates were high, the chicks died within a few days.

    Not only was Carson right on everything she claimed, there is now a solid study showing breast cancer correlations, and we have a problem Carson only hinted at, endocrine disruption, which may be a chief cause of premature menses in humans, but is a major problem for fish, reptiles and lizards, and birds in American estuaries (a recent Washington Post article noted that a majority of male bass in the Potomac were carrying eggs; DDT is one of the chemicals implicated in this bizarre and potentially catastrophic phenomenon).

    As far as she and DDT are concerned, are you aware of any case of human cancer due to DDT? Are DDT workers who have been spraying for years more likely to get cancers? I can tell you the answer is NO, but I am not an environmentalist.

    Carson noted correlations between chemicals and cancer in the book, but she didn’t claim that was a major problem, nor was it the major reason for DDT bans. However, the studies on breast cancer show firm correlations — where the link was thought to be very weak.

    But don’t take my word for it. Check the carcinogen lists of the world’s cancer-fighting agencies. DDT is a known carcinogen in animals, and it is listed as a suspected carcinogen in humans. This should obtain if the only effect of DDT were to mimic estrogen, which we know it does (checked your own breasts lately? About 80% of males who get breast cancer die; plus, DDT shrinks testes in mammals; humans are mammals . . .).

    It’s important to note that the current focus is on the next generation after the exposure. It appears that DDT is not toxic enough to kill large animals outright, like humans, usually. However, it looks as though it can set the stage for cancer in children exposed, and it disrupts the reproduction in the next generation. What we get is infertility problems . . . but of course, infertility is no problem among humans, right? (I’m being sarcastic; infertility is a huge problem among humans now.)

    Since the chief harms that led to the bans were the destruction of beneficial life in the wild, especially the destruction of natural predators of DDT vectors, which leads to a rise in malaria and other insect-born diseases, one would think that people who want to fight malaria would pay more attention to the connections. Whether DDT is carcinogenic to humans is a small factor, and not the deciding one.

    But it’s false to claim DDT is not a human carcinogen. No scientists have claimed that in any study. It’s not so. Every cancer-fighting agency lists DDT as a known animal carcinogen, and as a potential human carcinogen. Every responsible scientist urges reductions in exposures.

  38. I saw something a few posts before about “eradication” of malaria. Even with the use of DDT, I find this to be an impossible task. Smallpox was able to fit the criteria of a disease that can be eradicated. Malaria does not, due to the animal reservoir and insect vector. Control, a lessening of DALY’s and mortality decrease, yes. Eradication, no.

    Great thread by the way, I am learning a lot of new stuff here, thanks!

    Thanks, ADoc!

  39. Doc, thanks for a thought-provoking posting and insightful comments from those who posted. A lot of interesting points were brought up: public health, environmental equity, money, politics, junk science. I’ve grappled with the issue of being one of the well-fed, well-housed, opining what others should do.
    But I have come to the conclusion that:

    1- infectious disease will be with us always. There will continue to be new, untreatable emerging infectious diseases as well. This has always been the case, but as we crowd closer and closer together in some areas, the spread is magnified, and not locally contained, as was in the past.
    2- As a species we are profoundly successful. As our understanding of biodiversity grows, we will better understand the exquisiteness of the interconnections. We are currently still in the Great Sixth Extinction period (http://en.wikipedia.org/wiki/Holocene_extinction_event#The_Ongoing_Holocene_Extinction)
    Species disappearing before we even have a chance to catalog them. Point is: one of these disappearances may be the link that causes ecosystem collapse somewhere, or may be the next great cure for cancer, etc. We must take a long view, alleviate suffering, but also understand that we are here to stay and need healthy ecosystems for our long term survival.
    3. Efforts to eradicate a horrible, treatable disease such as malaria, should continue. What about TB? Talk about a reservoir for future infections! (Worked in TB control, so I understand the prioritisation thing; observed that with our patients that the disease was the least of their worries).
    4. The root cause remains poverty, as you pointed out. Until that is addressed, you will only eradicate one disease to find a new one, especially if environmental degradation allows opportunistic diseases to run amok.
    5. We should not think of ourselves as separate from our world. I believe that is a fundamental mistake, and will cost us dearly if we think we can even come close to replicating what has taken thousands, millions of years to evolve. Try to create a machine that duplicates the complexities of photosynthesis, for example..

    Anyway, we’re all in this together. Thanks again. I’ve learned a lot. Doc, I think everyone has fallen asleep…. 🙂

    Jackie,
    With you around, I am always wide awake. Thanks for a great comment!

  40. Ed,
    Thanks for an informative and detailed comment.
    I welcome responsible environmental awareness and protection. However, I am against the curbing of human activities on the grounds of unproven, hypothetical observations and hypotheses. As far as I know, the number of birds increased after the use of DDT in the US.
    “The success of DDT in controlling insects ensured that vector-borne avian diseases were dramatically reduced.” : The Burden of Malaria, by Barun Mitra and Richard Tren. According to Edwards (1999), fewer plants were destroyed by insects, leaving more bird food available.
    Isn’t the DDT just a potential carcinogen, like everything else (like coffee), almost?
    So, Ed, I do get your point, but there is also little by way of hard evidence to justify a ban.

  41. The number of birds in the U.S., overall, has been in constant decline since DDT was introduced. I don’t think there is a direct correlation to all declines, but I’ll wager you can’t find any reputable source that would argue that the number of birds in the U.S. has increased in the past 100 years, at any time. Eagles have been successfully brought back — but hundreds of other species are threatened or endangered, and are in decline. No source I know of argues there are more birds. I’d love to see a citation, if you can find one.

    DDT worked well in a few places. It was helpful against malaria in the U.S. — but then, the U.S. has money to help fight the disease, too: Americans have frame houses with windows that are suitable for screening, and are most often screened. The U.S. also has climate working in its favor, or did have until 2001.

    Birds eat insects, too. Edwards was quite deceptive like that, using a statistic that appears to support his case, but which is wholly irrelevant to the discussion. DDT did not effectively increase the amount of total plant biomass, either. It was used chiefly on crops like cotton, which die out each season, and which provide no food for birds other than the insects they might get from the plants. (Alas, there is no bird predator in America for boll weevils.)

    The Mitra and Tren paper is highly suspect to me. Tren is a frequent shill for unanchored-in-fact screeds against scientists and malaria fighters who don’t argue for Big Business solutions, and the article is wholly untouched by peer review. As was well established in the 1950s, DDT use contributed to typhus infestations when lice across Asia and Africa developed resistance or immunity to it. When health officials used DDT expecting a dramatic reduction in lice, they got a population explosion instead, probably because DDT took out all the insect and arachnid predators of the lice. That was documented by Carson in her book, and Tren, Bate and their colleagues have had a devil of a time acknowledging the studies — there are no contradictions or refutations of those studies known.

    Their claim is hooey of very high purity.

    I notice you appear as a publisher of the article in some venues. Surely you know the problems with it.

  42. BTW, at this blog, I don’t usually choose to have the last word. Usually my ‘commenters’ do. That is not because their point or mine is stronger or weaker, but that I believe in presenting the issues from one’s perspective and leaving the reader to decide what to believe. I do hope you like that.

    Yes rambodoc, that is very gracious of you, and it doesn’t matter who has the last word. I’m not against progress or development, I’m for progress and development that is well thought-out and sustainable, and takes ecological systems into account, and not just considers them as chairs+tables waiting to be made, or a place to build the next high-rise – without any concern for long-term impact. I consider us humans as a part of the complex web of life on this planet (along the same lines as Jackie), and that’s my angle/bias. 🙂

    Ed, thanks for the informed discussion.

  43. Oh and happy Diwali – I like the theme of removing darkness of ignorance with the light of knowledge/wisdom. 🙂

  44. Pingback: Another carnival of DDT « Millard Fillmore’s Bathtub

  45. WHO calls for spending $2 billion a year. You quote the Wall Street Journal:

    Critics assert that public health spending and injection of foreign capital do not result in desired results. Filmer and Pritchett (1999) showed that although mortality in very young children could be massively reduced in the poorest countries by spending only $10 per child, the actual amount spent by governments to spare one child death is an incredible US $50,000 to $100,000. Among the several reasons for this, a couple are worth mentioning.

    500,000 child deaths per year (conservative estimate) multiplied by the lower figure of $50,000 equals $25 billion, not $2 billion.

    When the chief financial paper of the U.S. gets its numbers wrong by a factor of 10, it’s time to look at everything they say with a high degree of skepticism, don’t you think?

  46. Ed,
    No, you are mistaken. It is WJS (World Journal of Surgery) and not WSJ.
    Furthermore, the Filmer and Pritchett stats relate to public health spending and child mortality, not on malaria per se. Since child mortality in malaria is significant, as you mention, these figures are relevant. Money has been spent in the past and is still being spent, on malaria. The efficacy is of this is for all to see.

  47. I still doubt that spending from developed nations comes to $10,000 per child, let alone $50,000 to $100,000. Do the math. That’s absurd.

  48. Ed,
    Sorry for forgetting to reply.
    Here, read this abstract from the article:
    “We use cross-national data to examine the impact of both public spending on health and non-health factors (economic, educational, cultural) in determining child (under-5) and infant mortality. There are two striking findings. First, the impact of public spending on health is quite small, with a coefficient that is typically both numerically small and statistically insignificant at conventional levels. Independent variation in public spending explains less than one-seventh of 1% of the observed differences in mortality across countries. The estimates imply that for a developing country at average income levels the actual public spending per child death averted is $50,000–100,000. This stands in marked contrast to the typical range of estimates of the cost effectiveness of medical interventions to avert the largest causes of child mortality in developing countries, which is $10–4000. We outline three possible explanations for this divergence of the actual and apparent potential of public spending. Second, whereas health spending is not a powerful determinant of mortality, 95% of cross-national variation in mortality can be explained by a country’s income per capita, inequality of income distribution, extent of female education, level of ethnic fragmentation, and predominant religion.”

    This was published in 2000 in the Social Sciences and Medicine. The authors are not really those who can be dismissed as ‘trash’ or similar.

  49. Allocating costs by child death averted makes the figures sound rational — what that complaint fails to take into account is that $50,000 per averted death may be a wholly rational amount to spend. We mean that we’re treating 20,000 kids, of whom one would die — but we’re also preventing 19,999 infections.

    It’s an apples and steak dinner comparison. If you expect to pay five cents for an apple, a $10.00 bill sounds excessive. But $10.00 is cheap for a steak dinner.

    If they would measure the impact of public spending on public health, instead of just mortality, they’d get a much different figure.

  50. Ed,
    “we’re treating 20,000 kids, of whom one would die — but we’re also preventing 19,999 infections.”

    Ah, if only things were so linear, we wouldn’t still be arguing about them!
    The more you spend, the better should be your results: more kids healthy, less numbers dead, and an overall improvement in health care.
    Unfortunately, none of this is true. Possibly uncountable trillions of dollars have gone down the healthcare drain. Where are we hence?
    Both diseases and deaths have kept on mounting. Not in the US, maybe, but we are talking of Asia and Africa, mainly.

  51. That may be so — but I doubt it. You are alleging that $50,000 per prevented death is a lot. Is it? compared to what? We spend far more than that in the U.S.

    And now you allege that such spending doesn’t mean we’re getting results.

    Just because one has a number doesn’t mean one has measured what is going on.

    Prior to the integrated campaigns, we had 2.7 million deaths per year from malaria. Now we’re at about 1 million. How much are we spending annually? To get 1.7 million lives saved — which is a good total — at $50,000 per life, that would mean we’re spending $85,000,000,000 to fight malaria in those nations.

    But if I recall correctly, the actual number is more like $2 billion, not $85 billion.

    Do you see yet why I think those numbers are suspect?

  52. Jeffrey Sachs said in 2002 that the total spending for malaria prevention was below $500 million annually, from donors.

    http://www.columbia.edu/cu/economics/discpapr/DP0203-11.pdf

    Where are you getting billions?

  53. Ed,
    The document we are talking about is a highly acclaimed, thoroughly documented paper from the World Bank. Just because this paper gives scientific spine to the long held rightist view that public health spending by Governments is mostly ineffective and overly expensive, you choose to disregard its veracity and use the word ‘allege’.
    Let me tell you again that the figures are of public health spending and the costs of reducing child mortality. These include gastroenteritis, malnutrition, and other infections, including malaria. Therefore, neither I nor anyone said that $50,000 per head is being spent on malaria.
    The point was that conventional spend-tax-money healthcare, as your current American Presidential candidates seem to be so fond of, just simply is too expensive in the Third World.
    The corruption eats up most of the money spent. The actual costs may be reduced to $10-4000, depending on the interventions and the disease.
    This is mentioned as an example of how the same may be applied to malaria.
    I am familiar with the linked article. Thanks.

  54. World Bank or no (we don’t put a lot of stock in banks here as authorities — especially banks formerly headed by Wolfowitz — but I digress) there are a couple of issues you’re still not addressing.

    First, why would it be untoward to spend $50,000 per life saved in the third world? The bank, or whoever, throws that figure out as if it is a problem. It’s not. You’ve still offered no comparison to suggest that it’s not too low. So to suggest it’s too high, in the absence of any other figures or valid comparison, just doesn’t cut it. It doesn’t matter that the figure comes from the emperor, when the emperor is nude.

    Second, the amounts claimed to have been spent seem awfully high, even for all diseases, in all countries. I’m reminded of the DDT-nuts’ claim that 500 million people have died from malaria since DDT was banned. That figure has circulated for more than a decade, but there’s absolutely nothing to back it up, and it’s absurd on its face.

    The figure came from a National Academy of Sciences paper. I presume it was some sort of typographical error, since the figure can’t be backed up with anything in the report, and more accurate mortality figures are carried elsewhere. But in any case, it’s cited as authoritative.

    By the figures you cite, we should be spending $85 billion a year to fight malaria. As you know, that figure is 42.5 times too high. Now you point out that malaria isn’t the only disease included — look, that just inflates the absurdly high estimate more. You’re working toward more absurdity, not less.

  55. Ed,
    The comparative figure of $10 to 4000 is given. You might think $50,000 is not a great amount of money to save one life in the Third World, but most people here have not received more than an iota of it. If you lived in Asia or Africa even for a short time, you would realise that the way forward is not more of Government intervention, but less of it. In fact, the private sector largely bears the burden of malaria prevention and care in some countries like India.
    As far as numbers are concerned, you surely know that a lot of malaria statistics are guesstimates, as the magnitude of the problem and the infrastructure of the poorer countries prevents data collection as reliable as in the West. Crichton, who I suppose qualifies as one of your ‘DDT-nuts’, estimates the number of deaths due to aggressive environmentalism to be between 10 and 30 millions.

  56. Crichton’s estimates assume that DDT was effective when its use was stopped, which was the case nowhere that I can find.

    He also assumes that there was a great effort to eradicate malaria that would have been successful in 1970, so he attributes every death from malaria to “aggressive environmentalism.”

    That’s very far from the facts. DDT use against malaria started trending downward in the early 1960s. By the middle 1960s mosquitoes in some locations were completely immune to it (the genetics of this immunity are discussed in lay terms in Jonathan Weiner’s book, The Beak of the Finch, a story of evolution in our time). So Crichton’s assumptions are very wide of the mark.

    Additionally, as anyone who has read on the issue should know, malaria could never have been eradicated with DDT. In the first place, no government in SubSaharan Africa was able to mount a mosquito eradication campaign at the time. DDT was never used against malaria in much of Central Africa. In the second place, mosquito eradication would have left a small pool of the disease in humans, so that if any mosquito of the Anopheles genus survived, it would come back. Fighting malaria works best when people understand it is a parasite disease of humans, and not a toxin borne by mosquitoes. Crichton’s numbers ignore that completely.

    So, yes, I regard Crichton as a DDT nut. DDT is available for use in in indoor residential/residual spraying (IRS — pick your origin for the acronym). If Crichton urges that, then he has come around to the “aggressive environmentalist” view he condemns — and that he condemns that view is only one more indication that he doesn’t know what he’s talking about.

    But if Crichton urges something more, broadcast spraying, then he’s a total idiot.

    Pick your view: Crichton as ill-informed, or Crichton as malevolent, total idiot. Your choice.

    Either way, DDT use beyond current authorization is uncalled for and could be, most probably would be, catastrophic.

  57. By the way, if you know of any private group that does DDT spraying, I’d be interested to hear of it. If you’re advocating DDT use, you’re advocating government intervention. Don’t try to paint me as a totalitarian, authoritarian, or imagined-evil socialist, apart from the facts.

    Malaria is a deadly disease. Crichton and DDT nuts get in the way of efforts to fight it.

  58. good! i’ve made my own blog

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