Global Health Nexus

Long Live The King

"The biggest man you ever did meet was once a baby.": Bob Marley

Couldn't beat it.

Don't Walk on Past

If the subject weren't so completely brutal I might actually be enjoying this.

I am referring, of course, to watching the American establishment press as they twist themselves into knots over the Bush Administration's now infamous torture memos. As it stands for now I will just have to take what I can get.

As the great Glenn Greenwald pointed out last week:

This remains the single most notable and revealing fact of American political life: that (with some very important exceptions) those most devoted to maintaining and advocating government secrecy is our journalist class, of all people. It would be as if the leading proponents of cigarette smoking were physicians, or those most vocally touting the virtues of illiteracy were school teachers. Nothing proves the true function of these media stars as government spokespeople more than their eagerness to shield government actions from examination and demand that government criminality not be punished. (3) The single most sacred Beltway belief is that elites are exempt from the rule of law. Amidst all the talk about how prosecutions would destroy post-partisan harmony and whether torture "works," it is virtually impossible to find any media star discussions about the fact that torture is illegal and that those who order, authorize or engage in torture are committing felonies. That is because -- other than for fun sex scandalsand other Blagojevich-like sensationalistic acts -- the overriding belief of the political class is that elites (such as themselves) have the right to break the law and not be held accountable. Amazingly, when it comes to crimes by ordinary Americans, being "tough on crime" is a virtually nonnegotiable prerequisite to being Serious, but when it comes to political officials who commit crimes in the exercise of their power, absolute leniency is the mandated belief upon pain of being dismissed as "shrill" and extremist. Can anyone find an establishment media pundit anywhere -- just one -- who is advocating that Bush officials who broke the law be held accountable under our laws? That view seems actively excluded from establishment media discussions.

But for all the hedging and vacillating going on everywhere nobody has quite topped Peggy Noonan's appearance on ABC's This Week show last Sunday. It was an absolute classic that will certainly live on in infamy:

Sometimes in life you just want to keep on walkin'

Yup. That's what she said. About official torture conducted by the American Government.

Reminds me of something I heard Stephen Colbert say once:

"Its not that we torture. Its that we're the kind of people who don't torture.".

I suppose when you spend your entire career writing such insipid, treacly, disconnected dross for the oligarchy, as Peggy has, its inevitably going to come back and bite you in the ass at some point. But who would know that it would ultimately happen in such spectacular fashion. I'm sure Peggy didn't get up that morning and think up and plan these words she was going to say. They just kind of fell out of her brain - and as such are even more revealing. Watch it again. Even George Will looks uncomfortable.

I love the way you can literally watch her revert to her old Reagan speechwriting tricks. Dropping her 'g' on 'walkin' to make her sound, I don't know, all folksy-wise. But then after that bombs she tacks right and tries to cultivate that cheap sense of spiritual awe she loves so much. She hushes her voice, and then actually, unbelievably tries to interject that, you know, she thinks- 'some of life has to be mysterious.'. But by then she's deep in total panic - 'perhaps thats not the right word' - she pleads.

That is pretty much the full Reagan oratorical persona right there. It just doesn't work that same magic every time out I guess.

But perhaps I'm being too hard on Peggy, just because I don't love her so. The fact of the matter is that this approach is something that we all engage in all the time with regards to all kinds of things.

I just can't go there, right now. Its spring. Somebody ask me about baseball.

I mean take your pick.

Nonetheless, I do take some comfort that this ones going to follow Peggy around all viral in cyber space for the rest of her days. Just somethin' kinda karmic here. Its a greatest hit for sure. TV giveth and TV taketh away.

So this ones for you Peggy, and in honour of your greatest decade, may we leave you with this classic bit of early eighties righteousness from those classic Canadian rockers - Blue Peter:

FURTHERMORE:

NYR: Mark Danner: The Red Cross Torture Report: What it means

NYR: Mark Danner: US Torture: voices from the Black Sites

Glenn Greenwald

Scott Horton

Wikipedia - UN Convention Against Torture.

McClatchy - CIA Official - No Proof harsh techniques stopped terror attacks on America

Net Present Value

Just in time for tax season.

As I am always on the look out for obscure concepts of one kind or another into which to shoehorn experience - let us for the moment consider Net Present Value.

Net Present Value (or NPV) is a concept that I have been thinking about a lot about lately. It comes to me from my many recent inquires into global mineral laws.

According to the authors of Mining Royalties: A Global Study of Their Impact on Investors, Government And Civil Society Net Present Value can be explained as - the optimal level of taxation:

"The more the government taxes the mineral sector, the greater the share of wealth created by mining that flows to the government. This means, of course, that less of the wealth is flowing to the companies. Therefore, rising tax rates undermine companies incentive to carry out exploration, to develop new mines, and even, if the increases are sufficiently large, to remain in production at existing operations. Thus, one critical issue for pulbic policy is determining the optimum level of mineral taxation. Clearly a tax rate that takes all of the wealth is too high, because it kills the goose that lays the golden egg. On the other hand, a tax rate of zero is likely to be too low, leaving the state with only nontax benefits that flow from mining and mineral production. Somewhere between these two extremes is an optimal level of taxation that maximizes the Net Present Value (NPV) of the tax revenues or, more appropriately, the NPV of all social benefits the country receives from its mineral sector.". (8)

So, two things:

First, I feel that Net Present Value as it is defined here by these well-meaning analysts at the World Bank is a limited concept that comes with its own prejudices and ideological assumptions. Through the prism of Net Present Value one analyzes the world and its minerals purely in financial terms, or that which can be presently quantified.

I guess my question here is whether there are other factors at work that we are not presently quantifying, or are able to quantify. Net Present Value assumes that nothing but "social benefits" can accrue to a country that engages its "mineral sector" provided that country discovers the optimal level of taxation. But what about the "social disruptions"? What about the "social benefits" of not mining at all? What about Net Future Value? These minerals of which we speak are, after all, Non Renewable. I am referring to that which we qualify. And the degree to which we are able to quantify that which we qualify. Or put another way - putting a number value on that which we cherish.

Consider:

I'm broke and I have no job or I may be a subsistence farmer of some kind. I am barely getting by basically, but at least I can take a walk in the beautiful forests and valleys where I live and listen to the birds in the spring just like my great grandparents did before me. And maybe I'm living off this land, but it is an incredibly hard life that comes with its own measures of unreliability and limitations, and I am certainly never getting ahead. Interestingly enough, this area also happens to lay on top some potentially lucrative mineral deposit of some kind. Some foreign company will come and help develop it all for me and my people provided I (we) give them a share of the profits. And ideally, with my (our) share I could maybe build a hospital and or a school, and provide opportunities for my children that I myself never had and my grandparents and parents never dreamed of. But the valleys and the forest will never be the same, if they remain at all. And once the minerals are gone, certainly the company will go to.

(*Note* : Interested readers may notice my own ideological, certainly bourgeois assumptions here in this idyllic 'walking in the beautiful forests and valleys and listening to the birds' image. Oh yes, everything is just hunky dory in the life of your average subsistence farmer - its just a walk in the park, really. As I write this, after all, I know that should I get thirsty all I have to do is walk ten feet from my desk, turn on the tap and I can drink all the relatively clean water I want. My computer seems to be running fine with all the power it needs. I could probably write whatever obnoxious thing I wanted right now and I doubt any jackbooted thugs are going to show up, kick in my door and haul me away. And even if they did and I survived - I could sue. If I have to take a shit I'm fairly confident the indoor plumbing is working fine. And even being Canadian, I know that if I were to step outside right now, get hit by a streetcar and break my leg I would be able to get to the hospital down the street and have it treated without anyone billing me extra. I certainly feel secure knowing I have somewhere to go and they won't turn me away. Pretty sweet really, all that, when you think about it. And we do a lot of mining, in this country and around the world. Almost makes you think there might be a correlation.)

I started to think a lot about this stuff recently after I attended a screening of the great documentary film Under Rich Earth directed by Malcom Rogge a couple of months ago at the Toronto Human Rights Film Festival. Its about the people of Junin, a tiny village in the Intag Valley of northeastern Equador. They are basically a group of small organic coffee and sugarcane farmers who band together to oppose the plans and plots of Mesa Copper (then Ascendent Copper) to mine the Junin porphyry copper deposit which lays beneath their homes. At one point the company goes so far as to hire this collection of freelance paramilitary thugs to come and try and intimidate these villagers. But the villagers stand their ground. They fight back by not only filming these confrontations but by ultimately, eventually 'arresting' this wayward mercenary crew themselves. They then marched them into town, locked them up in the church, and called the government and the international press.

The film was riveting and captured perfectly many of the issues involved in these kind of conflicts we see going on all over the world. And lucky for me during the screening I attended a couple of the activists themselves, including Carlos Zorilla , from the organization DECOIN - the group that originally opposed and organized against the mine - were on the premises. They just happened to be in town filing a one billion dollar lawsuit against the Toronto Stock Exchange and Copper Mesa - so they were kind enough to make themselves available for questions afterward.

Somebody asked them if, even after everything they had gone through, would they ever look to develop the Mine themselves? Provided they could do so in such a way they felt adequately addressed their environmental and equity concerns?

They took a moment, before answering - 'no'.

They explained that they saw themselves primarily as stewards of the land whose ultimate responsibility lay in handing it off to their children as they themselves had found it. Zorilla himself explained that 60% of the world's minerals go to 15% of the world's population and then they are gone. It was, according to him, a manner of doing business that was not only unjust but totally unsustainable - so why would he want a part of it? He pointed out that the stock exchanges of Canada are amongst the easiest places in the world to raise money for this kind of enterprise. He then asked poignantly why we didn't just leave them alone.

Good question.

For me it was another reminder that not everyone wants what we necessarily think they want. i.e. - they may not want to be like us. But they certainly deserve our respect.

And second, I kind of like this concept of Net Present Value - in that I think I can now go and apply it to a whole host of other issues.

Broadly taken I imagine Net Present Value as representing compromise. Just how much are you (dear reader) prepared to give, or give up, in order to get what you want and need. The perfect balance in this particular equation would be your Net Present Value.

FURTHERMORE:

Mining Watch Canada

World TB Day - 2009

This years World TB Day readings come from today's Globe and Mail:

First from national chief of the Assembly of First Nations Phil Fontaine:

Today, on World TB Day, Canada can - and should - celebrate its leadership in fighting tuberculosis abroad. In addition to the $30-million Canada invests in international TB control each year, it recently committed $450-million to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

TB control is a sound investment that provides health and economic benefits. The Copenhagen Consensus 2008 diseases-challenges paper noted that a $19-billion investment in TB control could generate a net gain of $1.7-trillion in wealth in the global economy by increasing the number of healthy workers.

What works for the global economy can work for Canada. Canada, however, is failing to reduce TB rates right here at home. Without new efforts, Canada will fail in its commitment to the United Nations Millennium Development Goal of halving domestic TB rates by 2015.

First Nations are among the most vulnerable for this preventable disease, with infection rates 29 times higher than the rest of the population - rates that have not decreased since the 1990s.

And the other story about an upcoming clinical trial funded by Canadian Institutes of Health Research:

Canadian researchers are about to embark on a quest for an answer that could make treating latent tuberculosis a lot easier and, it is hoped, more frequently successful.

Led by McGill University's Dick Menzies, they are on the verge of launching an international clinical trial to see if latent TB can be treated as effectively with a drug regime that takes less than half the time and may pose a lower risk of serious side-effects than the current standard of care.

"The study is very much needed," says Michael Gardam, director of the tuberculosis clinic at Toronto Western Hospital, who was involved in a pilot study but is not taking part in the clinical trial.

The clinical trial, which is being funded by the Canadian Institutes of Health Research, will be announced today in Montreal.

Nearly 6,000 people with latent (inactive) tuberculosis will be enrolled in five cities across Canada as well as in the West African countries of Benin and Guinea, and Brazil, South Korea, Australia and Saudi Arabia.

Half will receive the current regimen used to try to cure latent TB infection, once-a-day treatment with the drug isoniazid for nine months. The other half will receive the drug rifampin for four months.

Both groups will be followed for 28 months from recruitment to see how many go on to develop active TB - which should tell if rifampin is as efficacious as isoniazid. Dr. Menzies says the study will take about seven years.

FURTHERMORE:

Stop TB Partnership - World TB Day 2009

Let the Girls go to School.

Class Dismissed in Swat Valley

Hellfire: Welcome to the Neighbourhood

The first killing
missiles
of the New Administration
came raining down
from the sky
somewhere over the Federally
Administered Tribal Areas

And President Bartlett
turned to Leo
just past midnight
while they pondered
the coming assassination:

'But violence is impractical because it is a descending spiral
ending in destrucution for all'

'Ah, Dr. King' - said Leo.

'Dr. King wasn't wrong he just never had your job.'.

'Sounds like you're talking about a monster'-
the young student said to Nixon
just past midnight, at the foot
of the Lincoln Memorial

That stopped him. And haunted him
for the long moment it took
to truly take it in. And then never stopped, really

'Maybe I am', he answered.

(P.S. - Bless you Hollywood, for leaving me so prepared)

At Last

Naomi Wolfe in The Guardian: No More Fake Optimism for the People :

The great leaders in the US weren't the cheerleaders who promised ­morning in America. They were the ones that forced us to look in the mirror. Since Reagan there has been this tradition, which has become a cliche, of promising morning in America, this fake optimism, we're the best, the city on the hill.

In fact the great American task is self-scrutiny. Abraham Lincoln gave speeches about the civil war in which he said, in essence, "We've brought this on ourselves by enslaving Americans." Obama's speech was a diagnosis: "We have to take steps to rebuild our nation." I'm not saying, "Hooray, he offered a tough, dark recognition of our reality." I'm saying "Hooray" because he has recognised that the only way to save America is to confront it.

Stay tuned. Who knows what could happen.

Obama suspends Guantanmo Bay war crimes tribunals, and the sun hasn't even come up yet.

Year 2 AJB

In keeping with this great tradition we started here last year- marking new time by all these years post James Brown's death two years ago on Christmas Day - we here at GHN would like to wish everyone a Happy New Year - the year of our lord - Year 2 AJB.

Can't you feel it? Give it a try.

For when this thing finally catches on you'll remember where you heard it first.

Harold Pinter

"It never happened. Nothing ever happened. Even while it was happening it wasn't happening. It didn't matter. It was of no interest.".

The text of his above 2005 Nobel Prize acceptance speech, which I will admit I had never watched nor read until tonight, after I heard he had passed:

Political language, as used by politicians, does not venture into any of this territory since the majority of politicians, on the evidence available to us, are interested not in truth but in power and in the maintenance of that power. To maintain that power it is essential that people remain in ignorance, that they live in ignorance of the truth, even the truth of their own lives. What surrounds us therefore is a vast tapestry of lies, upon which we feed.

A writer's life is a highly vulnerable, almost naked activity. We don't have to weep about that. The writer makes his choice and is stuck with it. But it is true to say that you are open to all the winds, some of them icy indeed. You are out on your own, out on a limb. You find no shelter, no protection - unless you lie - in which case of course you have constructed your own protection and, it could be argued, become a politician.

Guardian obit from Michael Billington

UPDATE:

Johann Hari in the HufPost: "Pinter doesn't deserve it.".

"He absolutizes.". Defended Milosevic. etc.

And the debate goes on.

RTS,S/AS02 = hope for a malaria vaccine

NYT:

Researchers have been trying for more than 70 years to develop a vaccine against the elusive malaria parasite without notable success. Two studies conducted in East Africa suggest that they are finally closing in on their goal.

The Bill and Melinda Gates Foundation deserves huge credit for enabling this research to go forward when the drug manufacturer was unwilling, on its own, to take the financial risk to try to develop a vaccine.

The new studies showed that the most advanced candidate vaccine — made by GlaxoSmithKline — cut illnesses in infants and young children by more than half and could safely be given with other childhood vaccines that are already routinely administered throughout Africa. The results were published in The New England Journal of Medicine, along with an editorial that called the vaccine’s performance a “hopeful beginning” toward prevention of the disease.

There is no guarantee of success. The studies were carried out in areas with relatively low transmission of malaria; no one knows if the vaccine will work as well where malaria is more rampant. And the vaccine must still undergo much larger trials next year.

Even a vaccine that is partially effective could save hundreds of thousands of lives a year. It would bolster the gains already being made by insecticide-treated bed nets that prevent mosquitoes from spreading the parasite and by malaria pills to treat sick patients.

That the candidate vaccine has gotten this far is a tribute to the power of charitable contributions to generate and sustain industrial interest.

Glaxo had been funding development of a vaccine aimed at military personnel and travelers but was unwilling to undertake pediatric studies unless a financial partner could be found. That’s when the Gates Foundation came to the rescue. It has pumped in $107.6 million so far. Glaxo says it has spent about $300 million and expects to invest $50 million to $100 million more to complete the project. If all goes well, the vaccine could be submitted for regulatory approval in 2011.

FURTHERMORE:

NEJM - A hopeful begining for Malaria Vaccines

MVI/Path (Malaria Vaccine Initiative)

UN Dispatch - Malaria Vaccine explained

NothingButNets

Wikipedia - Malaria Vaccine

Bill and Melinda Gates Foundation - Malaria Page

The Lancet - November 3, 2007: Safety of the RTS,S/AS02D candidate malaria vaccine in infants living in a highly endemic area of Mozambique: a double blind randomised controlled phase I/IIb trial

GlaxoSmithKline Press Release

EVEN FURTHER STILL:

Malaria Atlas Project

Plos Medicine: The Malaria Atlas Project - Developing Global Maps of Malaria Risk:

(T)he evidence base for allocating resources for malaria control on a global scale is poor.

National reporting on malaria continues to be fanciful; Kenya, for example, reported only 135 malaria deaths in 2002 to the World Health Organization [3]. In addition, less than half (22/49) of the malaria-endemic countries in Africa provided information for the most-recent reporting year, 2003; the rest were older [3]. Information on the global burden of malaria remains the subject of best guesses rooted in national reporting systems [3], informed estimation based on epidemiological data linked to historical malaria distributions [4], or unvalidated models of malaria distribution in Africa [5–7]. As a corollary, resource allocations for malaria interventions remain driven by perceptions and politics, rather than an objective assessment of need. This status quo is untenable when global and national financial resources must be defined to meet needs for new, expensive antimalarial drugs and commodities to prevent infection, and to ensure that these interventions are optimally targeted.

It has been almost 40 years since the last global map of malaria endemicity was constructed [8], and a decade since the need for maps of malaria transmission in Africa was first advocated [9]. Although substantial progress has been made [10–21], an evidence-based map of malaria transmission intensity for Africa remains illusive, and there have been no recent efforts to construct a credible evidence-based global malaria map.

A New Mapping Project

The primary goal of the recently launched Malaria Atlas Project (MAP) is to develop the science of malaria cartography. Our approach will be first to define the global limits of contemporary malaria transmission; we have initiated this process [12,13], but will substantially refine these layers with additional medical intelligence in future years.

Within these limits, we plan to then model endemicity using a global evidence base of malaria parasite prevalence. This Health in Action concentrates mostly on how we intend to achieve this important goal. Once we have created these global endemicity maps, these will then provide a baseline to facilitate estimation of populations at risk of malaria and more-credible predictions of disease burden. These maps will also provide a platform to help target intervention needs, and may provide a means to measure progress toward national and international malaria public health goals at a global scale.