sicko

Here is the trailer to Sicko, the new Michael Moore movie on the healthcare industry. It's going to be exciting to see so much attention brought to the points we've been discussing all year.

backlog: week 9

I really enjoyed the ideas put forth on the Health Records of the Future video. The video describes a shift from electronic medical records to personal health records to a lifespan planning record that emphasizes a holistic view of health and preventive measures. A lifespan planning record sounds almost too good to be true. It is a complete change in paradigm, considering that I myself have never seen most of my health records, and that they have never contained any information regarding my "economic, social, educational, and spiritual goals", and that it does not utilize prevention in the least. How amazing would this be! However, I am left thinking that if this does come to fruition, would only the rich have access to such records? If this could be provided to all, regardless of race or SES or even residency status... but then that would be part of universal health care (which is another story).

Continuing on the sanitation theme (aka Google has a sense of humor)

I don't know if anyone noticed today, but Google has announced a new way to get free wireless broadband, called Google TiSP (beta). It is innovative, to say the least. As you can see here, once you sign up, you get a package containing all the essentials, including a spindle of fiber optic cable that you flush through your toilet to plug into the "global data networking system".


My favorite part:

In-Commode Package Delivery
With professional installation service, you can also have your Google Checkout purchases delivered directly through the sewage network into your bathroom. Each package comes pre-sealed in a watertight and nanobot-resistant bag made of biodegradable corn-based plastic. For a limited time, TiSP subscribers who sign up for a Checkout account will receive free bathroom delivery on their first ten Checkout purchases.

Also:

How can Google offer this service for free?
We believe that all users deserve free, fast and sanitary online access. To offset the cost of providing the TiSP service, we use information gathered by discreet DNA sequencing of your personal bodily output to display online ads that are contextually relevant to your culinary preferences, current health status and likelihood of developing particular medical conditions going forward. Google also offers premium levels of service for a monthly fee (see below).
Note: We take your privacy very seriously. So we treat all TiSP users' waste-related personal information with tremendous discretion, in accordance with our Privacy Policy.

Ah, the joys of a central sewer system.

backlog: week 8

Regarding the reading from the medical technology session, what struck me the most was a rapid diagnostic that distinguishes between viral and bacterial ALRI (acute lower respiratory infections). This would be amazing, because of the number of people that are receiving antibiotics unnecessarily. This is hazardous both for these people, as well as those that actually need antibiotics but can't get them. I myself have been put on antibiotics many times when it hasn't been necessary, and the havoc that it wreaks on your digestive system is horrible! Not to mention resistence. I think this would be a huge step for both developing and developed countries.

In doing research, I found some interesting things..

Dr. Malamud's research at NYU in oral-based diagnostics
some more saliva stuff
Gates-funded research in point-of-care diagnostics

backlog: week 7

It is ironic that a year ago, I got extremely annoyed when I told a person at a party that I was about to start grad school in public health and he said "You're going to be working with sewers?!" and now I'm writing my topical paper on sanitation. It is more ironic how much I'm interested in it. Ever since watching this UN HDR video, I can't get it out of my head that 2.6 BILLION people don't have access to basic sanitation, and what this means especially for women. Open defecation and flying toilets are unaccceptable in this day and age, yet they are the only options for so many people. This is in such stark contrast to our lives and anything we've experienced...

"Have these numbers lost their ability to shock or even move us? What are the human values in question when we hear, and fail to react to, the news that each day thousands die of these maladies unattended? Where, amid all these numbers, is the human face of suffering? What values might guide our response to such suffering?"

Today I was able to sit in on a presentation by Paul Farmer to a group of doctors at Harbor-UCLA (thanks to someone commenting on Payam's blog about Dr. Farmer's visit to Los Angeles and Farah posting the events on the discussion board).

Some things he mentioned:

- The importance of community health workers in not only developing countries (like Haiti, Rwanda, etc.) but also in the US (!!!!). He mentioned PACT (and here), a new project in Boston that provides DOT to HIV/AIDS patients that have a CD4 count below 150 and drug resistance.

- Applying community-based care to chronic disease(!!!).

- He couldn't seem to stop talking about community health workers and how important and successful they are in increasing treatment adherence (to greater than 90%!). Someone asked about family members providing DOT, and he said that they must be stipended regardless of relation, and that non-family members generally work better.

- (Concerning this week's discussion re Eastern European men) Having worked in Tomsk Oblast, Siberia treating MDR-TB, he said that progress in Russia has been due more to economic progress than anything else. Surprise surprise.

- Trying to make it easier for medical students to focus on global health rather than just having to tack it on to their residencies. A Global Health Equity and Internal Medicine residency program, initiated in 2004 at Harvard, is doing just this. He mentioned other schools that are interested in doing this (UCSF and University of Miami are the ones I remember).

It was so exciting listening to him discuss PUBLIC HEALTH to a room full of INTERNS and RESIDENTS! Talk about shifting the paradigm. Seeing all our theories actually being practiced was thrilling. I began having thoughts of DOT right here in LA. Is it happening right now? We need to find out! I could see it being its own program at AIDS Project Los Angeles. Possible?

All in all, totally worth losing the one participation point from leaving 501 thirty minutes early.

Nutriset and Plumpy'nut

I was really intrigued by Liyan's presentation last week on ready-to-use therapeutic food for the treatment of severe childhood malnutrition. CNN recently published an interesting article on Nutriset, the company that manufactures only treatments for malnutrition. The article reported that Nutriset made $25 million in 2006, mostly from buyers like Unicef. There is a huge market for treating malnutrition, but I guess this shouldn't be surprising, considering that there were 67 million people in 2002 experiencing severe food shortages and thus requiring international food aid.

The good thing is that they put 80% of the profits back into developing more products, and they are working on African franchises (for-profit) that will produce Plumpy'nut locally.

The Project Peanut Butter website also has a lot of information regarding this topic. The organization was formed by Dr. Mark Manary, the author of Liyan's article. What a small world! Or not..

old thoughts...

Public health has so much potential to be effective since it is (or can be) the crossroads for many disciplines (clinical medicine, research, social marketing, entertainment, etc.). As we've discussed, those countries that embrace technological advances and globalization are thriving while those that could not do this are being neglected.
In the same way, public health cannot use the same old techniques for health promotion, disease prevention, and getting the word out and making people listen. On my last visit to the Gapminder website, I saw that they have introduced "Gapminder World 2006, beta" in partnership with Google, where the ordinary internet user can choose to look at the relationships of the variables of their choice (life expectancy, child mortality, income per capita, etc. etc. etc.) for any country or countries from 1960 through 2004. How much more pursuasive than bar graphs and pie charts!
We have such a great opportunity right now to utilize new technologies and marketing methods that are generally reserved for the private sector.

china:africa?

According to a fascinating World Press article, China is stepping up where "American-style free-trade-driven capitalism" has failed. Here are some events that have occurred recently (according to Reuters):

-June 2006 - Beijing says it will give $35 million for building West Africa's biggest theatre in Senegal, in a major forays into high art in Africa. Beijing has also announced debt relief for Senegal worth 160 million Yuan ($20 million).

-Nov. 2006 - China and Africa sign 16 agreements worth a total of $1.9 billion. The deals between 12 Chinese firms and 11 African governments and companies, followed Hu's pledge offering $5 billion in loans and credit, and doubling aid by 2009.

-Jan. 2007 - China says it will lend Africa $3 billion in preferential credit over three years and double aid and interest-free loans, ahead of Hu's latest tour of Africa.
-- On the first leg Hu signs eight accords with Cameroon and cancels its debt to China pledging nearly $100 million.

-Feb. 2007 - Hu arrives in Liberia and signs agreements to donate anti-malarial drugs, cancel more than $10 million in debt owed to Beijing, and waive duties on Liberian exports to China. He also agrees to projects worth $25 million over two years to help Liberia rebuild after the 1989-2003 civil war.

I wonder about the effects these new trade deals will have on the health of Africa's people, especially the very poor.

Way #6: Increasing access to medications

In the article I mentioned in the last post, the author states the following as one way to increase access:

If antiretroviral therapy roll-out does not move rapidly and the main hindrance is cost of medications, then emergency suspension of relevant drug patents and authorization of regional generic production should be initiated.

I first thought that was infeasible, considering the power that pharmaceuticals have, but then I found a Reuters article from today stating that Thailand has done exactly that!

Thailand's army-appointed government has approved generic, copycat versions of Kaletra, an HIV-AIDS drug, and Plavix, a blockbuster treatment for heart disease, in a move likely to outrage international pharmaceutical companies.

"We have to do this because we don't have enough money to buy safe and necessary drugs for the people under the government's universal health scheme," Mongkol said.

10 ways to solve AIDS in Africa

In researching my topical review paper, I stumbled upon this fascinating learning module from the website Clinical Care Options HIV. It's titled "10 Ways to Solve AIDS in Africa" and it goes through the history of HIV/AIDS and specifically case studies in Africa (Malawi). I found one part of it really interesting:

In the few short years I have worked in Africa, there are certain catch phrases that I hear repeatedly by various functionaries in the region. They include sustainability, needs assessment, training, palliative care, and social marketing. These phrases are not necessarily bad ones, but in the context of the global crisis of HIV, they allow the speaker to delay making any actual impact on the epidemic. By preventing programs from being initiated because they might not be sustainable, the funding agency neglects to discuss the issue with the clients. A simple walk to an HIV clinic would get an answer as to whether or not the person with HIV cared whether a program started today might not be there tomorrow. Until President Bush's Emergency Response for AIDS Relief (PEPFAR) program began, most US government donor programs would not pay the salaries of the native personnel. For instance, the United States Agency for International Development (USAID) would pay for training of nurses or a needs assessment as to whether a problem existed or not, but the agency would not pay the salary of a nurse to actually solve the problem. Palliative care, while admirable in a country where there are medications to treat the disease and death results from a failure of such treatment, is obscene in a country where there are no medications. Holding hands and morphine are important but are more expensive than the dollar per day cost of antiretrovirals that would help the client avoid death altogether. Finally, the concept of social marketing is popular in some circles, either with condoms or insecticide-impregnated mosquito nets.[31] Social marketing uses concepts from commercial marketing to plan and implement programs designed to bring about behavior change that will benefit individuals and society. Although there is no question that there is a benefit from such techniques, sometimes this takes the form of putting a nominal charge on an item that the government would like to see used increasingly. The belief is that if a client has to pay for an item, he or she will value it more and will more likely use it. In a country such as Malawi, where income is so low, the success of such techniques is nonexistent. Fewer than 8% of the children actually sleep under a net purchased by their parents under the social marketing program.

(In case you're wondering, these are his ten ways to solve AIDS in Africa:

1. Promote the rights of women

2. Provide testing for all

3. Speak out publicly and personally about HIV infection

4. Eliminate Africa's debt

5. Eliminate corruption

6. Provide access to medications

7. Eliminate brain drain

8. Provide and upgrade infrastructure

9. Revamp systems for providing aid

10. Promote research – consider Africa-specific needs)

Another thing he points out is that Jeffrey Sachs estimates the cost of providing antiretrovirals to everyone throughout the world with advanced stages of AIDS to be $5 billion, while UNDP estimates it to be close to $15 billion. Where is this discrepancy coming from?

continuing the thought

Dr. Calderon said something interesting last week in class. He compared healthcare and fighting diseases to fighting a war. This may seem obvious and redundant, but it has been lurking in my mind since then. And something has become apparent (and not to just me, as you can see in the Voice of America article Dr. Shahi posted). In the same way that we can spend billions of dollars and lose a war, we can potentially spend billions of dollars unsustainably to fight the war in public health. In both endeavors, one must be prepared with a sustainable plan that takes into consideration all the circumstances and is not based merely on ideology.

a silence we can't ignore

This week, the World Press Photo of the Year for 2005 was announced. I suggest everyone take a look.

The photographer, Finbar O'Reilly, said yesterday (on Pat Morrison) that the mother and child are still alive, as far as he knows, but that the child, now two, still cannot walk independently as a result of malnourishment.

This is all our discussions come to life. It is very, very real.

the cost of war, the cost of health...

One of our readings (Institute of Medicine's Microbial Threats to Health: Emergence, Detection, and Response) describes in detail what we need to do to prepare for such threats ("The United States should seek to enhance the global capacity for response to infectious disease threats, focusing in particular on threats in the developing world... The United States should take a leadership role in promoting the implementation of a comprehensive system of surveillance for global infectious diseases..." etc. etc.) and defined the specific roles of various agencies that should be responsible. I loved that it was so specific in its prescription for the future of public health in this country. I feel that I could refer to it again and again. But it was also interesting that in the month that this article came out (March 2003), we began the war in Iraq.

In class this week, we discussed the cost of a rapid-impact package to help fight neglected diseases amongst the poorest people in the world. This "pro-poor" package is estimated to cost US$200 million. Someone brought up the price of the Iraq War, and I found a website (or costofwar.com) that gives the running total of tax-payer dollars going to the war. It is shocking, silencing. When I started this entry, $200 million was 1/1808th of how much we (the tax payers) have spent.

Ironically, the article states, "Despite our past achievements, we have still not done enough in our defense, or in the defense of others." Almost four years and billions (or trillions?) of dollars later, we are still fighting both wars. It is my hope that we can at least turn the tide in the one against infectious diseases.

"The African continent is littered with the wreckage of good intentions -

- international projects that started with pomp and hope and then died as foreigners lost interest. "

This morning I heard a radio piece (as always, on NPR), that began with a story very similar to one Alexis has written about the child in China. A woman in western Uganda had a c-section performed, but the hospital would not give her the sutures necessary to finish the operation until her husband paid for it. He bicycled home, borrowed a baby goat and sold it, but by the time he was back at the hospital, his wife had died. This happened because the hospital only had two sets of sutures left.

It is interesting that along with USAID, one of the people who did something about this situation in Uganda was George Halvorson, who is now the CEO of Kaiser. I was amazed to find how much he (and the program as a whole) has implemented the concepts we were discussing in our second session of class.

First, he believed that charity isn't the answer:

"The people who are being charitable give up, get tired, find a new charity, move on," says Halvorson. "When that happens, the programs die. There's a saying in one of the Ugandan languages... when the white faces leave, the care goes away. We think that's a bad model."

Second, the program hired someone in the community, a Ugandan woman, who worked with the Americans on the program. They worked with farmers in rural areas who already had farm co-ops in place (thus, not reinventing the wheel as we discussed).

This program, called the Uganda Health Cooperative, consists of health co-ops that decides what care they want to provide and collect their own money. Members pay a fee every four months. The total fees are said to be about $29 a year for a family of four.

I guess there are now 30 health co-ops in small towns, one that has even opened its own clinic.

The good things I noticed: The program empowers women, since health care is prepaid. It is sustainable. It is culturally appropriate.

Some problems: The co-ops do not provide treatement and care for HIV/AIDS. Also, the program is looking to find ways to apply this model to the city, which is difficult, as urban populations do not have dairy co-op systems in place.

All in all, this was pretty exciting!

The links:
The story I heard on NPR
The original story from 2002
George Halvorson even wrote a book!
And last, but not least, USAID

Good Jobs, Clean Energy?

What do you guys think about the Apollo Alliance? I recently found out about it through the Tides Foundation. This article on sustainability is extremely interesting and pertinent to our discussions.
"...the logical promise of industrial transformation is that it will lead to better lives for all - improved circumstances and health, greater economic security and brighter prospects..."

I guess all those concept papers weren't a waste.

It seems to me that if there is any field that must utilize systems thinking (which we are all very knowledgeable of thanks to Dr. Calderon) in order to succeed, it is public health. As Dr. Shahi mentioned, a new "21st century" perspective of health demands a holistic approach.

Also, now that I'm researching the topic, it's becoming apparent that the Global Health Leadership track is in essence social entrepreneurship. Wasn't Dr. Calderon's 564 class all about becoming a "changemaker"?

More to follow...

hello everyone!