Freewheel Burning

In this week’s Lancet, Christopher Murray published a paper presenting evidence that deaths due to malaria are vastly higher than “official” estimates from the World Health Organization. Specifically, Murray, et al. estimate that worldwide malaria deaths, though declining over time, exceeded 1.24 million compared with the WHO’s estimate of more than 600,000.

Most notably, the Lancet paper speculates that adult deaths from malaria are far higher than previously though, contradicting accepted medical ideas that immunity increases with age, freeing adults from the risk of mortality.

Murray’s paper is not without precedent. In 2010, Dhingra, et al. also called the WHO’s estimates for malaria mortality in India into question, estimating between 125,000 and 277,000 deaths were due to malaria, far exceeding the WHO’s extremely reassuring estimate of 15,000.

That malaria deaths are down worldwide is an uncontroversial notion. The wide discrepancy between published estimates of the worldwide burden of malaria mortality is, however, highly controversial. Overestimating mortality can stream precious monetary donations, most notably from big players such as the Global Fund, needlessly toward malaria, at the expense of other health concerns such as TB and HIV. Underestimating the number of deaths from malaria, can leave countries short changed and unable to fight their own malaria related problems.

Either way, controversy as to the accuracy of reporting dishevels confidence and could provide more fuel to those who advocate for reductions in global aid to fight developing world health problems (read: all of the current Republican candidates) and distract from the creation of efficient policy.

What is needed, of course, is accurate reporting and a reliable flow of health information worldwide. Many developing world governments, however, lack the resources to efficiently provide these numbers. World aid bodies, however, have, to date, missed this essential piece and reporting methods remain antiquated in many areas.

I just visited a facility in Kenya, where records are still kept on paper, and left to mildew in an unused toilet (I kid you not). One could assume that if the records were left in a functioning toilet, the numbers might end up at the bottom of a pit latrine. With the base of the worldwide reporting system in such a shambles, how can we expect accuracy in reporting?

New estimates of malaria deaths: concern and opportunity
[The Lancet, Volume 379, Issue 9814, Page 385, 4 February 2012 doi:10.1016/S0140-6736(12)60169-X] — (English)

This week we publish surprising and, on the face of it, disturbing findings. According to Christopher Murray and colleagues at the Institute for Health Metrics and Evaluation
(IHME) at the University of Washington in Seattle, there were 1·24 million deaths (95% uncertainty interval 0·93—1·69 million) from malaria worldwide in 2010—around twice the figure of 655 000 estimated by WHO for the same year. How should the malaria community
interpret this finding? Before we answer that question, we need to look beneath the surface of this striking overall mortality figure…

Global malaria mortality between 1980 and 2010: a systematic analysis [The
Lancet, Volume 379, Issue 9814, Pages 413 - 431, 4 February 2012 doi:10.1016/S0140-6736(12)60034-8] — (English)

We systematically collected all available data for malaria mortality for the period 1980—2010, correcting for misclassification bias. We developed a range of predictive
models, including ensemble models, to estimate malaria mortality with uncertainty by age, sex, country, and year. We used key predictors of malaria mortality such as Plasmodium falciparum parasite prevalence, first-line antimalarial drug resistance, and vector
control. We used out-of-sample predictive validity to select the final model…

 

WHO Defends Its Numbers On Malaria Deaths [Voice of America (blog)] — (English) The World Health Organization is defending its numbers on global malaria deaths and disputes a new study claiming that nearly twice as many people die of malaria than previously believed……

Malaria death toll disputed [Nature] — (English) Study doubles official estimate, but scientists say its methods are flawed……

Malaria deaths higher than expected, study finds [Deutsche Welle] — (English) The latest findings show that the number of malaria-related deaths is nearly twice as high as previously thought. But other experts have doubts about the methods used to produce these estimates……

Malaria deaths hugely underestimated – Lancet study [BBC News] — (English) Worldwide malaria deaths may be almost twice as high as previously estimated, a study reports……

Malaria kills twice as many as thought: study [Reuters] — (English) Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the mosquito-borne disease……

Malaria kills more people worldwide than once thought, study says [Los Angeles Times] — (English) In an alarming statistical turn, the number of malaria deaths every year may be vastly underestimated, according to new research re-examining mortality rates from 1980 to 2010……

Malaria deaths may be double WHO estimates [Financial Times] — (English) Worldwide malaria deaths may be almost twice as high as previously estimated, according to a new study that has sharply divided scientists tackling one of the world’s most deadly diseases……

Malaria death toll possibly twice as high as experts estimated [AP via FOX News] — (English) Malaria may be killing around twice as many people as experts previously thought, and it could also be hitting older children and adults – long considered the least susceptible – a new study suggests……

Malaria death toll possibly twice as high [USA Today] — (English) Malaria may be killing around twice as many people as experts previously thought, and it could also be hitting older children and adults – long considered the least susceptible – a new study suggests……

Malaria Kills Nearly Twice as Many People Than Previously Thought, but Deaths Declining Rapidly [Science Daily] — (English) Malaria caused over 1.2 million deaths worldwide in 2010, twice the number found in the most recent comprehensive study of the disease, according to researchers at IHME and the University of Queensland……

Malaria kills more people, older people [Washington Post ] — (English) A new study found that twice as many people die of malaria every year than was previously thought and that it kills many adults as well as young children……

 

 

Kibera is one of the biggest slums on earth. Out of 5 million people in Nairobi, up to 1 million (the number depends on who you ask) live in Kibera making it larger than even supposedly big American cities such as Detroit, MI.

Like slums everywhere, Kibera’s resident flow in from all impoverished areas seeking job opportunities and better lives for their desperate families. Like slums everywhere, Kibera plays an important role in Nairobi’s economy, serving as a source of cheap labor specifically in the manufacture and distribution of hand fabricated goods and migrant agricultural work.
Like slums everywhere, the greater economy depends on keeping the area poor. Public services are sparingly doled out, just enough to keep the residents from rioting, but not so much that the prices of goods coming out of Kibera will rise.

Public sanitation is the greatest challenge in the area. There exists no effective method of handling the large amount of human waste and trash that the area produces. Households will leave waste outside their doorways, where it eventually gets burned or washed away by the rains. One group has created public toilet facilities that composts the waste and uses the methane discharged to allow for cooking by residents. Other public pit latrines are visible in the area, but they are, as yet, too few in numbers to effectively serve the demands of the large numbers of local residents. It is important to note that toilet facilities are not free. If households do not have the money, they will not use them.

Clean water is in plentiful supply, but carefully managed through a system of gouging the public system. The city has run a haphazard series of municipal water pipes through Kibera. Residents either legally or illegally tap into the pipes and then sell the water to other residents. If the tap is legal, the resident must pay a fee to the city. All taps, legal or no, charge for their services. Locals imply that this is merely the market capitalizing on a surrounding demand, but the reality is that the poorest of households cannot afford the water fees. They either illegally procure water from unmanned taps or fetch water from the river which is polluted with human filth. The result of this commercialization of water resources is that poor households have no access to clean drinking water.

Health services are mostly unavailable to resident outside that which is provided by proactive NGOs and private clinics. Though health services are available at low costs from government run clinics, the nearest facility is too far away. I spoke with Elizabeth Akinyi of the “Power Women Group,” a community based organization which supports HIV positive women by selling handmade goods to tourists. She said that anti retrovirals (ARVs) are available from the public clinics, but that the clinics are so far away that even the sickest will not attempt to make the journey. Thus, HIV positive residents depend on the good graces of donor agencies and NGOs to provide medications. Medications, however, are not free so the revenues from the groups store are essential to keeping these women alive and, as they put it, “living positively”.

It should be obvious that the greatest challenge to poor Kenyans is being able to bear the costs of services. As one person told me, “in Kenya, the only thing free is the air.” In addition to water, the city provides power to some parts of Kibera, which also must be paid for. Homemade television antennas can be seen over just about every household. Every once in a while, one can see a satellite dish. Public schools exists, but slots are too few to accommodate all of the children in Kibera, so many go without. Local groups have stepped up to attempt to provide basic education to children but without formal education, the children of Kibera have little future.

All of this, however, should not distract from the incredible resolve of Kiberans to make a better life for themselves. Everyone in Kibera has some kind of business. Street sellers, small fabricators and small businesses are to be seen everywhere. Some follow western models of individual entrepreneurship such as that of the owner of “Apokolipto Cinema” a small DVD theater that runs showing of bootleg horror and action DVDs from morning to night. Many of the larger operations, however, do not. Employee owned fabrication groups produce products for sale in Nairobi, but split profits amongst themselves and provide for school fees of employees’ children such as that of Kibera Jewelry, who make necklaces and other goods from recycled bone products. Kibera tours, the group that allowed me to visit the area, is a mixture. Though owned by one entrepreneur, the success of his tour depends on cooperation with local groups. Profits from his tour group are split between himself and the groups who participate.

It could be said that unemployment is rampant throughout Kibera, but then it could be said that not a day goes by where Kiberans are not doing something to make some money for themselves. A lack of access to capital and dependable city services, however, prevent the area from reaching its true potential.

I’m going to tell a story. My uncle is 52 years old; that’s ten more years than I. When I was a kid he would introduce me to all kinds of amazing 70′s rock and psyche records. My uncle, like much of my family, is mentally ill.

Specifically, he fights severe depression; though through medication, he has been able to maintain a minimal standard of living and assisted my grandfather through his arduously long passing. Like many caregivers, his efforts are little appreciated nor recognized.

After my grandfather passed, my uncle had a job but lost his health benefits. Unable to obtain a new prescription for his depression meds, he started self-medicating through alcohol. Most people in his family are addicts. Little understood is the role that depression plays in addiction. Without anti-depressants, my uncle will drink almost constantly.

Recently, I went to see him. He looked nearly 20 years older than his actual age, was incontinent and hadn’t eaten in nearly two weeks. He subsists off calories from beer. I left heartbroken.

Six weeks ago, I received a call that my uncle had been admitted to the ICU. He had a stroke while buying beer at a local convenience store, fell and fractured his skull. Somehow, he managed to walk home and locked himself in his house. Someone found him and brought him to the hospital, where he was operated on for a brain hemorrhage. He then later had second stroke, fell again, and had to have the surgery once more.

My uncle has since relearned to walk, but has no use of his hands. I must stress again that he has no health insurance. The hospital discharged him since he could not pay. Now, he lives alone in his house, with no power, heat, nor food, he is barely mobile and will never be able to work again.

I tell this story because it fills me with rage. The Republican Party would happily let my uncle die. That we live in a country where basic health care is available only for the rich, and requirements that everyone enter into some kind of health plan are viewed as “Hitleresque” fills me with an indescribable rage. It’s almost cliché to point out that we live in the wealthiest country on the planet (by GDP), yet still can’t seem to figure out how to provide for the health of all of our citizens.

By far, out of all of the Republican candidates, , Ron Paul has the worst suggestions for what to do about the uninsured, let alone what to do about health care in the United States. He believes that insurance companies should be allowed to insure whomever they wish. That no one should be forced to pay for the health care of another individual. That hospitals should be allowed to decide whom to exclude treatment to.

Paradoxically, he believes that the solution to the problem of health care in America is to shift the burden of cost to doctors themselves. He believes that doctors should volunteer their time and resources to assist the poor so that they will stop troubling the rest of us.

Presumably, he’s never asked doctors whether they like working without being paid. Or that most of the cost of health care is for materials and services that do not involve the practitioner. Nurses, for example, are they to work without getting paid as well? Are doctors merely to absorb all the costs of care from their own incomes? If they pass these costs on (as they are now) to other patients, does that not also violate Paul’s ideas of forced remuneration from those who have? Paul, though, waxes nostalgic on health care pre-1965, ignoring the fact that health care was less complicated, less costly, less effective and less accessible in the good old days. But then we should expect no less from bull-headed Ron Paul.

Even worse yet, Paul believes that one of the solutions to health care in the United States is to support “alternative therapies,” such as as vitamin therapy, a movement that believes that massive doses of vitamins can cure cancer. Maybe he also supports aromatherapy?

He even fans the flames of a vast government conspiracy to control the supply of vitamins. What a great idea! It’s cheaper than surgery, and even cheaper than chemo! In Paul’s massively unrealistic world, if the vitamins don’t work, then there will always be a kindly doctor willing to step up and provide multi-million dollar cancer treatments for free to anyone who wants it.

Paul hates the FDA,, who ensure the safety of pharmaceuticals marketed in the US. He hates any hindrance to quackery and the protection of public safety , assuming the free market will weed out dangerous pharmaceuticals. It seems he never considered all of the people that have to die first, or the desperation of the poor who have to balance safety, cost, and the potential for relief.

Paul rightly recognizes that health care is costly, but wrongly believes that the free market will contain costs, assuming that health care is subject to standard models of supply and demand, an assumption that has been repeatedly proven wrong. Have you ever tried to bargain with your emergency room doctor for a better price?

He hates Medicaid, SCHIP, and Medicare. I would venture to assume that he even hates employer-provided health plans, which do not allow individuals to opt-out. In fact, the only insurance plan he seems to support is that of health savings accounts (HSAs).

The math might work out for Paul, but not for my uncle, who skated by on less than $20,000 a year. HSAs are hardly realistic. Even if he were to hypothetically save 2.5% of his income for thirty years (which is nearly impossible, the poor spend everything they earn) and receive a 5% annual interest rate, he would still only end up saving approximately $30,000. He hospital bill well exceeded $30,000 the first night he spent under surgery.

Worse yet, Paul believes that all foreign aid should be rescinded.

This includes successful programs such as the President’s Emergency Plan For AIDS Relief (PEPFAR), which has provided HIV medications for more than 1.2 million people in Africa. Paul believes the private sector should provide these funds and made all kinds of grand predictions about PEPFAR that didn’t come true. Here’s Paul on PEPFAR, spouting the same condescending and borderline racist nonsense that he disavowed from his newsletters:

“I concede it’s very well intended,” Rep. Ron Paul said, “[but] I think if we’re going to be doing any social engineering or social suggestions it ought to be here, and we ought not be naive enough to believe we can change habits that occur in Africa.”

In discussion of foreign aid, he ignores that fact that the Global Fund to Fight HIV, TB, and Malaria is overwhelmingly funded by public sources. The private sector provides a little chump change to improve their sales figures (e.g. the (RED) Campaign) but in reality, nothing substantive in comparison to public funding. Please note that Bill Gates is the exception, not the rule.

A Paul presidency would mean that scores of people around the world would die, simply for the crime of having been born poor and not having a little blue passport. It pains me to laud the health successes of the Bush Presidency, however, the Obama Administration has been embarrassingly lackluster compared to Bush, barely mentioning world health issues in his four years in office. I fear that the rise of extreme right-wingers like Paul signals a general indifference of America—and not only to world health issues—and that the day will come when programs such as PEPFAR are lost to history.

Paul’s attitude toward health care is akin to Jehovah’s witnesses who refuse to provide blood transfusions to dying children. He would let the world suffer and die for the sake of a pig-headed adherence to a limited ideology but what else should we expect form the guy who supports nuclear proliferation?

Václav Havel, the former dissident-turned-President of Czechoslovakia who just passed away this past December, argued in his seminal essay, The Power of the Powerless: Citizens Against the State in Central-Eastern Europe, that, “Ideology, in creating a bridge of excuses between the system and the individual, spans the abyss between the aims of the system and the aims of life. It pretends that the requirements of the system derive from the requirements of life.” Unfortunately for my uncle and millions like him, ideology is a prescription destined to fail each and every time. For Paul, it’s a talking point engineered to sell more newsletters and pad his pockets.

Domestically, the health concerns of the poor are not to be heard on the campaign trail. Republican voters simply don’t want to hear about it. Worse yet, conversations about Paul’s health care policy are absent amongst his youngest supporters, who seem to be more concerned about legalizing weed and the waning wars in Afghanistan and Iraq. The young and healthy, it seems, think little about the sick.

Fortunately, Paul will not become President. His ascendency, however, signals that a large sector of America is comfortable letting people like my uncle die.

In lieau of an actual post….

Despite making up only 37% of the state population, African Americans account for 78% of HIV cases[1]. HIV infections nationwide are increasing rapidly among African American women(find ref). In 2000, Rural Mississippi had the second  highest incidence of HIV of any region in the country, and heterosexual transmission of HIV was highest in Mississippi, compared with other states[2].  State policies such as abstinence only education, low access to health services and policies which prevent individuals from entering the system until they have full AIDS are exacerbating transmission[3]. HIV in Mississippi has long been shown to be disproportionately high in rural African-American compared with urban and rural whites[4]. Among HIV infected pregnant women, African-American women far outnumber women of other ethnicities, are less likely to present to clinics and more likely to have co-infections with other STIs[5].  Incarceration has been shown to be associated with HIV/Hep C co-infections[6].

Adherence to treatment regimens is affected by lifestyle factors such as drinking and drug use, individual symptoms of depression and social attitudes which stigmatize HIV infected individuals in rural Southern populations [7]. HIV transmission in rural areas of Mississippi has been shown to occur through heterosexual contact and partnerships largely occur between older men and very young women[8]. In urban areas, HIV transmission among MSM has been well documented. Increases in incidence rates of MSM in the urban South is higher than that of MSM in all other regions combined[9]. Like heterosexual partnerships among African-Americans in rural Mississippi that results in HIV transmission, age disparities among MSM pairings are highly associated with HIV transmission[10]. Rural African American male HIV cases were more likely to report being IDUs, were more likely to report concurrent sexual pairings and to report having exchanged sex for money than urban cases. Urban cases, however, were less likely to use condoms than rural HIV positive individuals. These results suggest vast differences in the nature of sexual pairings and thus opportunities for HIV transmission between urban and rural African American populations[11].

Mississippi has one of the highest incarceration rates in the country, and prison populations tend to be overwhelmingly African American and male[12]. Prisons and crime are known to be associated with HIV transmission[13].  Among formerly incarcerated HIV positive males residing in rural areas, those with larger number of past arrests are associated with more sexual pairings, are less likely to use condoms and more likely to buy or sell sex[14]. Risky sexual behavior among parolees has been shown other contexts to be common[15].

Migration which might affect spatial data quality appears to not coincident with HIV diagnosis. One study concluded that although IDUs were more likely than others to change location of residence following diagnosis of HIV, in general HIV transmission in new HIV cases in rural Mississippi and Alabama appears to be occurring locally[16].

 

1.            Mississippi State Department of Health SHO: Reported cases of HIV disease in Mississippi, 2010. Jackson, MS: Mississippi State Department of Health, STD/HIV Office; 2010.

2.            Hall HI, Li J, McKenna MT: HIV in Predominantly Rural Areas of the United States. The Journal of Rural Health 2005, 21:245-253.

3.            Talha Khan B: State policies worsen HIV/AIDS crisis in Mississippi. The Lancet, 377:1994.

4.            Young RA, Feldman S, Brackin B: HIV SEROPREVALENCE AMONG ADOLESCENT MISSISSIPPI SEXUALLY TRANSMITTED DISEASE (STD) CLINIC ATTENDEES-IS THIS A RURAL EPIDEMIC? Southern Medical Journal 1990, 83:2-103.

5.            Rana AI, Gillani FS, Flanigan TP, Nash BT, Beckwith CG: Follow-up care among HIV-infected pregnant women in Mississippi. Journal of women’s health (2002) 2010, 19:1863-1867.

6.            Burton MJ, Reilly KH, Penman A: Incarceration as a risk factor for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection in Mississippi. Journal of health care for the poor and underserved 2010, 21:1194.

7.            Amico KR, Konkle-Parker DJ, Cornman DH, Barta WD, Ferrer R, Norton WE, Trayling C, Shuper P, Fisher JD, Fisher WA: Reasons for ART non-adherence in the Deep South: adherence needs of a sample of HIV-positive patients in Mississippi. AIDS care 2007, 19:1210-1218.

8.            Cluster of HIV-Infected Adolescents and Young Adults–Mississippi, 1999. JAMA: The Journal of the American Medical Association 2000, 284:1916-1917.

9.            Mena L, Johnson K, Thompson C, Thomas P, Toledo C, Heffelfinger J, Sutton M, Ellington R, Larkins T, Rynn L, et al: HIV Infection Among Young Black Men Who Have Sex With Men-Jackson, Mississippi, 2006-2008 (Reprinted from MMWR, vol 58, pg 77-81, 2009). JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 2009, 301:1428-1429.

10.          Oster AM, Dorell CG, Mena LA, Thomas PE, Toledo CA, Heffelfinger JD: HIV risk among young African American men who have sex with men: a case-control study in Mississippi. American journal of public health 2011, 101:137-143.

11.          Williams PB, Sallar AM: HIV/AIDS and African American men: urban-rural differentials in sexual behavior, HIV knowledge, and attitude towards condoms use. Journal of the National Medical Association 2010, 102:1139-1149.

12.          Stemen D, Sorensen J: The Effect of State Sentencing Policies on Incarceration Rates. Crime & Delinquency 2002, 48:456-475.

13.          Okie S: Sex, Drugs, Prisons, and HIV. The New England Journal of Medicine 2007, 356:105-108.

14.          Oser CB, Leukefeld CG, Cosentino-Boehm A, Havens JR: Rural HIV: Brief interventions for felony probationers. American Journal of Criminal Justice 2006, 31:125-143.

15.          Morrow KM: HIV, STD, and hepatitis risk behaviors of young men before and after incarceration. AIDS care 2009, 21:235-243.

16.          Agee BS, Funkhouser E, Roseman JM, Fawall H, Holmberg SD, Vermund SH: Migration patterns following HIV diagnosis among adults residing in the nonurban Deep South. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV 2006, 18:S51-S58.

 

Anyone who has been to a grocery store in the past 2 years can tell you that food prices have increased. Intuitively, one would think that a few key factors have contributed to this rise in food costs.

Rising fuel prices increase the price of delivery. Rising demand for food from an increasing world population, and demand for protein rich foods from a rapidly urbanizing world, specifically from the emerging economies of China, India and Brazil increase demand for grains. A turn toward using biofuels increases competition for grains that would normally go to feed humans and livestock. Climate change and extreme weather events create a volatile agricultural market.

However, despite all these very obvious players, the amount of volatility seen in the food commodity markets is unprecedented. Agricultural production, though regionally volatile, has not experienced the same level of fluctuation as that of prices in the food commodities markets. Energy demand and production, though increasing, also do not exhibit the same behavior. Conflicts have negatively affected market prices in certain commodities, most notably that of cocoa due to recent political conflict in the Ivory Coast, but, the large ag-producing countries of the United States, China, India and Brazil have experienced no such disruptions. In fact, China and Brazil, despite a growing population and experiencing an expansion of the middle class, are still largely able to maintain food security.

In short, demand is rising, though not volatile. Supply also, is rising, though not volatile. One can make the argument that volatility in the oil markets is spilling over into grain commodity markets, but biofuels still only account for a small percentage of energy use. These factors do little to explain the large fluctation of the of the food commodity markets that we are experiencing today.

According to a UN Conference on Trade and Development report

• “these factors (rising food demand, biofuels, climate change) alone are not sufficient to explain recent commodity price developments; another major factor is the financialization of commodity markets. Its importance has increased significantly since about 2004, as reflected in rising volumes of financial investments in commodity derivatives markets – both at exchanges and over the counter (OTC). This phenomenon is a serious concern, because the activities of financial participants tend to drive commodity prices away from levels justified by market fundamentals, with negative effects both on producers and consumers.”-UNCTAD, 2011

Prior to the private equity bubble (remember the dot-com bubble?) of 2000, financial markets relied on investments into stock equities. Following the burst of what was up until then an unheard of rise in the financial markets, investors, speculators and hedge fund managers moved increasingly toward commodities investments outside of the traditional equity markets. Financial investors seeking new opportunities, moved toward to commodities markers, including oil and food, anticipating rising worldwide demand. Commodities of all kinds were financialized and brought into the portfolios of hedge funds and money markets.

I am not an economist. Through my limited understanding of futures markets, I think that what I understand is this: Prices of commodities are usually set on a supply and demand basis, with considerable elasticity. If one wants to buy gold, for example, demand and supply work to set prices. If one wants to take advantage of cheap gold now, all one has to do is buy and store to sell it later. The storage costs must be rolled into the final resale price. With oil and agriculture, the model is similar, but these commodities can only be stored temporarily, before they are unsalable (rot). Thus, as there is little to hedge against future risk, speculators will buy contracts for future, as yet unproduced, goods at set prices. This practice is not uncommon and was originally conceived to protect American and European farmers from risk and to insure consistent supply and price in the market.

What is different now is that interest prices are rolled in based on the length of contract, linking worldwide financial markets with the prices of commodities and distorting the true supply and demand relationship. As futures, by definition, are conceived to protect investors from risk, they are a perfect target for large hedge funds, which protect large investors from long term risk. The tying of interest rates into commodity prices means that end prices will fluctuate wildly with the market, while protecting investors from losing their shirts.

One important way that hedge funds minimize long term risk, is thorugh machine trading. Computers and mathematical models available market information, predict future fluctuations and sell when necessary. What this does is insert an even greater level of volatility into the market. Sudden sales of commodity futures will induce other funds to sell as well, creating a herd effect of commodity sales that has little to do with true supply and demand models. Imagine how flocks of birds or schools of fish move in response to one change in direction by a member of the group and you can get an appreciation for how machine trading works.

We are already see the effects of the financialization of food commodities. There was an unprecedented rise in food prices during the period of 2000-2007. The financial crash of 2007, brought in part by the activities of the very same financial players that are driving food prices up, saw a drop in prices, but as the market rebounds, prices are increasing once again, now higher on average than they were in 2007.

In fact, futures markets in commodities are exploding with the number of contracts rising to never before seen levels over the past decade as can be seen in the figure to the right.

Der Spiegel recently penned an excellent article on the rising price of food. In it, they spotlighted scumbag of the week, Alan Knuckman. Mr. Knuckman and a host of other US and worldwide speculators are unconcerned as long as the money is flowing to them. To Mr. Knuckman, he could be investing in GM, a new chain of box hardware stores, big pharma, copper, oil or food for kids, it’s all the same as long as it brings him a profit. In fact, he is quoted as saying, without a hint of irony, “the age of cheap food is over. Most Americans eat too much, anyway.” Yep, these dirtbags are just like the rest of America, blind to whatever happens outside their own gated communities.

Rising food prices are not a problem for Americans. In fact, we only use, on average, 13% of our income on food. In places like Kenya, however, food can consume nearly 100% of a household’s monthly income. In Kenya, food must be imported to account for shortages due to underdeveloped ag and transportation infrastructure, which prevents Kenyans from protecting themselves against extreme weather events and disruptions in supply. Even a 1% shift in the worldwide price of food can spell death for an Kenyan infant. What we have seen, however, is not a 1% shift, but rather a 71% increase in the worldwide price of grains since 2007. In Kenya, the price of corn meal has shot up 100% in the past five months. To Knuckman, this is just “an undesirable side effect of the market,” kind of like having to drink coffee that sat in the pot too long and turned bitter.

Truthfully, there is little attention paid to that which the US Federal Government gets right. News coverage continually conflates government and politics. Recently they have turned into sounding boards for self-interested groups which unfairly malign public entities and public employees and seek to dismantle all public services from education to environmental protection to parks management. Nearly zero airtime is given to those in the US Government who get it right.

That is why I’d like to introduce my new government hero, Todd Park. Todd is Chief Technology Officer at the Department of Health and Human Services and should be our next head of state.

Todd, through funding under the Affordable Health Care Act, is responsible for helping the HHS leadership “harness the power of data, technology, and innovation to improve the health and welfare of the nation.” Todd vision is simple. Several departments at all levels of government routinely collect data. As an example, the National Oceanic and Atmospheric Administration (NOAA) collects weather data from around the world. This data is not only essential for determining whether you should carry an umbrella to work tomorrow, but also essential to local planners, disaster preparedness, aviation and military planning. NOAA took the extra step of not only making the data available internally, but also has posted all of it on their website for use by anyone at no cost. That’s right, NOAA data is completely free.

The private sector, not willing to let an opportunity to make a buck pass, has siezed the opportunity to capitalize on this tax payer funded system to produce such heavyweights as The Weather Channel, weather.com, AccuWeather and your local news station.

Todd believes that the same model can be applied to the wealth of public health and medical data that the government collects anyway. He, while protecting the privacy of individuals, approaches businesses to develop ways to create new and innovative ways to create profitable opportunities for the private sector, putting people to work AND improving the public health in the process.

He doesn’t just want to offer it to them, he also wants to offer it to the rest of us as well, and wants to make sure that the data is absolutely free. This strategy not only benefits nerdy researchers like myself, but also creates entrepreneurial opportunities for anybody with a good, moneymaking idea.

Todd believes in what he does, and his successes have already been documented. On top of that, he’s an amazing speaker, perpperiong his impassioned sell of government public health data with a litany of Star Wars references. America needs to hear people like Todd Park speak, if only to get them excited about the things that government does right.

In Africa, western medicine often has to compete with it’s indigenous counterpart. Traditional herbalists have long offered medical services to the ill, treating a variety of physical ailments and offering help to the injured and sick. Some merely offer herbal services, but others offer assist in the treatment of spiritual illnesses. Diagnosis of disease however, is a holistic matter, where practitioners look into the spiritual nature of the patient to discover answers to the type of ailment and the strategy of treatment. If ones looks hard enough, one can find herbalists on the outskirts of public markets. Often though, they wait by the entrance to standard hospitals, offering there products to anyone who passes by. Where western medicine fails, herbalists readily provide.

Many readily discredit herbalists and traditional medicine, but its my view that the characterization of fraudsters and hacks are undeserved. Herbalists often come from a long blood line of traditional doctors, and recipes are handed down and modified from father to son. Both of the herbalists I spoke with indicated that they first learned their trades from their parents or relatives.

Herbalists in Malawi are licensed to practice by the Malawian government and their legitimacy formally preserved. The Malawi Medical Practitioners and Dentists Act of 1987 protects the rights of traditional healers and herbalists to practice their trades in Malawi, assuming that life is not threatened:

“Nothing contained in this act will be construed to prohibit or prevent the practice of any African system of therapeutics by such persons in Malawi, provided that nothing in this section shall be construed to authorize performance by a person practising any African system of therapeutics of any act which is dangerous to life.”

Medications are intended for a variety of conditions, a few of which I list here. These were the medications which appeared in the short video I shot below:

1. Kuthenta Mapadzi – Medication for aching joints and feet

2. Mauka – for pain in urination, likely due to urinary tract infections or sexually transmitted infections

3. Konjzela Mphamvu - an aphrodisiac and sexual enhancement medication

4. High blood pressure medication

5. Back pain

6. Burns on the hands or body

7. Any type of problems at all, it appears to be an aspirin like medication

8. Chibayo - for kidney problems

9. Kudya Kanzanza - medication for diarrhea

10. Eye problems

11. Njohka - for cases of intestinal worms

Not surprisingly, most of these medications are for chronic conditions associated with aging. Medical service in Malawi, being as rudimentary as it is, likely cannot accommodate more serious chronic diseases. Thus, herbalists provide some level of relief for desperate patients. I asked the gentleman if he treats malaria, a disease readily treatable with western pharmaceuticals. He readily said no, that when patients come to him with malaria, he sends them to the local health facility. With the exception of basic pain killers and some anti-helminthic meds, none of his treatments were for commonly treatable conditions.

This is not to say that herbalist medications do not work. In fact, I am positive that at least some of them do. In contrast to more ambiguous forms of care, such as spiritual healing, traditional medicines cannot be completley ineffective. The ingredients in at least some of the medications are likely the same ingredients of more expensive factory produced meds. Studies of traditional medicines have been performed in the past, but it has only been recently that western practitioners have begun to take them seriously. The anit-helminthic and anti-diarrheal meds likely work to some level. I know that marijuana is commonly used throughout Malawi as a means of controlling nasuea during malaria episodes in adults. By probably no coincidence at all, traditional herbal meds to treat malaria in Tanzania contain cannabis.

My conversations with both of these men revealed immensely proud and professional medical practitioners. Both of them readily and openly discussed their craft with me as clinicians and not as charlatans. Neither one attempted to sell me any type of medication. Perhaps if I had gone to one complaining of some physical ailment, one might have. As with western doctors, there is no sense in treating those who are not ill.

Interesting to me was the method of packaging and sales, which follows a western paradigm. Medications are packed at pills, given at particular dosages from clearly marked containers. While the methods of pharmaceautical creation and diagnostic strategies may be as they were before Colonialization, the practice has clearly been absorbed into a standard western paradigm of licenses and packaging. In my experience, most things in Africa, from medicine to music to religion, are a fascinating reinvented mix of indigenous and western, producing something new and old at the same time in contrast to merely adapting new ideas to sell to a local population. Malawians, while in some ways very conservative, are in other ways a very curious and inquisitive people, eager to explore and integrate new ideas into everyday life.

Below is a short video I made while conversing with an herbalist in the Limbe Market last month.

Although I know many that go without, anyone travelling to a malaria rich area like Sub-Saharan Africa, should take anti-malarial meds. It’s almost stereotypical, and is seen by many as a symbol of the colossal failure of African economies to create hygienic environments, or an indication of the terrifying blackness of Conrad’s “Dark Continent” spoken to scare privileged white children at night. The truth is, that it’s only been in the past 60 years that the United States successfully eliminated malaria, and even more recently that Europe experienced it’s last indigenous cases. For the rest of the world, malaria is still a fact of life, such as that which has been the norm for all of human history. To this day, the number one killer of children worldwide is malaria.

Meds now have come a long way since the discovery of quinine, a miracle drug which allowed the white man penetrate his parasitic, resource extracting tentacles ever deeper into the African continent. Now, for those of us who were not born in a malarious area, we can safely travel to places which would likely kill us, or leave us incapacitated to the point where we wished we would die. Some medications are more expensive than others, but they all have a similar bizarre side-effect which varies in intensity according to how much you are willing to pay. Anti-malaria meds induce nightmares.

I don’t dream, or, should I say, I don’t remember my dreams, perhaps mostly because I don’t sleep well. However, on malaria meds, I do. These dreams are graphic to the point of being past NC-17, vivid and detailed visions of bloody dissections and exposed bone, of horrid beasts and killings performed with the precision of a scientist. It’s frightening to wake up from one of them, as the thread between dream state and awake state is often thin under the fog of being rustled from mid-sleep. The world is often still tainted with the color of blood red and pristine white bone matter against a back drop of gray tinged blackness that seemingly extends without bound. Fortunately, the details are quickly forgotten.

While the nightmares are reportedly milder on the meds I take (Malarone, $3.00 a pill, taken every day), persons who take cheaper meds such as Doxycycline and Mefloquine report graphic visions, sometimes leading to the point of insanity. Doxycycline prescriptions often recommend a psych evaluation. The suicide rate on Doxy is extremely high, one of the highest of all prescription meds, and the context in which they are taken likely doesn’t help. Women report commonly of graphic sexual assaults, almost as if the drug plays on the individuals greatest fears. During waking hours, hallucinations on Doxy are common.

For many that come to countries in Sub-Saharan Africa, the reality of actual human suffering, insanity and depravity comes as a shock. Against a back drop of contented smiles and a level of happiness absolutely unknown in the depressed and debilitatingly lonely developed world, one sees evidence of the spoils of disease. Walking TB and HIV cases publicly teeter on the cusp of death. Common are the scars of burns, some perhaps intentional, and mysterious lesions that could be the results of accidents or attacks. Worse yet is the linear gash of a panga knife across a head or face, remaining as a testament to the incredible violence that Africa is famous for.

Conversations with Africans will reveal that incredible 1 in 10 people, who tell tales of seeking refuge after entire witnessing entire families murdered in the midst of conflicts like the 30 year Mozambiquan civil war, of abductions by rebels in Somalia or of witnessing the decomposing results of mass killings by rebel groups. It’s a fucked up thing, and although the US is no stranger to violence, we do a much better job of keeping its victims sequestered silently away. Here, people will smile and casually relate horrific stories of senseless and disgusting violence as if relating any other past memory. In the US, we’re not allowed to talk in real terms about violence, and if we do, we’re considered weak and somehow deserving of our fate. Here, it’s a fact of life.

My feeling is that suicides on Doxy and Mefloquine are fed by this grim and terrible reality and the inability to parse out the apparent contradictions between a continent full of some of the most mild mannered people on the planet, and the incredible capacity for mass insanity and bloodshed. We rationalize things in the west, occupying our own separate compartments at the bottom of a greater hierarchy of powers. The heart is contained within the mind, which is contained in the body which is contained in the family, in the social group on up to the greater order of things. Here, the only order is as much that can be given on a day to day basis, security is only in the preservation of precious friendships and family relations, evidenced in Malawians incredible ability to remember those who even only casually pass through their beautiful country.

 

While everyone is focused on the uprising in Egypt, part way around the world, Thailand and Cambodia are killing each other over a temple and the conflict threatens to kill millions of children on a completely different continent. Last year, UNESCO certified the Preah Vihear a World Heritage Site, and recognized it as rightfully belonging to Cambodia. Thailand across the border, likely in hopes of capitalizing of the vast tourist dollars (bhat?) which flow out of such sites, exploded, triggering a series of border clashes which have resulted in several deaths and the displacement of thousands of residents living along the border areas.

This strong arming of Cambodia over temple sites is not new to Thailand’s pattern of aggression against it’s neighbors. Angkor Wat, an internationally famous temple site, despite lying more than 150 miles from the Thai border, has long been claimed by Thailand. Conservative voices within Thailand have called for the Thai government to forcibly take Angkor Wat as a bargaining chip against Preah Vihear which would undoubtedly lead to an all out war between Thailand and Cambodia.

This not only poses a threat to regional and local stability and presents a danger to an important historical landmark, but also threatens efforts to contain a strain of drug-resistant malaria. After vast selective adaptation of P. falciparum malaria to standard malarial medications, Artemisinin Combination Therapy, a cocktail of malaria medications is the end of the line for effective treatments that prevent death from one of the world’s biggest killers. Recently, artemisenin resistant strains of malaria have been found in southeast Asia along the Thai-Cambodian border. Vast efforts are being undertaken to contain it’s spread.

It is widely feared that the strain will reach Sub-Saharan Africa, where ACTs are being successfully used to prevent mortality in children. If it does reach SSA, treatment efforts will be undermined and clinicians expect incredible spikes in childhood deaths. ACTs are expensive compared to other medications, but effective. Unfortunately, they are thought to be the last of effective treatments against malaria for the near future. If an artemisinin resistant strain of P. falciparum spread out of the border regions, it will likely reach sub-Saharan Africa in months. If this comes to pass, it is thought that millions more children will die than do already.

Border regions in any country are hot beds of poverty, violence and infectious disease which does much to explain why deadly strain of malaria are able to propagate along the Thai-Cambodian border. Containment efforts by public health groups are now undermined due to the senseless violence. Clinics are no longer able to effectively operate in the area. Displacement and instability forces residents to live in conditions conducive to the transmission of malaria, making a bad situation even worse, exacerbating the spread of dangerous strains of the disease.

All this over a single temple.

It what was a landmark triumph of science over warfare, Dr. Louise Reiss single-handedly put an end to nuclear testing in the United States in 1959. Collecting more than 300,000 baby teeth from the St. Louis, Reiss was able to demonstrate that the levels of radioactive agents in teeth post nuclear testing were significantly higher than before. The implication was that fallout from nuclear testing was entering the food supply and placing the American population at elevated risk for a host of negative health outcomes. President Kennedy, recognized the results of the study and successfully worked in a worldwide ban on atmospheric nuclear testing with the cooperation of the Soviet Union.

One can only assume that Reiss’ study, had it been performed in 2011, would have been widely discredited and decried as fabricated science and a threat to national security. Thankfully, the powers on both sides of the Cold War saw fit to put human health above the ability to wipe out all life on earth. The data and samples collected from her study, continue to this day.