When we sailed to the Sea of Tranquility on a High Tide of Technology

Neil Armstrong (1930 – 2012)
[via http://www.esquire.com%5D

In 2009, Captain Chesley Sullenberger, the pilot who landed a commercial airliner on the Hudson River in New York durring an emergecy manourvre and singlehandedly saving the lives of 155 people on board, was being awarded the Neil Armstrong medal of excellence (at Purdue Univeristy). Armstrong himself, was ofcourse on hand to make the presentation, and in his speech giving Sullenberger the medal, he quiped “The recipient of this award, Captain Sullenberger is [now officially] a fellow member of Pilots who land in Strange places Club” – This summed  up Neil Armstrong! Self affacing, understated, surprisingly witty, and yet – as was evident from those immortal first words stepping onto the lunar surface –  profoundly poetic.

Obviously his life and legacy are inextricably linked with the exploits of NASA and the space race, and to fully appreciate them, we need to go back to 1961 when (President) Kennedy was making his famous pledge of landing a man on the moon before ‘the decade was out’.  At the time of that Speech, Yuri Gagarin had already become the first man in space and to orbit the earth in a series of historic ‘firsts in space’ for the Soviet Union. The Americans in comparison, with their Mercury Program had only a modest 15 minutes of successful manned spaceflight (courtesy Alan Shepard) to their credit. That is all they had in their locker at the beginning of their journey to the moon. They had to learn, innovate, engineer new ways that would require a prolonged time in space for the astronauts, mastering techniques to dock and maneuvre spacecrafts; build said spacecraft from scratch and build the most powerful rocket in history to send them on their way; all within of timeframe of roughly 10 years.

Naturally the figure-heads of these campaigns were always going to be the astronauts. But this was a complete new field of endeavour and new protocols and skills had to be develop to train these people. The guys in pole position to do that job were Air Force pilots, and more specifically Test Pilots who made their living testing novel state of the art and very risky aircraft at unprecedented speeds and altitudes. Armstrong was always going to be in the running as he had established himself as reputation of a phenomenal test pilot handling the X-15 which was basically akin to piloting a rocket through the edge of the atmosphere at three, four or even five times the speed of sound. However, having Test Pilot chops was not going to be enough, and all these prospective astronauts had to demonstrate that they had what was called ‘the Right Stuff’. They were spun, shaken, bolted and jolted in myriad different ways which would test them physically and mentally – a lot of it probably unnecessary in hindsight. But out of all of that shaking and poking, emerged an elite group of Astronauts that who were selected for NASA’s Gemeni program, which succeeded Mercury and was to lay out the foundations for subsequent Appollo program and the eventual moon landings.

The Soviets demonstrated yet again that they were ahead as they got their cosmonaut Alexey Leonov to do the first ever Extra-

Alexey Leonov performing the first ever Spacewalk (via http://spacecoalition.com)

Vehicular Activity (EVA) or space-walk in Earth Orbit. The entire purpose of the Gemeni mission was to demonstrate that NASA could master these EVAs and “Rendez-vous” which was a term used to describe the meeting of two space crafts in orbit without which there would be no landing on the moon. The Americans eventually came up to speed as Astronaut Ed White completed the first ever EVA for NASA. The subsequent few Gemini missions were to improve upon Ed White’s initial EVA by increasing the difficulty level of tasks for the astronauts while they were out in space. Then came Gemeni 8 and Neil Armstrong’s maiden space flight as he commanded the first ever manned redenez-vous, docking with the unmanned spacecraft Agena. The initial docking was successful, however, soon after ,his space craft spiralled out of control and he had to undock and abort the mission mid-way to save his (and crew mate Dave-Scott’s) life. The remarkable calmness he showed under immense pressure was a key in NASA earmarking him as one of the first choice commanders in Apollo missions. By the final Gemeni mission, NASA had pretty much perfected the EVAs and Rendezvous as Gemini 12 commanded by Jim Lovell (who would later command the fateful Apollo 13 mission) and Buzz Aldrin. They successfully completed their rendezvous with an unmanned space craft and used its engine to go into an even higher unprecendented orbit around the Earth. Buzz Aldrin also demonstrated flawless EVA techniques in that same mission thus achieving all the mission objectives of the GEMINI program.

It was time for Apollo and that one final push for the moon. Key obstacles stll remained in the planning of the mission. Namely the rockets used to send them on their way, the capacity of the Command module which was the main spacecraft to go to the moon and the building of a Lunar lander which could negotiate the alien conditions on the lunar surface. All these things had to be tested and demonstrated before a mission to send astronauts to the surface of the moon could be given the green light. However tragedy struck in the very first Apollo 1 mission as the crew Gus Grissam (one of the original Mercury guys), Roger Chaffee, and Ed White (the same person who had previous done the first space-walk for NASA) died in a cabin fire in the command module durring a routine training exercise in Houston only a few weeks before lift off. Later investigations revealed systematic flaws and failures within the design and protocols which meant that the Astronauts’ safety was severely compromised.

It was a body-blow for NASA in more ways than one, and could have even spelled the end of the enterprise. However, they dusted themselves off and returned with a renewed focus to get the job done right this time. Apollo 7 was to take up Apollo 1’s mission riding the Saturn V rocket (the most powerful in history pioneered by Wernher Von Braun) and test the Newly designed Command Module. The success of that mission was not only poignant because of the Apollo 1 tragedy  but also because it now meant that Astronauts can now be sent to the Moon’s orbit.

And Apollo 8 did exactly that as they sent Frank Borrman, Jim Lovell and Bill Anders to lunar orbit. Never before in human history had anyone been this far from home. They were also the first humans to see the far side of the moon from only 60 miles no less. It was Apollo 8 that sent back those iconic – and now ubiquitous – pictures of Earthrise. However this was also one of the most risky missions to date as the spacecraft had to fire its engine behind the far side of the moon (out of contact with Houston) to ensure a return trajectory to earth. They had no backup. Any mistake or miscalculation and they would have either crashed into earth and burnt, or gone into deep space. Fortunately for them and the Apollo program, their Maths was spot on and they fired their engine at exactly the right moment.

Apollo 9 was the first time the Lunar lander or the Lunar Excursion Module (LEM) was going to be tested. NASA outsourced the development of the lander to a private company called Grumman Coorporation. They came  up with a weird spidery looking spacecraft which consisted of two stages. A descent stage to land on the surface of the moon and an ascent stage (which was essentially a detachable top half) to lift off from it. Apollo 9 successfully demonstrated the Lunar Modules capabilities in near earth orbit, and its subsequent mission Apollo 10  left near earth and tested it out in lunar orbit. They did every thing but land one the surface of the moon. The stage was now set for the next mission, Apollo 11, to attempt to  make the first ever lunar landing.

Neil Armstrong, Buzz Aldrin and Mike Collins were given the responsibility. Everything went according to plan, the lift-off, the aquiring of Lunar orbit and the undocking of the Lunar Module (LEM) for final descent. However, just as the Eagle (their LEM) was approaching the surface, the auto-pilot encountered problems with data overload. Its astonishing to realize that the computers involved in landing the LEM on the surface of the moon had less processing power than ordinary smart-phone these days. Also lets not forget that no one had ever actually landed the LEM as it is not designed to fly on Earth Surface with its atmosphere. The had a Lunar Landing Research Vehicle (LLRV) to simulate the conditions on the moon but the ‘flying bed sted’ – as it became known among astronauts – almost ended in disaster as Armstrong had to bail out as this extraordinary footage shows. A fraction of a second late and he probably would have died.

Mare Tranquillitatis or Sea of Tranquillity; the landing site for Apollo 11 [via http://barnesm.wordpress.com%5D

(Back on the Eagle) Neil Armstrong noticing that there was an error with the mapping of the lunar surface, decided to switch to manual.As he searched for an improvised landing sight, he was alerted that there were only 60 seconds of fuel left. In 30  seconds he had to decide whether to land or to abort the mission. Moreover the Lander was above a very large crater which meant that chances of crashing were higher. A crash landing on the moon would have meant there was no hope of Armstrong and Aldrin returning to Earth. However, as his Gemini 8 mission was evidence, Armstrong kept his cool and with only 20 seconds of fuel remaining relayed that now famous message

“…Houston…. Tranquillity base here!… The Eagle has landed”

What happened after – as they say – is well documented history.

Aldrin and Armstrong clocked about 2 and half hours of EVA on the moon, and the mission objective for the subsequent 6 missions was to improve upon that. By Apollo 17 – the final mission –  the astranauts were taking Lunar rovers (which were essentially an auto-mobiles designed to whizz around on the surface of the moon) and they were able to stay there for about 3 days. But – as it has been for the last 40 years – the hunger and the appetite for more began to wane and the US government decided to cut the funding for Apollo 18 and 19

Apollo 11 was to be Neil Armstrong’s final involvement with NASA as an active astronaut. In retirement, because of the notoriety of being the first man on the moon, Armstrong became much more of a  reserved figure and limited his public appearances to handful of NASA events. He was not a bitter or frustrated celebrity; just someone who clearly valued his private life and understandably wanted to be out of the fray. He became a lecturer at the University of Cincinnati before accepting corporate directorships of Aeronautical Engineering Companies. In his last few years he became quite a vocal critic of President Obama’s decision to scrap the Manned Space program. Along with friend and fellow Astronaut Gene Cernan (Commander of Apollo 17) even went to Congressional Select Committee to voice his disappointment over the direction of the Manned Space Program.  In the biography authorised by him “First Man” by James Hansen (added to the Quackonomics Bookstore, Armstrong  was always keen to make the point that he was merely the arrow-head in what was a massive effort by hundreds of thousands of people who worked on the moon landing. He was convinced that he was only doing his job and  many of his colleagues in the previous and subsequent missions would have been just as accomplished as he was. He wanted to be remembered by the ledger of his work over a long time rather than just a solitary firwework he was part of 43 years ago. Though its probably fair to say that  the ‘solitary firework’ is STILL the most electrifying moment in human history.

Apollo 11 Crew’s triumphant return to Earth. Armstrong (L) Collins (C) and Aldrin (R) [http://www.allwrite.com]

For me, the most astonishing feat of the Mercury,Gemeni and Apollo missions (other than the obvious one ofcourse) is rate of innovation that was involved througout the process.The eagerness and the motivation to find solutions to physical challenges that presented themselves. That spirit of improving upon the previous best, the learning from failures, and the standing on the shoulders of Giants, exemplified the very best of Engineering and Science. Will we ever send manned missions to the moon again? Or even better it? Is the first person to walk the surface of Mars alive among us right now? Currrent political and economic climate suggests that the answer to all these questions is probably unlikely.

But the 1960s wasn’t a happy time either. There were a whole host of issues, priorities and obstacles for the public and politicians to deal with. Yet that generation managed to land on the moon. Perhaps with renewed vigour and motivation to take up challenges, we can create an appetite for attempting to send astronauts to Mars. Just maybe, if we manage to live long enough, in the tail end of our lives we can yet witness a moment to rival Armstrong’s; when we send a human mission to Mars and watch in awe, as that Astronaut takes her first step onto the Marsian surface.

Posted in History, Science, Space | Tagged , , , | Leave a comment

When we’r misled about the dangers around us, we take real risks to avoid imaginary ones

The Daily Fail’s Cancer scare stories are something to behold                                                (via http://www.paulnixon.org)

The assessment of Risk is one of the great big things of our time. From business to politics to social cultural history, we are constantly engaged in a seemingly relentless pursuit to uncover causes and effects; and more often than not, the hidden risks that lay within. I’v had countless conversations with people who confidently make pronouncement of complex social matters on the strength of anecdotes or personal experiences. And while that sort of thing is generally harmless, it does hint at a desire, we all have to seek patterns and theorize about causes and effects – without applying scrutiny to any confounding factors that may foil our thinking.

Not surprisingly, the popular mass media (and yes I know, they are ‘not a monolith’..blah blah blah.. tedious point raised again and again by hacks…*rolls eyes and yawns*) are keen to pander to that instinct. Whether its the tabloid newspapers or cable news channels, this constant ‘sinister scare’ narrative is too attractive an opportunity for them to pass up. And unfortunately, critical appraisal of evidence behind the said sinister scares, often becomes the first casualty in these instances

Chief among them are medical stories. Most tellingly of course the “MMR Vaccine causing Autism scare”. As I wrote in that post, I think one of the biggest drivers of that scare was the media’s inability to grasp the concept of rational risk evaluation. They found a sinister scare story, they found a doctor who was vaguely superficially plausible authority on the subject – and they ran with it.

The Daily Mail

They Daily Mail is one of the top selling newspapers and most visited websites in the UK . And their ‘Cancer stories’ are just utterly bonkers. Among the things that they claim, ’cause cancer’ include ‘divorce‘,wifitoiletries , facebook and Coffee. While the things that ‘prevent or cure cancer’ are ‘crusts‘ ‘tea-spray‘, red pepper, carrots and coffee. Yes, according to the ‘Daily Mail’, Coffee both prevents and causes Cancer. Ben Goldacre of Bad Science thinks that they are “involved in bizarre exercise to divide all the inanimate objects in the world that either cause or cure cancer”.

To that end there  are couple of awesome websites devoted to documenting just that . The magnificently titled Daily Mail Oncologogical Ontology Project and “Kill or Cure Heruko” ;  both studiously document the latest musings on Cancer risks by the Daily  Mail. While this is all fun and games, there is a more cynical side to this as well. To set this up I urge you to look at this story where they are calling into question the safety of the cervical cancer vaccines.

Martin Robbins of the LayScience blog,  made a fascinating discovery. Just a short boat ride across Irish Sea in Ireland, the same paper (i.e. The Irish Daily Mail)  ran a campaign “to Roll out the Cervical Cancer Vaccine”. Yes you read it right. The SAME paper  which was highlighting the dangers of vaccine in the UK was putting pressure one the (Irish government) to roll them out. Two completely contradictory positions on health risks. How do we explain this discrepency?

I suppose in the UK, they were campaigning AGAINST  it because perhaps its a transgressive thing which possibly encourages promiscuity among young people – something the mail famously rails against. And in Ireland, maybe they were campainging in FAVOUR of it, because its a chance to kick an incumbant government. Its just idle speculation really, but essentially what seems to be happening here, is that they’r making scientific health/medical pronouncement on the basis of their political narrative. I don’t think you can fully attribute this to an inability to read obscure medical journals on the risks of Cervical Cancer Vaccines, I think – and this is a point made on Bad Science – it can only be explained thorough mischief and distortion. Things which arise out of a desire to fit the science into pre-existing political narratives. Its all utterly farcical as Goldacre observes

As far as I can tell and I must stress this is only my interpretation of the available evidence; they just find something they disagree with politically, and pretend it GIVES YOU CANCER

Fukushima and Nuclear Power

Another example of this is perhaps the fallout from the 2011 Tsunami and Earthquake disaster in Japan. Soon after the catastrophic event, attention turned the Fukushima Nuclear Power plant and the meltdown that occured there. It triggered a mass hysteria over the dangers of radiation and how it is bound to affect populations. Article after article was going on about risks of radiation following that meltdown. Except most of it has really failed to materialize in the way people were claiming.

Among the more prominent voices driving this case were Greenpeace and Friends of the Earth, two environmental organisations founded on anti-Nuclear activism. I think this also demonstrates that exaggerating dangers and praying on hysteria isn’t just the preserve of the Right Wing. I’ll write a more detailed post on how some campaign groups like Helen Caldicott’s “Physicians for Social Responsibility”, have misrepresented the evidence around the dangers of radiation, in contradiction to the mainstream scientific consensus in and  in favour of fringe studies. But suffice is to say, this was a prime example where a rational risk assessment was thoroughly undermined by political activism. In fact undermined to the point which saw governments, including esteemed ones like Germany, deciding to shut down its Nuclear plants- replacing them with Coal/Fossil Fuel plants  in a move that is set to increase their carbon emissions from the energy sector over the next decade – even if overall emissions in Germany did fall in the last year. Increasing their dependence on Fossil Fuel in the Climate Change context is essentially an environmental disaster – spurred on by environmental activists.

Urban Crime

The same hysteria-led risk narrative often drives the media reporting on Crime Issues. Actual Crime Statistics are going down but the perception of Crime in people’s minds is as high as ever. The London Riots of 2011 provided a perfect storm for them to kick this into overdrive.   I would go an develop this point, but I think this absolutely stonking talk by Michael Story (@mwstory) does a very good job of it already. It is about five minutes of your time, and well worth it.

People often look for a conspiracy type smoking gun in matters like these, but I think that is mistake. You won’t find men stroking cats demanding their minions to distort evidence around Cancer risks. In reality the push for hits/ratings and  the time consuming nature of verifying stories (and disincentives associated with them) are probably a better explanation for all these shenanigans. Either way, I do think that the public is misled, and its ultimately a spurious distinction whether there was any premeditated intention to so or not. In the world where we’r we are exposed to a million different things everyday, it is even more important that we get good, solid, scientifically verified information about the risks in our day-to-day lives – not wild goose chases which only serve to confuse and mislead us.

Posted in Cancer, Carbon Emissions, Climate Change, Media & Journalism, Medicine, Science, Science and Politics, Statistics, Vaccines | Tagged , , , | 3 Comments

Our Trendy Ideological Narcissism doesn’t help Africa

Ok so it doesnt quite roll of the tongue as the Invisible Children campaign!

I’m not going to do what countless others have done already and rip the piss out of Invisible Children, their Kony2012 Campaign and the obvious dodginess about  their methods/operations. Although I’ll let this little musical number (that they came out with back in 2006) speak for itself. It is simply breathtaking in sheer zaniness (especially about 2 minutes into the video, truly bizarre). On the main however, I find it hard to feel too indignant about them, as they are not the problem itself but only a symptom of a broader set of cultural idiosyncrasies. A fact which is exemplified in the success of this slick PR campaign-y approach which straddles both politicians and celebrities alike, in a bid to ‘change the world for the better’ where no one has to make the tough calls.  The details and nitty gritty is proudly de-emphasized.

But as I said, KONY2012 deconstruction has been done to death by now and it would be tedious in the extreme, to indulge in that exercise again. Instead what I want to focus on is the work of a group of people who are as passionate and interested in tackling the various issues surrounding Africa (& the developing world); but with an empirically informed approach. An approach which borrows from evidence based medicine and employs Randomized Control Trials to answer questions of whether specific policy interventions (on poverty) actually deliver successful results on the ground.

While it is laudable that people are willing to help out in terms of their money and time, the real action is in the quest to figure out what actually works and (just as importantly) what doesn’t work in that context. Frankly, being happy with ‘doing something instead nothing’ strikes me to very ambiguous and unambitious mindset. And it has always perplexed me as to why this mindset is so pervasive in society. Though Adam Curtis produced a short film which has a stab at explaining why this kind of thinking that permeates through popular thinking on Africa and the world’s poor

The failings of the Aid Debate

Meanwhile, in slightly less bonkers circles (not involving Invisible Children), the debate rages on whether Aid to Poor countries actually works or not. In the pro-Aid camp are people like Jeffrey Sachs, Bob Geldof and Bono (The Live-Aid crowd) ; who claim that it is the responsibility of the rich nations to pledge money towards helping build and rebuild the poorest in the world as they face some of the harshest challenges on the planet. They believe that the world’s poor simply CANNOT be expected to meet those natural obstacles and come up to speed with the developed world.

In the Aid-sceptic camp are people like Bill Easterly and Dambisa Moyo; who claim that International Aid actually makes the situation worse for Africa’s poor,  as it empowers corrupt leaders, creates this ‘Desperate Africa’ image which means people are hesitant in investing into Africa thereby reducing its prospects of progress. Moreover they argue that if the free-market system was allowed to operate, it would be much more effective in tackling the problems of poverty, healthcare, nutrition and education.

Both sides have a semblance of validity in their arguments. However, once you go through their work, you’d be hardpressed not to notice that both sides are quite fond of making grandiose claims about the challenges faced by the poor. Also, the definition of what works seem to vary from person to person and argument to argument. It is remarkable to see, how certain they seem to be, about the assumptions they’v made about the situation and the prescriptions they offer, to address the endless challenges faced. Problem is,  most of them, tend to be high on anecdotes and rhetoric, but low on hard evidence. Sure, a smattering of statistics is ever-present in highlighting the various issues of poverty, malnutrition etc, but there is no real way of knowing whether these approaches/policy recommendations are grounded in any  good quality evidence- something  which frames these problems a scientific manner.

You could say, that since they are dealing with ‘macro-issues’ and it is unreasonable to expect them to frame/discuss these in  micro-economic terms  – and of course that is a legitimate point to raise at first glance. But, what inevitably ends up happening, (as I hope to to show a little later on)  is that their ‘macro’ prescriptions for the global economy perfectly map onto their ‘micro’ prescriptions on single challenge issues like Malaria prevention Strategy; where, this same debate is rehashed – and therein lies the problem.

What are Randomized Control Trials (RCTs)?

RCTs form the heart of evidence based medicine. There is a hollywood notion of medicine that has people in labs, tinkering around with chemicals and coming up with novel formulas to cure diseases. In reaility it could not be further from what actually happens. And there is a very good reason for it also. Any drug or treatment has to stand the test of trials which are basically experiments of sorting out the signal from the noise. Making sure that alternative explanations (or confounding variables) are accounted for, before we give the green light for a drug or a treatment as a viable choice for a better  health outcome. What is repeatedly found, is that patient responses to interventions, are complex matters, and it requires a careful systematic approaches to sort out the causes-effect relationships – or lack thereof. That’s why people selected in trials, are randomized; which is a fancy way of saying that the study is not biased as a result of selecting different groups of people.

For example, if your running a trial of a drug for a particular medical condition, and you select 2 groups; giving 1 of them the new drug and the other, the control (which could either be a placebo or other alternatives depending on the context of treatments available for said condition). Suppose then, that the first group is made up of younger people who recieved the new drug (note: just for argument sake, assume younger people get healthier quicker, which may not necessarily be the case all the time); and the 2nd group, comprising of older people, received the ‘control’. I dont think it would be difficult to deduce that the younger set of people are likely to get better quicker anyways and to attribute the success of their recovery solely to the drug/intervention, just on the basis of this study, would be erroneous. The design of this study would  therefore be termed as biased towards producing a positive result for the drug and lacking in proper ‘Randomization’.

RCTs are basically a way to account for such inherent systematic challenges in data aquisition which can contiminate the cause-effect analysis in order to iron out what assumptions have sufficient grounding in evidence –  to be considered for further scaling up. They are very effective methodological tool for clearing out the clutter and systematic flaws which can lead spurious false positives or negatives results for a given hypothesis. And conceptually, they do not require a drug or a pill to study these cause-effect cases.

An organisation called Abdul Latif Jameel Poverty Action Lab (or J-PAL) employs this tool in addressing the myriad issues linked to poverty and development. Many people (like Sachs and Easterly) have ideas as to how we ought to proceed, but in reality, none them have really demonstrated the willingness to test them out in conditions where the clutter and noise is accounted for. Abhijit Banerjee and Esther Duflo who co-founded J-PAL have also co-authored the book called Poor Economics (Its in the Quackonomics Bookstore, among other fine selections for your reading pleasure) which looks at this very problem. Another one called More than Good Intentions (authored by Jacob Appell and Dean Carlan) also looks at similar issues compliment the work of Banerjee and Duflo. Both advocate the deployment of a rigourous Evidence-based anaylsis of development and poverty related issues before actions/interventions are scaled up. The fact that mainstream political and economic policy thinking has been slow in incorporating this approach is more of a comment on their way of working, than any difficulty associated with costs, expertise or reliability of RCTS.

So lets move on to some concrete and substantive examples of their work.

Pricing Insecticide-treated Bednets for Malaria Prevention

Insecticidal Bed-nets to sleep under at night (via ensnewswire.com)

Malaria is one of biggest life-threatening diseases  in Sub-Saharan Africa. It was responsible for the estimated deaths of a 1 million people each year (mostly in Sub-Saharan Africa). More pertinently, it is a preventable disease which makes the current situation even more tragic. Whats more, there are really well established solutions (in the context of Africa) for Malaria prevention; like the use Insecticidal Bed-nets which have been shown to not only protect people sleeping under them but to also reduce the risk for the rest of the population. Pretty much everyone is in agreement that there are huge benefits to be had from the widespread adoption of these bednets, and the need for comprehensive subsidization and distribution.

But what is the best way to achieve that optimum distribution. And how do we price them in order to ensure maximum effectiveness? Should we give them away for free? Because the benefit is likely to be far higher than any cost of the bed-nets themselves. Or should put a price on them? because giving them away for free would mean people wont value them and use them for other things.

Not surprisingly, those who want the bednets to be given away for free are the  Jeffrey Sachses of this world and those who want to put a price on it and let the market decide are the Bill Easterlys  and the Dambisa Moyos. The Sachs’ argument is that the productive windfall from a malaria free population would comfortably override the cost of providing the bed-nets for free. And if we start to price them, people would not be able to afford them, and the demand would fall rapidly which will lead to a decrease in their use. The Bill Easterly and Dambisa Moyo crowd, on the other hand, feel that if they are given away for free, people will not value them, use it for other stuff like fishing or as wedding veils (they provide some anecdotes to that effect) and other things, not for sleeping under them – thereby defeating the purpose of the bednets themselves to begin with. Again, both parties, like the AID debate, make confident and conflicting claims as to what will happen and they make policy recommendations based on that – and these carry alot of sway with influential people. So what happens when people test out these assumptions?

Pascaline Dupas and Jessica Cohen, are two researchers who did exactly that. They decided to evaluate a bednet delivery organisation called Together Against Malaria (TAMTAM) in Kenya and how different ways of subsidizing affected the purchasing of the bednets.In 2006, they looked at around 20 prenatal clinics in Kenya with 20,000 pregnant women (hence access to 20,000 families) . Then, they randomly selected 16 clinics, where the nets were distributed at varying rates. Moreover, to check whether (and how) these nets were being used, they sent people/supervisors on unannounced visits to check whether these nets were being used for their purpose (which is easy enough to do). What they found was, that there was indeed a correlation between pricing the nets and their acquisition. The demand did indeed fall, and thus concerns raised by the Sachs camp were indeed justified in the data. Moreover (in a further torpedoing of Easterly camp) the data showed that people were NOT ‘more likely’ to use the nets for other things, if they had bought them for free compared if they paid money for it.

Predictably the Sachs camp were very quick to point to studies such as these as vindication for their ideas. I’m not too sure about this truimphalism. I think the main lesson to be learnt here is, that assertions without a good evidence-base are not a good idea – and that is something we cannot entirely exonerate the Sachs crowd of either. What these studies also showed was that once people got these bednets for free, they were more likely to buy them the following year and so they were NOT ‘getting used to free things’; rather they were getting used to the NETS.

Immunizing the Poor

Randomistas: Banerjee (L) and Duflo (R) authors of Poor Economics (via mit.edu)

Leaving aside the nutty anti-Vaccine crowd, it is a well established fact, that Vaccines have been one of the most successful public health interventions of all time. It is easy to forget – especially in the oasis of prosperity that we inhabit – how certain diseases like polio, mumps, measles simply don’t kill children anymore. The simple fact of our world is, that the richer we are (and this applies internationally as well as within country); the more,  our basic needs and necessities,  are taken care of. So when we get a little uppity and start pointing out “how irrational these people are, for  not bothering to immunize their children or boiling their water?”; we forget that all of these decisions are basically taken out of our hands. Immunizations are easy-to-access and compulsory in the rich world, and the water we drink comes out clean from the tap. I don’t think that none of us are in a position to play the rationality card here.

So how do we approach the problem of low vaccination rates in the developing world. We need to first figure out why we think immunization rates are so low? Is it because of a supply-deficit? Is it because of ‘health professional’ absentee-sim? Is it because the cost of immunising a child is too high for some people? Is it because there are some deep-rooted local cultural reason why people are refusing to vaccinate their children? Or Is it simply because people just cannot get round to having their kids immunized? How do we sort these questions out because knowing which of these factors are more important than others is key to finding out what policy intervention will best optimise the vaccination rates in poor areas.

Around 2004-2007, Esther Duflo and Abhijeet Banerjee et al.(pictured above) decided to team up with an NGO in Rajisthan (India) attempted to answer this very question. Immunization rates there were around a paltry 6% at the time. What they did was to select random villages in the district of Udaipur, and proceeded to compare and contrast different incentives with the vaccination schedule while at the same time improving the reliability of healthcare services to ensure supply. Obviously an increase in immunization rates was to expected. So to compare and contrast, they offered incentives for vaccinations in some of the villages whereas others followed the conventional method of simply offering immunization services. In this case, the incentive was a 1kg of Lentils, to the families. who were getting their kids vaccinated. (Does not have to be that in all cases)

Now some people find this OUTRAGEOUS, claiming that this is tantamount to bribing these people to do the right thing by their kids and that is just MORALLY UNACCEPTABLE – forgetting of course, that we’r essentially bribed to do the same thing ourselves in the West also.  They found that the immunization rates in those districts (where the provided lentils) rose to an astonishing 38% whereas those without the lentil only manage to rise to 16% (the rise is attributed to improvement in the supply of health care services, which turned out to be a valid concern as expected). So it basically vindicated the incentive view of immunization that, people just had to be compensated for the cost that they were incurring for having their kids immunised. Its not that they were culturally opposed to vaccines, just that they could not get round to doing it. It was – in the end – a rearrangement in their ‘to-do’ list and a little prompting was all it took to get alot of people to get their children vaccinated.

Perhaps, the most astonishing part of this was that the introduction of lentils actually drove down the costs of the program. Previously, the average cost for immunization of a child was $55.83. With the lentils incentive, (even though they’r were cost associated with purchasing the lentils) the average cost of immunization of child fell to  $27.94 – almost halved. And it begins to make sense (after the fact) because, while prior to the lentil incentive, people were not showing up, but the health care providers (nurses) had to be paid a fixed to immunize a smaller amount of children. With the lentils, more people were coming through the turnstiles so to speak, which meant that the nurses in the same time were able to immunize many more kids in the same time. That is an astonishingly counter-intuitive way of cost-saving, which can really come from empirically evaluating the situation. And that is not even include the monumental public health benefit, vaccines have on the whole of the population long term. This doesnt mean that we must now provide lentils in every case, but it does validate the effectiveness of using incentives to boost immunisation rates. And that is something empirically confirmed – atleast in Rajisthan, India.

The trouble with the ‘White-Guilt’ Brigade

I hope I’v done more than enough to convince you why I think Kony2012 is bizarre campaign which is out of touch with the realities in Africa at a time when there are genuinely exciting things like JPAL going on. However one thing that  troubled me was part of the critical response to that the campaign got from some quarters. Many were quick to jump for the “White-man’s burden” line on this which – beyond knee-jerk – seemed to me to be a bit of an outdated response to what is increasingly a [pretentious word alert!] globalized narrative. By-gone thinking continues to exist in the West, but I’m not sure any input from the West should  necessarily be saddled with that label as articles like this and this, are keen to stress. I found this excerpt to be particularly interesting

 “African solutions for African problems”isn’t just a State Department slogan, and it isn’t about promoting African leadership, although that’s certainly important. Africans are already leaders. There are many reasons for Africa’s amazing rise over the last ten years, but one of the biggest has been African leadership. It’s not a coincidence that the 200 years of Western leadership in Africa were some of the continent’s worst. Africans have proven time and again that they’re better at fixing African problems

There are a couple of problems with such polemics. Firstly who speaks for the African poor? I think there is a high probability (note: probability does not mean everyone) the people typing up these articulate ripostes are quite privileged themselves, and for all intents and purposes NOT in the same boat as (most of ) those they seek to represent – who lest we forget are, still, quite poor people. This is not to say that you reject their viewpoint, outright. Of course not! But I think we have to be skeptical of the viewpoint of people of privilege (within the developing world) when or if they start to drone on about how they speak for the rest of ‘their people’ – especially if they offer less than full disclosure about their own privilege. Dambisa Moyo herself, possibly falls in that camp a little bit as well. Also, I think there is something very dubious about the point of view, that somehow if your white, you’r not allowed to have an opinion on Africa. Its a complete non sequitur. Ultimately – as with the aid debate –  it boils down to the evidence you can summon in support of the arguments and the tenuous conclusions that you draw from them, and whether they stand up to critical scrutiny. Rhetoric and anectdotes are just that – rhetoric and anecdotes. They are not Data.

A more pernicious form of this kind of thinking can seriously endanger many people. My last post was about AIDS-Denialism; the conspiracy theory which states “that there is no link between HIV and AIDS and this is just a con by Western Pharmaceuticals to keep Africans sick so that they can sell them their anti-retroviral drugs”. Tragically, the South African government under the stewardship of Thabo Mbeki, was a subscriber to this rotten Denialism.

And alot of it, was expressed in the “we will not accept this western science imposed on us” attitude. They denied their population (which has the highest rates of HIV infected people) vital life-saving anti-retrovirals, resulting in what is estimated in the deaths of 300,000 preventable deaths. That is a phenomenal price to pay for an indulgent attitude (which may have grounding in legitimate historical grievance). But 300,000 people dying because of ‘politicising’ what was a scientific question and should have had a scientific approach to resolve it, is unimaginably tragic and disgraceful. Thankfully (if very belatedly) the South African government under Jacob Zuma has had a change of heart over Mbeki’s policies, and are now working to have ARVs available for South Africans.

Perhaps the fundamental difference between our decadent lives in the West (or the privileged world), is that we have the safety nets which shield us from the consequence of bad ideas, and thus it allows us to pander to our preconceived notions/ideas/indulgences of the world, without incurring much of a downside. The poor don’t have that luxury and it is therefore even more important for Critical thinking and systematic empiricism to take center stage. We need to make sure that subject our ideas to rigorous scrutiny before we advocate for them to be scaled up. Because, the lives of the poor are a great deal more complex than we give them credit for.

Posted in Africa, AIDS, Development, Economics, Politics, Poverty, RCTs, Statistics, Vaccines | Tagged , , , , , , , , , , | Leave a comment

Deadly Denial: The Conspiracy Theories about AIDS

J.A. Seidman, pandemonium pandemic, pastel, Johannesburg 2004 concieved as a comparison between AIDS denialism in South Africa and the Xhosa cattle-killing episode of 1856-1857, a millennialist movement based upon the prophecies of a fifteen year old girl Nongqawuse

AIDS – as a disease – has an almost emotive side to it. Talk of it is altogether different from, say, Cancer. This is not to suggest that the urgency about AIDS (globally) is any less, but there are remnants of a by-gone era which rear their ugly (and discredited) head from time to time. The Catholic Church unfortunately, is one institution which has form in promoting  that by-gone thinking; the attitude which tells us that “Aids is bad!…no doubt… but not as BAD as Condoms, heaven forbid”. But kicking The Holy See  is good knockabout stuff – and I’m sure I’m bound to revisit our friends in the Vatican later – but this post is NOT going to be about that. Rather, it deals with the unscientific ideas about Aids and how a suspension of critical faculties in examining them, can lead to catastrophic consequences.

One of the bête noire(s) of this blog is outright Science Denialism. This is not a rejection of people fawning over scientists. Clearly they are fallible; prone to biases and errors as much as anyone (though science as an institution does have really good ways of accounting for those biases). Instead, it is about the people who show blatant disregard for carefully acquired peer-reiewed (i.e subject to the best scrutiny) evidence on matters of Science, Health and Medicine. This is exactly the kind of thing I talked about previously while looking at the Creationists and Anti-Vaccine Proponents. If you revisit those posts, you’ll find many similarities in the kind of tricks and fallacious arguments used by people to advance politically charged beliefs that are not supported by the facts. While there is a sliding scale of the impact of such corrosive ideas (I would argue that Vaccine conspiracy theories are potentially more dangerous than Creationism) few can match the sheer numbers-affected, the ferocity and the downright viciousness of Aids Denialism (or AIDS dissidents as they like to call themselves).

A Brief Overview of AIDs 

Acquired immune deficiency syndrome (AIDS) was first reported by the US Center for Disease Control in July 1981. In lay terms it is a disease which compromises the immune system of the body which would otherwise mount a response to various viral and bacteria based threats to the system. This is a good accessible explanation of the Biological processes involved. Initially there was a lot of confusion as to what caused it. Then in 1983, a group of scientists under the supervision of Luc Montagnier, discovered a new retrovirus in a patient with signs and symptoms that often preceded AIDS. They named the retrovirus lymphadenopathy-associated virus, or LAV, and sent samples to Robert Gallo‘s team (which was another US-based group working on a retrovirus which they believed caused AIDS); findings were peer reviewed and were set for publication in the journal Science. Meanwhile in 1984, the US Department of Health and Human Services announced that the virus found by Gallo’s team was the likely cause for AIDS. After a few years of toil, (in 1986) it was discovered that the two retroviruses found by Gallo and Montagnier were genetically indistinguishable and were renamed human immunodeficiency virus HIV. This was the breakthrough discovery of the (virus) disease which in 2009, the UNAIDS estimated infected

33.4 million people worldwide (living), with 2.7 million new HIV infections per year and 2.0 million annual deaths due to AIDS  (UNAIDS Report)

This makes it one of the biggest killers ever. It is difficult, even to comprehend the utter devastation brought about by this disease. Although treatments for HIV/AIDS can slow the course of the disease, there is no known cure or an ‘HIV vaccine’ of any kind as of yet. Anti-retroviral treatment reduces both the deaths and new infections from HIV/AIDS, but these drugs are expensive and the medications are not available in all countries – a fact which was to prove utterly devastating for the populations of Africa in particular. Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the pandemic with health organizations promoting safe sex and needle exchange programes in attempts to slow the spread of the virus.

History of a Corrosive Counter-Claim

Perhaps the first recognizable murmurings of AIDs denialism came in 1984 when Casper Schmidt, a psychiatrist, published a paper in Journal of Psychoshistory entitled “The Group-Fantasy Origins of AIDS” which basically argued that AIDS was not a disease but rather an example of epidemic hysteria in which groups of people would subconsciously act out social conflicts rather than displaying symptoms any real disease. This was at a time when the Science did not have a handle on what caused AIDS, or in many ways what was AIDS. So these ideas were never too far from the surface. Schmidt, himself – in a twist of dark irony – would later die of AIDS in 1994. But the meme was planted, that ‘AIDs was something fake and cooked up’. And from that, came Peter Duesberg (an academic at UC Berkeley) – who would go on to become possibly the most prominent AIDS-denialist out there – when he first questioned the link between the link between HIV and AIDS in his paper Retroviruses as Carcinogens and Pathogens: Expectations and Reality, in the journal Cancer Research. In itself, questioning Scientific orthodoxy is no bad thing. In fact that is how Science is meant to progress, ruling out other factors that may challenge the consensus view (which was steadily emerging in favour of HIV causing AIDS).

But insisting on the same things when you’r arguments have been addressed is another matter altogether. Duesberg’s work got quite a lot traction among many, early on – enough even, to get him published in a Journal alongside some of the mainstream stuff. As time went by though, the evidence (for HIV causing AIDS) hardened and in 1988, a  a panel of the Institute of Medicine of the US National Academy of Sciences  found that “the evidence that HIV causes AIDS is scientifically conclusive. But as we find with most conspiracy theories,a hardening of evidence is never enough to stop these ideas in their tracks. And so it proved to be the case as Duesberg embarked upon a campaign of quackery and conspiracy theory which saw him steadily gain influence among some of the most powerful people in the world (particular in the developing world where the consequences of AIDS were much more horrific than in Western Europe or North America)

Dr. Peter Duesberg (or what he should really be called) - Dr Peter 'Douche'berg

He wrote the book “Inventing the AIDS Virus” which came out in 1996 asserting that HIV is harmless, and that it is recreational drugs and Anti-retro-viral drugs (specifically AZT, an early developed Anti-Retroviral drug) which caused AIDS. It gained him quite a lot of notoriety as this rather (stomach churning-ly) deferential interview demonstrates. It even got a foreward from Nobel laureate (in Chemistry) Kary Mullis, who among things (like being into Astrology apparently) is also a climate-change denialist – shows that sometimes the brightest of the bright can be taken in by the conspiracy theory quack mindset. Soon enough, other people like David Rasnick also started appearing on the scene; peddling the same ideas, that HIV does not cause AIDS and the Scientific consensus is a conspiracy to allow big Pharma to profit. Remember all of this was happening as the evidence was for HIV causing AIDS was becoming even more watertight. Both Rasnick and Duesberg were to take their ideas to South Africa over the turn of the Millennium, where President Thabo Mbeki tragically gave them credence and enacted actively AIDS-denialist policies throughout his reign from 2000-2008 – a period which was to prove deadly for many South Africans. Perhaps Mbeki’s attitude was a legacy of the brutal Apartheid regime in South Africa, notorious for committing various bio-ethical atrocities on the population – but this paranoia is a feeble excuse (at best) not an exoneration. I’m actually preparing a post specifically on that aspect of this wretched idea, so I won’t go into in much detail now. Suffice is to say that Duesberg and Rasnick play a significant and deplorable role in facilitating the South African catastrophe.

For anyone, who thinks this is a cautionary tale of how bad ideas influence things in the past but are now discredited and we don’t have to deal with them, think again. As recently as 2009, a film called House of Numbers was released, which posited itself as ‘an objective, naive investigation’ into AIDS. Here is the trailer if you can stomach it. That is how it was marketed to people but as Ben Goldacre of Bad Science explains, It contained

All the usual ideas are there. It’s antiretroviral drugs themselves that are the cause of symptoms called Aids. Or it’s poverty. Or it’s drug use. HIV doesn’t cause Aids. Diagnostic tools don’t work, Aids is simply a spurious basket diagnosis invented to sell antiretroviral medication for a wide range of unrelated problems, and the drugs don’t work either.

We have to beware of things like ‘Oh we’r just starting a debate, we’r just asking questions’ line on this. Firstly because its so trite and meaningless, but more importantly it is then an invitation for you to put the most comprehensively assembled evidence on AIDS that is out there, on equal (or even less of a) footing with fringe crackpot conspiracy theories. It also highlights how ‘On the one hand, and the other hand’ model of journalism breaks down in explaining these things – though I don’t think the film even amounts to that.

The Specific Claims of AIDS-Denialists

Because this has the potential to get really long-winded, I will for brevity and clarity, address them in point form. (Also I’m not going to link directly to each claim because a) they are so many and b) I don’t want to direct too much traffic their way. Suffice to say, you can easily find them yourself, and if I have misrepresented their basic contentions, do let me know. I will  definitely review it.)

  1. HIV does NOT Cause AIDs: This claim – as I have mentioned above – is the cornerstone of the AIDS denialist movement. The work of Gallo and Montagnier initially showed that HIV causes AIDs. Since then with very few exceptions, HIV itself or antibodies to HIV are detected in people with AIDS. Studies of people who are HIV-positive show they are more likely to develop AIDS symptoms and more likely to die at younger ages than people without HIV. Scientists can now describe in great detail how HIV infection occurs and how it causes AIDS. In fact there are very good peer reviewed studies showing where the virus originated.
  2. AIDS in the West is high because of Recreational Drug Use among Minorities/Immigrants:  This is a curious claim. Because I think it has its roots in all the moralistic sentiments that are often banded about in AIDS discourse (usually dinner time discussions in aloof suburban idylls) And part of the AIDS-Denialist brief, is to tap into that (right wing) sentiment, hence Duesberg contentions (see links/references above) that it is THIS (rater than HIV), that causes AIDS got alot of play in some circles  because it flattered their preconceived ideologies about race, drugs and immigration. But what is the evidence for these claims? For starters, the fact is that no published peer-reviewed study supports this theory should immediately raise a red-flag about the veracity of this claim. There are interesting tidbits about how alcohol use may increase risk of AIDS but that too is indirect i.e. from it being undisciplined about taking medication/using protection(condoms) – no direct biochemical link to AIDS as the denialists want to imply. AIDS can be spread using needles, ofcourse but that’s a transmission claim – not a causal one. M.S. Ascher examined this by looking at the data of several research cohorts and found no correlation between drug use and AIDS. The graph below is from that study, Does drug use cause AIDS? published in Nature in 1993 shows that there is no correlation between recreational drug use and AIDS. It is important to note that drug use may indeed facilitate transmission AIDS through the use of needles, but that is not AIDS-Denialist are saying; which is that drug-use itself causes AIDS

    No Correlation between increased drug-use & AIDS (via AIDStruth.org)

  3. HIV cannot be transmitted hetrosexually In fact studies investigating this claim have shown the EXACT OPPOSITE opposite as this article demonstrates. I don’t think, this claim even fools people who are remotely interested in this topic, as the sheer numbers of victims and deaths are so visible to everybody. You really have to have tunnel vision to believe this one. Though this idea is very popular with people who believe that homesexuality is a sin (often with religious undertones) and AIDS is a risk of that sinful behaivour. As with needles other forms of sexual intercourse, there is no evidence for homosexual lifestyle causing AIDS, only that it can spread if contraception is not used – the same with heterosexuals. As this study showed, that none of these things ’cause’  AIDS. Its conclusively the HIV Virus.
  4. AIDS in heomophilliacs is caused by clotting agents in donated blood not HIV  Heomophillia is genetic disorder which affects the clotting of blood which is used to stop bleeding when the vessel is broken. So another conspiracy theory was based on the fact that a high proportion of haemophiliacs were exposed to Factor VIII (a clotting agent) and it was THAT (not HIV) that caused AIDS in the US. But retrospective tests of US blood supply showed that  “in 1978, at least one batch of Factor VIII was contaminated with HIV”. Talk to a denialist, and they will purposely omit that finding from the discussion. And onwards they will move to their next claim
  5. There is no serious HIV epidemic in Africa, it is merely another name for diseases from poverty  Of all their claims, this is perhaps the most hideous and dispicable. Effectively this is a denial of death on a biblical scale in Africa. And true to form, it is totally demolished by empirical evidence. Various studies in Africa have shown that the HIV infection is a predictor of  higher disease and death rates. While poor people have greater exposure to HIV and are more likely to progress to AIDS faster, once infected with HIV, there is no evidence that poverty itself is the cause of AIDS. This study in Rakai, Uganda looked at nearly 20,000 people and found a much higher death rate among HIV than other impoverished people. Moreover, the HIV-related death-rate was higher among better-educated and well-off people as well, which completely torpedos this notion that there is no HIV epidemic in Africa. A Statistcs South Africa study looked at a count of death certificates in South Africa from 1997 to 2002 showed a 57% rise in deaths that cannot be explained by population growth or an improved death registration. The HIV-related mortality trends have become even clearer. This cannot be explained by poverty, because (i) economic conditions in South Africa have not changed drastically enough to explain this sudden rise in adult mortality (on the contrary, the social wage in South Africa has increased during this time) and (ii) if it had, we would expect to see a much higher rise in deaths among the elderly which we didnt. The only plausible explanation of the increase in adult mortality in South Africa is HIV.
  6. AZT causes AIDS  (AZT is a type an Anti-retroviral drug – one of the earliest developed) One thing that deniers never focus is extremely diversity and adaptability of HIV. This is perhaps why its so deadly, because it can adapt newer strains which are very difficult to identify let alone fight off. So by definition, any Antiretro-viral treatment will have some people for whom they won’t work. That is just how HIV operates. That reality instead is fudged and mangled to the point (by the Denialists) where they start to make the absurd claim that it is AZT itself that causes AIDS – using ‘sciency-sounding’ language while doing so. And ofcourse it is book-ended with the phrase ‘it all fits’ hinting at the Big Pharma Conspiracy. Whenever you hear the phrase ‘It all fits’, be suspicious, because in life, nature, societies – nothing fits in neat little boxes and preconceptions. There are always caveats, hedges and outliers which confound explanation. The way to deal with them is through employing empirically testable methods like Randomized Controlled Trials. In the first AZT trial on people with AIDS symptoms, known as BW 002, 19 patients out of 137 on placebo died and 1 patient out of 145 on AZT died. The AZT patients did better on a range of scores including quality of life. In another randomized placebo-controlled study known as ACTG 016, the efficacy of AZT in reducing disease progression in symptomatic people with CD4 counts of 200 to 500 was again demonstrated. No benefit was found for people with CD4 counts above 500.
  7. Anti-retroviral drugs are untested and are harmful to feotus in Pregnant women  Every Anti-retroviral registered in South Africa and the USA (of July 2006) had demonstrated its safety and efficacy in clinical trials. As with the pregnant women claim,  the short term evidence is quite categorically against it, that pregnant women who take Anti-retrovirals reduce infecting their infants. The results of long-term data are awaited, but every bit of incremental evidence that has been gathered shows that Anti-retrovirals have been efficacious.
  8. HIV Tests are unrealiable because they produce False Positives As with any epidemiological study there are two vital measures that allow us to discriminate; Sensitivity Tests (likelihood that the research/trial/study will return positive results) and SpecificityTests (the likelihood that the researcg/trial/study will return negative results) and on both counts the tests for HIV (or its anti-bodies) have been demonstrated to be reliable.
  9. Tests that measure HIV are flawed because they find only dead virus particles This is simply a bogus assertion as there are viral load tests which give us an indication of a live viruses in a person with HIV
  10. AZT does not triophosphorylate and therefore cannot work  AZT has to go through process known as triophosphorylation which allows AZT to work. Since this requires a nuanced understanding of Biochemistry, it is often trotted up by Denialist to bamboozle folks without prior knowledge of this issue. The fact is that there is both evidence that AZT works (above) and that it triophosphorylates
  11. HIV cannot be detected post-mortem  Another bizarre claim which disintegrates at the first instance of scientific or any kind of examination. In fact it can be detected with high degree of accuracy and is vital information in screening for tissue donors.
  12. The fact that many people live in good health for many years is proof that HIV is harmless This is the classic small sample size fallacy. Sure some people will be able to live in good health with HIV for many years. But all big studies involving large sample size have demonstrated that most HIV people will develop AIDS. The plural of anecdotes is anecdotes, NOT Data
I have not been able to go through each and every claim of the Denialists (indeed each debunking seems to spawn a new theory) but I hope I have painted a picture of how the AIDS Denialist mindset works. “At no cost must you accept that HIV causes AIDS. If you can’t demonstrate it empirically, then blame secret cabals, censorship, shadowy figures – anything but the Science”. And the more time people invest in this kind of thinking, the more strident they become. A key thing to remember is that most AIDS Denialists will be highly educated individuals, because even to deny some of the evidence, you need a requisite proficiency in the areas of research (although that’s not always the case).
This is by far the longest post I have written on this blog (so apologies for that). For those interested in the content, really do have a look at Denialism, AIDSTruth.org, AIDSmyth  and thebody – they really are brilliant resources for not only AIDs-Denialism, but also anyone interested in a consistent narrative on the history of AIDS and the rush to prevention and mortality reduction. It is enlightening, and will very much challenge some of the commonly held notions about AIDS. Almost every mythology proposed by the Aids Deniers revolves around HIV not causing AIDS – something which investigation after investigation (over the past 28 years) demonstrates to be entirely nonsense. Yet they keep going on; clutching at whatever political, emotional or historical foothold they can use to promote their fabrications. A lot of it is rooted in the “Big Pharma = Evil” attitude which  – I’m embarrassed to say – is quite prevalent among those of us, of a left liberal hippy disposition also. Again this is no way exonerating the big Pharmaceutical companies role in the problem of AIDS in Africa. The exorbitant and unreasonable pricing employed by them,  played a huge role in delayed delivery of life-saving ARVs – something which doubtless, I will have to write about later. But opposing them – by no means – should ever lead us to humor these hufffy cartoon-ish conspiracy theories around AIDS.
Equally, there is also right wing appeal to AIDS-Denialism, especially the hypothesis of it being caused by ‘degenerate behavior-isms ‘ – as they see them – of drug use and homosexuality.  Part of the problem is the traction this kind of thing gets at dinner time conversations. It is especially chilling to see people in power basically repeating those dinner time extravagances as policies to combat AIDS in their countries (often with large HIV infected populations). This is an illustration of the dangers of being (polite) silent witnesses to bad ideas and rank stupidity; because when these ideas go unchallenged, they have the capacity to do real world damage; and that – to me at least – is cowardice of the most basic kind.

Posted in Africa, AIDS, Conspiracy Theories, Denialism, Quacks, Science, Science and Politics | 2 Comments

Egyptian Revolution: Food for Thought

The Egyptian Food Riots of 2008 (via sultanknish.blogspot.ca)

2011 was some year for Egypt.  From the overthrow of Hosni Mubarak in February, to the electoral gains by his erstwhile nemesis The Muslim Brotherhood (and co.) in December, the shift in the political climate seems to have happened at almost warp drive (the obligatory Star Trek Reference!). Yet (plus ca change. plus c’est…) as it was in February, 10 months on, the same protesters at the iconic Tahrir square, now face some of the most brutal Security Forces crackdowns in the region. This article in the Atlantic and DemocracyNow’s Sharif Abdel Kouddous describe the harrowing details of the latest wave of state violence  . On Dec 29, they raided NGO Offices in Cairo, claiming they were responsible for this ‘rise’ in protests. I don’t think I have anything useful to add, so I will leave this there.

Revolutions which overthrow entire governments are a complex phenomenon. Being the pattern seeking creatures that we are; can’t help but look for that one defining cause or group of people which drive such a popular revolt. Perhaps that is why post-revolutionary time periods are dominated by a jostling for credit of the revolution, and  in many ways Egypt has been no different. Usually a myriad of factors converge, creating a critical mass which sweeps a nation. This is likely to be what happened in Egypt and it would be presumptuous to claim, one single factor, or one particular group of people as the sole architects or drivers of the revolution.

Food Riots of 2008

So after having poo-pooed the habit of people trying to find one single reason/explanation for the revolution, I am going to*coughs* venture upon that exercise myself.  One of the significant early movers of the uprising was the shortage in global food supply in 2008, which sparked an unprecedented spike in the price of food (and subsequently protests) in Egypt. For a country where 40% live on 2 dollars a day, this was a full blown life-on-the-line crisis for a vast number of people. Interestingly, this report from AJE of about 3 and half years ago, reveals the urgency of the situation back then and is quite prophetic in its predictions for a turbulent future for the Egyptian regime. It is certainly a somber realization that most folks could not even afford to take part in the protests at the time, so desperate was – and in many ways is – their need to make ends meet. Without formal employment, many are left to scrounge around for leftovers from a system that offers little prospects for social mobility.

Of course, to the outside viewer, all this, is rather surprising to discover. After all Egypt is historically a ‘nation of farmers’ with the ability to produce adequate food supplies to sustain itself. It is host to a vast network of fertile lands around the Nile Delta which should – in theory –  have protected them from supply shocks from outside. But now with more than 85 million mouths to feed, it is one of the largest importers of wheat in the world (primarily from Russia and the US).  So why was this situation allowed to develop in the first place?

The Food Subsidy

Inevitably, the place to start is ‘that subsidy‘, the Mubarak regime offered for wheat and bread (among other staples). In many quarters, this was the conversation killer. Whenever you broach the topic of food, within the context of Egypt, you were immediately shot down by the notion that, “were it not for the benevolent Government subsidy, Egyptians would likely starve to death”. Of course the sad reality of the situation is that this assertion is probably true and the main reason why any discussions surrounding the subsidy need to exercise a degree of caution because of the potential devastatation in the event of its removal.

Yet this line,  unfortunately, was also used to bat away any critical investigation of the Egyptian Food sector as whole. More pertinently the rather obvious questions of, why should Egypt be so heavily dependent on importing wheat and hence the need for those subsidies. And why aren’t they even trying to get a foothold in local production? (There are some very interesting papers on the feasibility and efficacy of these subsidy programs but for brevity, I will limit this discussion to subsidies as whole, as opposed to their specific strengths and limitations – perhaps that’s a topic another post.)

“Open” Sesame 

Part of the answer lies in the role of ‘opening up the Egyptian economy’ policy (first pursued under Sadat and then later – and even more aggressively – under Mubarak) in creating this situation. Now, I am not one of the anti-globalization “Occupy Wall street” posse, who instinctively go into convulsive fits, at the mere mention of words like ‘markets’ or ‘the private sector’. In fact I think markets and private enterprise can genuinely be a beneficent force for society. The only thing I want, is government accountability in dealing with the private sector. The reasons and processes for giving out contracts and preferences (because that will always have to happen in order to facilitate growth through capital) should be transparent and open for public consumption and criticism.

 However, when market economics marries dictatorship, the essential scrutiny mechanisms (which are vital for the prosperous aspects of market economics to take shape and create a local feedback loop) are circumvented. And that  is essentially what seems to have transpired in Egypt as well. It resulted in the emergence of a new class of food producers which catered for the wealthier foreign markets of Europe instead of the local one. The focus shifted from producing vital food stuffs like bread and lentils, to producing luxury food items for mainly the European market. In effect, (for these producers) this created a competition between feeding (the demand of) Europeans, and feeding (the demand of) Egyptians, and there was really only ever going to be one winner in that one.

It was called “The Export Agro Sector of Egypt” because it really did boost it’s export revenues. But the effects of it becoming the focus of Egyptian food production meant that their population was now heavily dependent on imported wheat and bread. This is a good illustration of how a lack of skepticism and critical thinking around the use of economically-neutral terms like ‘investment’ or ‘boosting exports’ can have quite a pernicious impact on the overall discourse of the economy – especially if it relates to one of its most fundamental aspects, namely feeding the population. As a result, vast sways of land which could have been used for producing food for local consumption, were now being used on produce for foreign markets, benefiting a narrow class of Egyptians and creating a hugely disparate society in the process.

The Beneficiaries of Export Agro

“Crony Capitalism”

Obviously part of the problem was also the nexus of institutional corner-cutting both in the private sector and government. This new breed of ‘Food Entrepreneurs’ did not go into this for love of country (nor should it be their remit to do so, I hasten to add) but because this offered them, cheap land, cheap labour, cheap (govt) credit, and ultimately a cheap way to make a quick buck. Once again, the blame doesnt lie with the ‘evil’ capitalist, but the criminal lack of government foresight and oversight, in allowing this situation to rise. Magda Kandil, who has studied this phenomena in great detail calls this straight up  “Crony Capitalism”.

They are entrepreneurs, some of them live abroad, live in the U.S. They’ve been capitalizing on connections that the average farmer cannot have in terms of marketing, economy of scale, access to water, access to technology, access to subsidized fuel, access to subsidized fertilizers. So I’m against this model because it doesn’t help the social agenda. (Magda Kandil)

Coupled with this, the increasing price of (land) rent meant that many of those small-scale farmers, who would otherwise cater for local demand, were now put out of business and were essentially left to rot like the millions of other unemployed that wander the streets of Cairo today. Moreover, the preferential treatment of these ‘new food entrepreneurs’ resulted in some of the earliest clashes with the security forces. Indeed this formed a significant part of the food riots in 2008.

Population Growth, the Obvious Confounding Factor

Just to be clear, I’m not saying that the Export Aggro sector, or the government backing of it, is the sole reason for Egypt’s vulnerable position on food. Clearly the ballooning population, in any case, would have made it difficult for Egypt to sufficiently produce its own wheat and lentils. The population is thought to have nearly doubled in the past 30 years (when Hosni Mubarak took over the reigns) to around 85 million today. Some estimate that, if current trends continue, a further 55 million will be added by 2050. That means, sustaining the current food subsidies becomes harder and harder in the future.

But the core point remains, that instead of attempting to ameliorate the problem, the Mubarak government chose prioritize other things – and in that choice, betrayed their staggering levels of ineptitude (and that’s the most generous reading of it). Its another reminder of how the bottom classes (even when they are local farmers) are shafted in disparate developing economies. Happens in Egypt, happens in other parts of the world as well.

The Islamist Bloc

It will be interesting to see how the Islamist Bloc –  consisting of the Muslim Brotherhood, the Salafis and some others (when they come to power) – address this issue. Because handling population growth means improving Family Planning programs, Maternal & Women’s Healthcare and the promotion of Contraceptives on a large scale, among others – all  of which are total anathemas to their traditional ideologies. Moreover, one of the best ways to address the issue of population growth, is to bring in more women into formal employment – another thing, which is sure to prove  a mind-bender for them. This is not to suggest that these will be impossibilities in religiously conservative governments; certainly Iran – with all the baggage of its religious leaders – is one example where family planning programs have been successfully implemented. But, failure to adequately address this issue, will mean that a majority of Egyptians will be continually dependent on food imports from such countries as the US, Canada and Australia – not exactly what you call ‘Islamist-friendly’. So far, the Islamist Bloc haven’t really articulated a response to this dilemma. The  Salafis’ (the most religiously conservative of the lot) position on this complex nexus of intractable public policy problems, can be summed up by the footage below

A Time for Introspection

This is an extremely unpalatable situation for many sections of Egyptian society. For the privileged classes (yes even those of the leftist, liberal, secularist persuasion), it is an uncomfortable reminder of how the social economy has been perverted to the point, where their own prosperity (even if they don’t like it) probably comes at the cost of pushing others further down in the mire. It is something that they will have to consider and incorporate in the daily narrative of their struggle against the powers that be. Failing that, could mean risking being as out of touch with Egyptian life, as those they are (so bravely) seeking to oppose. For the thriving entrepreneurial-business classes, it should give them a moment’s pause, at the realization that fulfilling their interests may have made the problem of disparity in Egypt, even worse. For the Islamist Bloc, it ought to inform them how the vast majority of Egyptians (the bottom 60% or so) depend for their lives on those wheat imports from abroad and any reckless anti-american populism has the potential to devastate and pulverize those bottom 60 percent in unprecedented ways – if indeed that’s an outcome which concerns them. I don’t think the Hosni Mubarak regime even merit a mention here – so contemptible and morally bankrupt was their role, in facilitating this current predicament.

The problems of food and population cannot be pretended away or wished away or sloganned away. Platitudes wont do at this stage. They will require objective and critical appraisal of the empirical realities at hand. They will require a nuanced understanding of the economic (and demographic) forces at play. For all the bluster and talk of ‘Egyptian sovereignty’ on the world stage, the thing that matters – or at least ought to matter – most, is whether it is able to sustain feeding its own population. If it cannot, all the other professions of national pride like, ‘international recognition’,’strength of the army’, ‘lapel pins’, ‘flag-waving’ and ‘speechifying’ etc etc, mean diddley squat. If you don’t own the food you eat, you don’t own the thoughts you think, that’s a lesson for Egypt (and others). Because defeat on this, would mean the price of acquiring food, is going to shoot up. And with that, the value of human life – and all its concurrent edifices like this revolution- will fall by the wayside.

Posted in Arab Spring, Corruption, Development, Economic History, Economics, Food, Global Food Supply, History, Middle East, Politics, Poverty | Tagged , , , , , | 1 Comment

#Burzynski: Silencing Legitimate Criticism is NOT Charity

Stanislaw Burzynski: In the Centre of a Blogostorm

So a very interesting story has developed over the last few weeks. Like many stories of questionable cancer ‘treatments’, it involves a desperate family trying to do whatever they can to save their child, it involves celebrities and communities wanting to lend a helping hand, it involves a prominent media outlet keen to publicize the story but also, sadly, it also involves a party which is – shall we say – less than transparent about its claims of being able to treat cancer thus opening itself to legitimate criticisms about its setup.

The Story

It all began when Billie, a girl of only four years of age from the town of Exeter in the UK , developed inoperable brain tumor. This was a desperately sad situation for the family even more so because Billie’s mother Terri is also suffering from Breast Cancer. It is impossible, not feel anything but the utmost sympathy for somebody in this situation. Not only is it unimaginable for parents to see their child in such trauma but the thought of not having anything concrete to grasp for their child’s recovery is something I cant even begin to fathom. Luke Bainbridge (who is Billie’s Uncle) wrote a heartfelt article in the Observer (which is affiliated with the Guardian) and this is where it all began.

Naturally, without fail, many people – from all walks – willingly wanted to do whatever they could, donated money, time and effort to the cause. When the life of a little child like Billie is at stake, I defy anyone not to be moved and shaken to their very core. But the problem was not people’s good intentions, it was where those intentions were being channeled. And unfortunately they were being channeled towards a Dr. Stanslaw Burzynski who claimed to have the cure for cancer.

Burzynski has an interesting history and frankly there are others who have done a rather good job diggin him up so I suggest you  take a look. His treatment involves “personalized gene targeted cancer therapy” which  – suffice to say – lacks genuine scientific evidence behind it, as ScienceBasedMedicine so thoroughly demonstrates  For those interested in the nitty gritty of the story, I urge to read Respectful Insolence ‘s take on it. One of the interesting bits about this story is the fact that he seemingly used a loophole to conduct and essentially run a treatment operation for cancer patients. While the FDA can block  cures devoid of evidence, it is somewhat handicapped if the essence of the operation is presented as a ‘trial’. He seems to have worked out a clever strategy of marketing this thing as pioneering by using this trial loophole and charge an exorbitant amount of money from the most extremely vulnerable set of people.

Revenge of the Nerds

This is where the story got interesting. It came to my attention through a site called Quackometer. More pertinently, when the proprietor of that site Andy Lewis got threatening responses from the Burzynski clinic in response legitimate questions that he aired about his protocol. It veered from the absurd to downright intimidating as someone (posing as a lawyer but in fact a PR guy for the clinic) sent him email after email pushing him to delete all the content at his blog. Prior to that Rhys Morgan, a 17 year old from Wales (who incidentally has had a previous altercation with another Miracle Mineral Solution quack named Jim Humble) was also contacted and intimidated in the same bizarre way by Dr Burzynki’s clinic. Not unsurprisingly this story started doing the rounds and over a 100 bloggers have now written about this (further hurting Burzynski’s google search results)

Rhys Morgan was threatened with legal action

When someone is so quick to push the libel button and threats, a red flag must to go up in your head. In matters of Cancer research, where surely the objective has to be finding what works and ironing out what doesn’t work HAS to be the priority. It is an ethical imperative. Cancer research cannot (MUST not) be subservient to people’s commercial interests (whether they be big pharma or big quacka; no matter how groundbreaking they say their treatment is), the stakes are just too  high for such heavy-handedness from these parties, to be allowed.  This ‘Red flag’ is essentially what these bloggers spotted and were attempting to follow up on. They were skeptical of the work of Burzynski and they wanted to make sure people were doing there due diligence before pumping so much money into this enterprise.

Who to Blame?

Now, personally I think its important to exonerate the family themselves ENTIRELY from this ‘lack of due dillegence’. They are under unimaginable pressures and to expect them to make ultra-rational decisions at a time of great distress is an ask that is simply unrealistic. And in fact I don’t think there decision to go to the clinic was borne out of irrationality, as their primary aim is to do whatever it takes to save their child. There can be no doubt about that whatsoever.  So I have No bone to pick with them at all.

I do however, feel that the surrounding actors in all this, have let them down. Chief among them is the clinic itself which willfully promotes itself having a cure for cancer (when there is no scientific evidence to back it up). Also the Observer (Not even, Luke Bainbridge who authored the peice) as an institution have some serious questions to answer. They have resources, (e.g. the Guardian – up until recently employed Ben Goldacre among other really clever people who have done great work at exposing unscientific ‘cancer treatments’) they have the financial muscle and frankly they have the time which the average person does not to investigate things of this nature.

Quacks will always exist, but we are entitled to have higher expectations of journalistic institutions like the Observer. Unfortunately they have gone for the “compelling human interest angle” above and beyond the science and in doing so, they have not only promoted what seems alot like cancer quackery, but they have also blurred the lines between good science and bad science. They did respond to the uproar by the blogs with this rather feeble attempt. Unfortunately it seems like the have not learned from the MMR-debacle – and that is such a shame.

An insidious part of the story is this attitude of “I’m doing charity, so shut the f*** up and dont ask questions”. Yes people’s (especially celebrities like Peter Kay who planned to do gigs for Billie’s benifit) willingness to help the little girl is laudable but they should have some inkling for due diligence rather than thoughtlessly following everything. And if there are concerns, they should have the moral fortitude to raise them with the family. Instead, it almost forces the family to stick with this decision, now that so many have invested time, money and effort – and its not a healthy position to put them in. We all wish Billie well and are desperate for her to somehow find a way fight off this battle. Criticism and raising genuine questions about the treatments – I think – is a moral and a valid contribution in that fight. It should be encouraged and not silenced by intimidation.

Update: It is with profound sadness that I need to report that Billie unfortunately passed away on 1 June, 2012. Whatever the ifs and buts and wherefors of this story, let us never forget, how terribly heartbreaking this has been for Billie’s family and lets hope that they find the strength to cope with their immense loss. Thoughts and sympathies with them.

Posted in Cancer, Media & Journalism, Medicine, Quacks | Tagged , , , , , , | 4 Comments

The Perils of Amateur Epidemiology

The pitfalls of Over-extropationg (via XKCD)

I have just finished reading the excellent The Panic Virus by Seth Mnookin. It details the rise of the anti-vaccine movement, how their ideas have been scientifically discredited and further how a maelstrom of media, social and cultural pressures have meant that those ideas (despite the ‘debunking) have as much currency as they ever had in the public imagination. I have already written an article  on the Anti-Vaccine movement and if you found that interesting then you definitely ought to read this book. It is one of the most comprehensive journalistic works, on this issue. out there. (The Panic Virus has been added to the “Reading List” Page, where I have added other books of relevance to the content of this blog, if you want to check them out)

So with book recommendation out of the way, I’ll move onto a brief and particularly fascinating passage in the book. It is a simple yet highly illustrative case of how ‘common sense’ approaches to epidemiological matters can be misleading. Furthermore how that misunderstanding is then latched upon by the press in a bid to satisfy preexisting narratives which do not cater for most basic level of complexities. The rush to link ’cause’ to ‘effect’ is a very tempting thing to do and a large part of scientific endeavor is to account for any (confirmation/publication) biases that may influence any such accounting. We like to connect the dots, see patterns and while its a rule of thumb that serves us well on a day to day basis, it simply cannot establish cause and effect in terms risk exposures and disease outcomes. This is why I found this particular passage in book fascinating
In March 1992, Lorraine Pace was diagnosed  with breast Cancer. This came as a shock not, Pace said, because a cancer diagnosis is always upsetting, but because she thought her healthy lifestyle should have protected her from the disease. Even more alarming to Pace was her awareness of the rather large number of cancer patients in the area; Eventually she counted a total of twenty people in her neighborhood in West Islip (Long Island, New York) who’d also been diagnosed with cancer in the past several years alone. This might have been an informal sampling but it left pace convinced that an unidentified toxin was stalking her community. (The Panic Virus pg 138-139)
Sampling Error is the first thing we learn about in a statistics class. It is simply an acknowledgement of the fact that a small data set can be misleading indicator of the whole population (The Small Numbers fallacy). Of course Statistics is a field built on approximations of patterns in the whole population without having that information (in full), it is still a well established concept that small sample sizes are often very unreliable. This is especially key, while establishing ‘facts’ regarding the prevalence of disease rates in a community. Were the Cancer rates really higher in Lorraine Pace’s neighborhood (of West Islip)  than they were on a state or national level? We need to establish that beyond a  reasonable doubt (or a small sample size) before we entertain a further proposition of a causal link between the cancer and particular risk factor. Yet this is not what happened as Mnookin explains,
Frustrated with what she saw as lack of official concern, Pace took  matters into her own hands and founded the West Islip Breast Cancer Coalition. Day after day for months, the organization’s members would meet in Pace’s living room to add new data points to a giant, color-coded map; yellow dots for homes with malignant breast tumors, pink for benign tumors, and blue for no tumors at all. After analyzing its data , the group announced  that cancer rates in the area were 20% higher than the state average. The Media and and local politicians alike jumped on story much to the dismay of scientists, who knew that epidemiological studies that start with the desired outcomes in mind are almost by definition of worthless. (The Panic Virus)
So what could have been the mitigating factors which can explain/confound the existence of an apparent higher rate of cancer without having to resort to the ‘unidentified toxin’ hypothesis. (With some prompting from Mnookin) here are a few
1) The West Islip region area of Long Island has a higher proportion of wealthy people than normal, hence more people with better access to healthcare  which means that tumours in other communities may not be as readily noticed as in this community
2) The life-expectancy in West Islip is higher and cancer rates rise with increasing age. Hence that could account for a higher cancer rate
3) (According to the passage) West Islip women tended to defer their childbearing to later in life which is apparently points  to a higher risk of cancer
4) Sampling Error
Before we embark on establishing a causal link (toxins) for the apparently higher cancer rates, one has to account for the above (and undoubtedly other) confounding factors. So what happened
Ultimately, Pace’s crusade spawned a controversy that raged for nearly a decade at a cost to taxpayers of more than $30 million. When in 2002, an exhaustive study found the cancer rates in Long Island were barely distinguishable from those in the rest of the country; the news received a fraction of the attention the initial scare caused (The Panic Virus)
In this case, it was probably sampling error. But even if it wasn’t, there were quite a few confounding variables that had to be accounted for. This also highlights the pitfalls of the media coverage of health/science stories in general. The compelling narrative of a defiant, crusading cancer patient means that the ability to check for accuracy of the claims made, is compromised. This is one of the main reasons why things like this and vaccine scares get so much purchase in the media and popular culture as a whole.
Posted in Cancer, Evidence-Based Medicine, Medicine, Science, Statistics, Vaccines | Tagged , , , | 1 Comment