Who pays the price of war? Iraqi children, that’s who.

May 9, 2007

Who pays the price for war? Iraq’s children.

Postings have been erratic lately – this happens when I’m locked up studying for medical tests and boards. I’ll make it up to my faithful readers during the summer with the usual critical postings about global health and human rights.

But right now this article from the Independent UK is making my blood boil:

Infant Mortality in Iraq Soars as Young Pay the Price for War

Two wars and a decade of sanctions have led to a huge rise in the mortality rate among young children in Iraq, leaving statistics that were once the envy of the Arab world now comparable with those of sub-Saharan Africa.

A new report shows that in the years since 1990, Iraq has seen its child mortality rate soar by 125 per cent, the highest increase of any country in the world. Its rate of deaths of children under five now matches that of Mauritania.

Wow, Iraq went from the “envy of the Arab world” league to “sub-Saharan Africa” status. “Envy of the Arab world” is quite a statement. I wonder what led to such a decline:

Sanctions against Saddam Hussein’s regime were imposed by the UN in 1990 after Iraq’s invasion of Kuwait and remained in place until after the coalition invasion in 2003. The sanctions, encouraged by the US as a means to topple Saddam, were some of the most comprehensive ever put in place and had a devastating effect on Iraq’s infrastructure and health services.

Precisely how many children died because of sanctions is unknown but a report in 1999 from the United Nations Children’s Fund (Unicef), suggested that between 1991 and 1998 an additional 500,000 died.

Denis Halliday, who resigned as the UN’s humanitarian coordinator in protest at the sanctions, said at the time: “We are in the process of destroying an entire society. It is as simple and terrifying as that. It is illegal and immoral.”

Oh that’s right, Clinton sanctioned the hell out of Iraq, but Bush bombed the hell of it. Make no mistake, infant mortality in Iraq started rising well before Bush illegally invaded Iraq. In 1996, then Secretary of State, Madeline Albright, was asked by Leslie Stahl of 60 Minutes the following regarding the Iraq sanctions:

We have heard that half a million children have died. I mean, that is more children than died in Hiroshima. And, you know, is the price worth it?”

To which Ambassador Albright responded, “I think that is a very hard choice, but the price, we think, the price is worth it.”

So the question should be, who pays the price of war? Children do. Poor children, and especially the children of the poor do, to be precise. You haven’t seen Bush’s daughters enlist yet, have you?

Unsurprisingly, just pennies a day are needed to truly save the world’s children.

“More than 10 million children under age five still die each year. That’s almost 28,000 a day, almost all in developing countries,” said the charity’s US president, Charles MacCormack. “Vaccines, oral rehydration therapy and insecticide-treated mosquito nets are not expensive. Yet, sadly, many mothers and children lack access to these life-saving measures.”

What’s the budget of the Pentagon these days?

Here is a list of the 10 worst countries with the worst child mortality rate.

1. Sierra Leone: 282 (per 1,000 live births)
2. Afghanistan: 257
3. Niger: 256
4. Liberia: 235
5. Somalia: 225
6. Mali: 218
7. Chad: 208
8 (tied) Democratic Republic of Congo: 205
8 (tied) Equatorial Guinea: 205
10. Rwanda: 203

For the geographically-impaired, 9 of those countries are in sub-Saharan Africa. The other country is Afghanistan, which has the second-worst rate. You want to take a guess if the Bush invasion has helped Afghanistan’s healthcare statistics? How bad do you think the child mortality will get in Iran if the Bush decides to invade that country? Hint: the child mortality is not that hot now in Iran.

When you hear George W. Bush or Dick Cheney saying that they “care about the people in the Middle East”, you should now be informed enough to know that statement is pure B.S.


Gardasil studies stopped due to sucess

March 2, 2007

I just found out about this – rest assured I’ll post more about it when details surface:

LONDON, Feb 27 (Reuters) – Clinical trials of Gardasil, the recently launched cervical cancer vaccine marketed by Merck & Co Inc and Sanofi-Aventis SA, are to be halted because of the success of the product.

Sanofi Pasteur MSD, a joint venture of the two companies, said on Tuesday the independent Data and Safety Monitoring Board for two trials had recommended they be terminated on ethical grounds, so that young women on placebo could receive Gardasil.

Gardasil was approved last year as the first vaccine to prevent human papillomavirus (HPV), which causes cervical cancer. GlaxoSmithKline Plc has a rival product called Cervarix in development.

People without scientific or epidemiological training may be confused about this result. For the uninitiated here are some explanations.

People are somewhat familiar with clinical trials, in which the drug is given randomly to one group and a placebo to the other. It is unethical to not give a patient a treatment that we know that works, so in the case of clinical trials we give one group the experimental drug and the other group the established standard treatment – again, it is unethical to not treat patients.

Specifically, these are parallel track phase III studies, one previously completed in females, the other ongoing in older females and in adolescent males, which had not been completed at the time of original licensure.


Low-Cost Antimalarial Pill Available!

March 2, 2007

A child finds out he got Malaria

God, finally some good news to cheer my day up!

A new, cheap, easy-to-take pill to treat malaria is being introduced today, the first product of an innovative partnership between an international drug company and a medical charity.

The medicine, called ASAQ, is a pill combining artemisinin, invented in China using sweet wormwood and hailed as a miracle malaria drug, with amodiaquine, an older drug that still works in many malarial areas.

A treatment will cost less than $1 for adults and less than 50 cents for children. Adults with malaria will take only two pills a day for three days, and the pill will come in three smaller once-a-day sizes for infants, toddlers and youngsters.

Needless to say, this is a very good thing, and a team effort as well:

“This is a good thing,” said Dr. Arata Kochi, chief of the World Health Organization’s global malaria program, who has publicly demanded that drug companies stop making pills that contain artemisinin alone because they will lead to resistant strains of malaria. “They’re responding to the kind of drug profile we’ve been promoting.”

[…]Sanofi-Aventis, the world’s fourth-largest drug company, based in Paris, will sell the pill at cost to international health agencies like the W.H.O., Unicef and the Global Fund for AIDS, Tuberculosis and Malaria.

The rollout of the drug is the result of a two-year partnership between Sanofi and the Drugs for Neglected Diseases Initiative, a campaign started by the medical charity Doctors Without Borders to find new drugs for tropical diseases.

Doctors Without Borders, better known by its French name, Médecins Sans Frontières, has long been one of the harshest critics of the pharmaceutical industry, charging that it spent billions on drugs like Viagra, Ambien and Prozac for rich countries and almost nothing on diseases killing millions of poor people.

But, recognizing that new drugs would have to come from the industry’s major players, Doctors Without Borders founded the initiative in 2003 and began seeking partnerships. This is the first to come to fruition.

See, ain’t that the way to do things? Major disagreements, but communication is still open, and compromise. I know a government or two that could apply these principles into practice.


HPV: maybe it is women’s fault (Cartoon of the Day)

February 20, 2007

Bad news

(From Nick Anderson, Houston’s Chronicle’s excellent editorial cartoonist)

Ah, so what is it gonna be, conservative idiots? As a future doc, this picture sums up my feelings quite nicely.

Given all the brouhaha over HPV and Texas Governor Rick Perry’s order to implement a mandatory vaccination program for all school-age girls in Texas, I found an interesting nugget that has been largely ignored:

First lady’s influence?

Also, a spokesman indicated that first lady Anita Perry’s strong support for the vaccine may have played a role in the governor’s decision. A former nurse and the daughter of a doctor, Anita Perry works for an organization dealing with sexual assaults.

“I know they have discussed it, and it’s something they both feel very strongly about,” said Press Secretary Robert Black.

But some who oppose the bill have suggested that a political contribution from the vaccine-maker influenced his decision.

So his wife, a former health professional, may have had a bit to do with it. Do I buy that? Sure, why not – but lots of first ladies are involved in humanitarian and educational endeavors as well. If politicians actually listened to their wives a little, things would be a lot better in ALL countries.


Hell Just Froze Over – Mandatory HPV Vaccination in Texas?

February 3, 2007

Did hell just froze over because of Texas?

Yes my friends, apparently hell just froze over:

HOUSTON, Feb. 2 — Texas on Friday became the first state to require all 11- and 12-year-old girls entering the sixth grade to be vaccinated against a sexually transmitted virus that causes cervical cancer.

Averting a potentially divisive debate in the Legislature, Gov. Rick Perry, a Republican, signed an executive order mandating shots of the Merck vaccine Gardasil as protection against the human papillomavirus, or HPV, starting in September 2008.

Mr. Perry’s action, praised by health advocates, caught many by surprise in a largely conservative state where sexual politics is often a battleground.

“I had no idea; I was absolutely caught off guard,” said Representative Jessica Farrar, Democrat of Houston, who sponsored a bill to require the vaccinations starting this September. “Normally, the governor does not take things like this upon himself, although I’m glad he did.”

If you live in Texas and see some snow falling, it is not due to global warming, it is because Gov. Rick Perry – a stalwart conservative republican who is against abortion and stem-cell research – finally recognized that doing the right thing is not such a hard thing to do:

“Requiring young girls to get vaccinated before they come into contact with HPV is responsible health and fiscal policy that has the potential to significantly reduce cases of cervical cancer and mitigate future medical costs,” said Mr. Perry, who was re-elected to his second full term last November.

And it is official as well:

It is Republican Gov. Rick Perry who issued an executive order directing the state’s Health Human Services Commission (HHSC) to get ready to administer the HPV vaccine in girls at noted ages before they enter sixth grade.

The order, effective September 2008, also directs HHSC and the Department of State Health Services (DSHS) to “make the vaccine immediately available to eligible young females through the Texas Vaccines for Children program for young women ages 9 to 18, and through Medicaid for women ages 19 to 21,” says the statement of the governor’s office on its website.

See? It wasn’t that hard. Good for you, Gov. Perry. So every parent must vaccinate their school-aged girls with Gardasil, right? Wrong:

Under the order, girls and women from 9 to 21 eligible for public assistance could get free shots immediately. The governor’s office said parents could opt out of the school program “for reasons of conscience, including religious beliefs.”

Ahh, I see. So at least he didn’t completely screw over his conservative friends. I wonder what is the point of having a mandatory vaccination program if parents can opt out because of religious beliefs, but I digress. Time and education will eventually replace misinformation and stereotypes.

But I wonder, did Gov. Perry did this out of the goodness of his conservative heart, or because the scientific evidence finally convinced the guy? If by “scientific evidence” you mean “my former Chief-of-Staff, who is now a lobbyist for Merck, told me this would mean truckloads of money for them and for me”, then yes, he was convinced:

Is Perry’s order politically motivated? No one knows. But, USA Today has reported today that Perry has several ties to Merck, the maker of the HPV vaccine, and Women in Government, a not-for-profit organization comprised of state woman regulators, which some watchdog has claimed is too cozy with Merck.

Media has reported that Women in Government is quite active in promoting the Merck’s vaccine, which analysts say is positioned to make Merck more than billion dollars a year. According to USA Today, Mike Toomey, Perry’s former chief of staff, serves as one of the drug company’s three lobbyists in Texas. Perry’s current chief of staff’s mother-in-law, Texas Republican state Rep. Dianne White Delisi, is a head of Women in Government.

“Perry also received $6,000 from Merck’s political action committee during his re-election campaign,” USA Today says.

Ah, now everything seems to make sense. A conservative politician from Texas is opposed to everything this vaccine stands for, and knows he can lose his conservative base over this, but he can make up those votes from the other side, and make a ton of money for his friends at Merck in the process.

Now let me play Devil’s Advocate for a moment. Is there a conflict of interest here? Very likely. But are Gov. Perry’s actions regarding mandatory HPV vaccination wrong? Well, no. Merck does make the damn vaccine, and a generic will not become available in a long time. This vaccine represents a huge leap forward for women’s health. At around $400 for 3 shots over an 8-month period, it is expensive, and most health plans will NOT cover it. But while preventing cervical cancer is morally and medically correct, it is not exactly sound fiscal policy:

Mr. Perry says it makes sense to use the vaccine to prevent cervical cancer which would otherwise cause a large burden on medical expenditure. But does this mandatory inoculation of the HPV vaccine really save medical costs?

On average, a 5-year treatment for a case of cervical caner would cost $11,000, early studies show. For a 5-year span, about 5800 new cases of the disease are expected to be diagnosed in Texas, which means the medical cost for five years is 63.8 millions or 12.8 million a year.

In Texas, there are about 6.31 millions people now under age 18, meaning the number of girls who are required to receive the HPV vaccine each year is about 0.35 million. The total number of girls to receive the vaccine is 1.76 million, meaning that Merck can rake in 630 million dollars in five years or 126 million dollars in the vaccine sales in Texas alone with Mr. Perry’s order.

The cost for the first year would be double the price tag as girls both at age 11 and 12 will receive the vaccine. The calculation is based on the price of the vaccine at $360 per girl.

It seems that this state mandatory vaccination can save about 700 women’s lives a year in Texas at a cost of 126 million dollars a year spent on the preventive vaccine. These 700 women would otherwise need 7.7 million dollars for treatment of their cervical cancer.

Perry’s order can save some women’s lives, but it does not save money.

I am not saying that vaccinating women with Gardasil is not worth it – it is. It does make sense from a public health point of view, because cervical cancer it is the second most common cancer in women after breast cancer. Gardasil, the HPV vaccine, will definitely be most valuable in the developing world, where most women don’t have access to a yearly PAP smear. But the big fight, the one that will set the precedents for other countries to follow, is taking place in the United States and Texas, of all places, just landed a knockout blow.


When cutting part of your wiener counts as vaccination…

January 15, 2007

Wiener

I have commented about this issue previously. By now you may have heard that researchers have found that circumcised men end up getting the HIV virus half as often as uncircumcised men.

Now comes this article in the New York Times:

Last month, scientists invented the AIDS vaccine. Missed it? Perhaps that’s because you were still seeking the vaccine fantasy: the magic bullet, the impenetrable shield that finally pitches this disease into the trash bin, the shot that will end not only the AIDS epidemic but our anxiety about the AIDS epidemic as well.

[…]The vaccine that arrived last month was not actually a vaccine. It was, instead, a confirmation of what scientists had long suspected: circumcision helps protect men from AIDS infection. For years, AIDS researchers have observed that many African tribes that circumcise boys or young men had lower AIDS rates than those that don’t, and that Africa’s Muslim nations, where circumcision is near universal, had far fewer AIDS cases than predominantly Christian ones. The first research proof came in 2005, when a study in South Africa was stopped early in the face of evidence that the men who had been randomly assigned to be circumcised were getting 60 percent fewer H.I.V. infections than the men assigned to the control group. Last month, ethics boards halted two similar studies, in Uganda and Kenya, when they found similar results. In both, the circumcised men caught the AIDS virus half as often as the uncircumcised control group.

I don’t have a problem with the results of the research itself, besides the obvious ethical questions, such as letting men have unprotected sex with HIV-positive women: if it is no biggie, then why didn’t the researchers try this little experiment somewhere in the U.S.? Ethics rule #1: if an Institutional Review Board (IRB, the one that regulates all research in every institution) would object to a certain experiment in your country, it is probably unethical to do so in another country as well. In layman’s terms, such research would never be allowed in the U.S.

But I digress. I don’t have a problem with the results of the studies. My problem is that because of these results, some people think that cutting part of their wiener is all it takes to fight AIDS. Thankfully, the New York Times article does tackle those issues, such as:

1) Will knowledge of circumcision’s protective status increase dangerous and ill-informed sexual behavior in men?
2) Does this protective status extend to the women circumcised men have sex with?
3) Will it increase or decrease research efforts for an AIDS vaccine?
4) How on Earth are we going to mass circumcise men in Africa? (really, what the hell do people think circumcision is?)
5) Who will train the medical personal?

You have to keep in mind that Africa’s health systems are very delicate – sometimes there is no sterilized equipment, or no autoclave machine, or surgical kits, or for that matter, very few medical personnel – and just cutting wieners left and right is not going to help in fighting AIDS.

Circumcision is a surgical procedure, however, and in the hands of traditional ritual circumcisers, it has a high rate of infection and mishap. The solution is to train these circumcisers and give them decent tools, and at the same time encourage men to come to clinics. Since men in studies say that cost is the biggest reason they are not circumcised, the operation must be free. Countries will also have to equip these clinics and train counselors and medical circumcisers, who don’t have to be doctors.

As you can gather, I oppose circumcision. It is a barbaric practice of ancient times, and you won’t see many docs offering circumcisions (unless you are Jewish). Here is another question for you: are we going to mass circumcise African children now? I really, really don’t want a religious crackpot to dictate that all those poor African children must be circumcised to prevent HIV.

You can read the rest of the article here. The article compares circumcision to a vaccine, and even though it is clear to make the distinctions, I don’t like it one bit. The best way to prevent HIV/AIDS is through education. Education, education, education! Not prayer, certainly not wishful thinking – education.

Either you don’t have sex (you’re not going to last long in this group), you use condoms and protect yourself and your partner, or are faithful to your partner (once you have an honest dialogue, both are faithful to each other, and of course none of them have HIV). That’s the foolproof method. You need to be educated about your own body, and respectful of your partner(s).

Of course, the biggest question to me is that while circumcision is protective only 50%, perhaps 60%, of HIV in each sexual encounter the individual has, you are out of luck the other half of the time. You really are going to take your chances? Who is going to protect you the other 50% of the time? It’s basic statistics – in this case, almost like a coin toss. And it’s also common sense – a condom, or a circumcision? Thanks but no thanks Mohel, you can keep your Metzitzah b’peh to yourself. You can cut part of your wiener, but if you have unprotected sex with someone who has HIV/AIDS, trust me, you will eventually get HIV.


Malaria vaccine within sight…

December 9, 2006

But don’t get your hopes up too much, there is still a lot of work to do:

The challenge faced by the medical and scientific community stems partly from the nature of the causative parasite which is unlike other organisms that cause infectious diseases. ‘’Until now, we don’t have a vaccine against parasites; only against bacteria and viruses,” Morel said. ‘’The malaria parasite is very smart.”

By the way, the blood parasite Plasmodium which is spread by mosquitoes, is very, very preventable & treatable