I highly recommend Patient Zero, the latest episode of the podcast RadioLab. It covers Typhoid Mary, the origin of HIV, and the diffusion of ideas. Evocative as always, but what I like the most is how they add new information to stories you think you know. For one, you really feel sorry for Mary. And I’ve read quite a bit on the origin of HIV (a great way to learn more about phylogenetics!) but RadioLab takes it back even further and highlights some research I hadn’t seen.
Archive for November, 2011
Mr. Epidemiology, a PhD student who blogs at mrepid.wordpress.com, has put together a great round-table where he asks open-ended questions about grad school and collects answers from a variety of Masters and PhD students from across mostly related fields. A little about the roundtable and its respondents is here.
Questions covered so far include:
- Why did you go to graduate school?
- What is important when picking your adviser/committee?
- How do you deal with criticism?
- Are there tips for fighting impostor syndrome?
- What if things aren’t going so well?
I thought the piece on impostor syndrome was particularly helpful. Although not exactly the impostor syndrome (which also hits me often), this is somewhat related: While blogging and going to school concurrently I’ve had difficulty writing about certain subjects that I’ve studied more intensively. The more I study, the more I realize my lack of expertise and hesitate to say anything definitive without endless qualifiers and references. For instance, I TA’ed a class on on malnutrition, infection, and immunity, and spent a summer researching lead poisoning in New York City — but those are two of the more difficult subjects for me to write about for a popular audience. I know PhD students and true scholars must feel this more intensely, but at the same time it’s probably even more important for those with more time invested in a subject to weigh in on it.
Update: the latest addition to the series is What has surprised you the most so far?
There are many things we can do to avoid illness and injury. Given the proper resources and opportunity, you’d think we would all maximize our well-being: eat well, exercise, get your vaccines, and wear your seatbelt for starters. But no, not only do we not do those things, we humans go far out of our way to expose ourselves to all sorts of exotic risks. Four recent illustrations of collective human stupidity from the news:
(1) Epidemiologist Tara Smith writes, “Does bestiality increase your risk of penile cancer?” (See Cowen’s First Law: there is literature on everything.) These Brazilian researchers should win an Ig Nobel. And true to form for public health, they coin an acronym: SWA (Sex With Animals). Prof. Smith read the paper so you won’t have to — but you should at least read her summary to get the complete mental picture.
(2) Why is Delta Airlines running anti-vaccine in-flight infomercials? Doh-inducing background and petition here.
One of my Hopkins classmates who does not yet have a blog (but should) emailed a small group the following two stories:
(3) Parents in the US are mailing each other chickenpox-infected lollipops, amongst other things, to spread the disease and acquire natural immunity. Her summary: “Because asking your child to exchange bodily fluids with a sick stranger is a great idea!” True.
(4) Finally,though this one strikes me as an example of the “They’re calling it […]!” genre of local news stories about teenaged antics based mostly on hearsay, someone somewhere tried it: “Teens using vodka tampons to get drunk.” My friend helpfully notes: “Your vagina does NOT have a gag reflex.” Very astute. [Update: For the record, Scopes calls this one “undetermined.”] OK, this one was an urban legend — sorry.
I can’t even begin to write an appropriate closing sentence for this post.
Jean Dreze and Amartya Sen, writing in Outlook India (“Putting Growth In Its Place“) argue that India should see economic growth as a means to an end and not the end in and of itself. Whether you see GDP growth or human development as an end will shape whether India’s recent history is an extraordinary history or something much more grim:
So which of the two stories—unprecedented success or extraordinary failure—is correct? The answer is both, for they are both valid, and they are entirely compatible with each other… Indeed, economic growth is not constitutively the same thing as development, in the sense of a general improvement in living standards and enhancement of people’s well-being and freedom. Growth, of course, can be very helpful in achieving development, but this requires active public policies to ensure that the fruits of economic growth are widely shared, and also requires—and this is very important—making good use of the public revenue generated by fast economic growth for social services, especially for public healthcare and public education.
On a more specific social policy, they comment on how conditional cash transfers — the hot social policy of the moment (of the decade?) — worked in Latin America precisely because some level of public social services were already in place, and the condition of receiving the transfer was often utilizing those services. They argue that India can’t shortcut around investing in social services, skipping straight to the transfers and waiting for things to get better.
In Latin America, conditional cash transfers usually act as a complement, not a substitute, for public provision of health, education and other basic services. The incentives work for their supplementing purpose because the basic public services are there in the first place. In Brazil, for instance, basic health services such as immunisation, antenatal care and skilled attendance at birth are virtually universal. The state has done its homework—almost half of all health expenditure in Brazil is public expenditure, compared with barely one quarter (of a much lower total of health expenditure) in India. In this situation, providing incentives to complete the universalisation of healthcare may be quite sensible. In India, however, these basic services are still largely missing, and conditional cash transfers cannot fill the gap.
Cash transfers are increasingly seen as a potential cornerstone of social policy in India, often based on a distorted reading of the Latin American experience in this respect. There are, of course, strong arguments for cash transfers (conditional or unconditional) in some circumstances, just as there are good arguments for transfers in kind (such as midday meals for school children). What is remarkably dangerous, however, is the illusion that cash transfers (more precisely, “conditional cash transfers”) can replace public services by inducing recipients to buy health and education services from private providers. This is not only hard to substantiate on the basis of realistic empirical reading; it is, in fact, entirely contrary to the historical experience of Europe, America, Japan and East Asia in their respective transformation of living standards. Also, it is not how conditional cash transfers work in Brazil or Mexico or other successful cases today.
Here’s the rest of the article.
Amanda Glassman of the Center for Global Development and Vicky Hausman of Dalberg Global Development Advisors write about the “elusive power of mHealth” (ie, mobile phones and technology for global health efforts, a hot field):
Yet despite these successes, mHealth remains in its infancy, with many of the characteristics and issues typical of young industries. The majority of deployments are still small-scale pilots, so much so that it’s been said there are more pilots in mHealth than there are in the US Air Force. In many of these pilots, the evidence base that would enable decision-making and prioritization for further investment is missing. Finally, mHealth tools are not always clearly linked to health systems’ needs and priorities, at times leaving solutions in search of a problem rather than products and services designed with end-user preferences and needs in mind.
Their five recommendations for moving forward:
- Invest in the evidence base.
- Align on standards and systems.
- Ground mobile and information and communications technology (ICT) strategies in country-level realities, needs and opportunities.
- Share learnings and best practices.
- Build a coalition of global health funders to improve coordination.
GiveWell is an “independent, nonprofit charity evaluator” that finds “outstanding giving opportunities and publish[es] the full details of [their] analysis to help donors decide where to give.” Their Giving 101 page is a good place to start regarding their methodology and conclusions.
I want to highlight a recent blog post of theirs titled “Errors in DCP2 Cost Effectiveness Estimate for Deworming“. DCP2 stands for “Disease Control Priorities in Developing Countries,” a report funded by the Gates Foundation and produced for many partners including the World Bank.
The DCP2 blog post and its comments are wonky but worth reading in full because of their implications. It’s a pretty strong argument for why calculations need to be as transparent as possible if we’re going to make decisions based on them:
Over the past few months, GiveWell has undertaken an in-depth investigation of the cost-effectiveness of deworming, a treatment for parasitic worms that are very common in some parts of the developing world. While our investigation is ongoing, we now believe that one of the key cost-effectiveness estimates for deworming is flawed, and contains several errors that overstate the cost-effectiveness of deworming by a factor of about 100. This finding has implications not just for deworming, but for cost-effectiveness analysis in general: we are now rethinking how we use published cost-effectiveness estimates for which the full calculations and methods are not public…
Eventually, we were able to obtain the spreadsheet that was used to generate the $3.41/DALY [Disability-adjusted life year] estimate. That spreadsheet contains five separate errors that, when corrected, shift the estimated cost effectiveness of deworming from $3.41 to $326.43.
From later in the post:
Whether or not the long-term effects are taken into account, the corrected DCP2 estimate of STH treatment falls outside of the $100/DALY range that the World Bank initially labeled as highly cost-effective (see page 36 of the DCP2.) With the corrections, a variety of interventions, including vaccinations and insecticide-treated bednets, become substantially more cost-effective than deworming.
Perhaps surprisingly, the most interesting incentives have been developed in an emerging economy: South Africa. The Discovery group, based in Johannesburg, has crafted a programme called Vitality that applies the “air miles” model to health care. You earn points by exercising, buying healthy food or hitting certain targets. You rise through various levels, from blue to gold, as you accumulate points (rewards are adjusted to your starting level of fitness to give everybody a chance of making progress). And you are given a mixture of short- and long-term rewards ranging from reduced premiums to exotic holidays… This model has taken Discovery from “one man and a desk” in 1992 to become South Africa’s largest health insurer, with 5,000 employees.
That’s from the Economist. One disagreement: I don’t find it surprising that some of the most innovative models are coming out of an emerging economy — in fact I imagine that if you’re looking for innovative social ventures and policies, BRICS are the countries to keep an eye on.