Archive for the ‘ethics’Category

Adaptive Ebola vaccine trials

There’s a New York Times Room for Debate feature has an excellent discussion of the ethics of trials for Ebola treatments and vaccines. Here’s part of the essay by Nancy Kass and Steven Goodman:

Ethics is not just figuring out which side poses better arguments; often it’s best to find a third way. Given the breadth and deadly nature of the current Ebola outbreak, and unknowns about treatments, an “adaptive approach” seems most appropriate. Adaptive approaches allow researchers to plan a sequence of studies, or modify a single study in almost real time, as they learn more about a drug. In West Africa, for example, the first 40 Ebola patients in a trial could all get an experimental treatment, and nobody would take a placebo. If nearly all patients survived, in settings where most others were dying with the same supportive care, then it is possible that placebo testing could be avoided, and subsequent trials could randomize to different doses or treatments.

But if the results of the first trial, without placebos, revealed anything less than an almost certain cure, a design with proper controls would have to be initiated, and explained to those participating in the trial. Patients must be told that the drug is not a guaranteed life-saver, so they can see the point of the control group. (And given the multiple beliefs about Ebola among West Africans, creative approaches to promoting understanding and consent are important as well.) These placebo-controlled trials could themselves be adaptive in design, randomizing more patients to whichever therapy appears most effective, until the verdict is clear. If we are to design trials to minimize suffering and death in a whole population, we must temper our compassion with humility about what we think we know.

05

12 2014

Biological warfare: malaria edition

Did you know Germany used malaria as a biological weapon during World War II? I’m a bit of a WWII history buff, but wasn’t aware of this at all until I dove into Richard Evans’ excellent three-part history of Nazi Germany, which concludes with The Third Reich at War. Here’s an excerpt, with paragraph breaks and some explanations and emphasis added:

Meanwhile, Allied troops continued to fight their way slowly up the [Italian] peninsula. In their path lay the Pontine marshes, which Mussolini had drained at huge expense during the 1930s, converting them into farmland, settling them with 100,000 First World War veterans and their families, and building five new towns and eighteen villages on the site. The Germans determined to return them to their earlier state, to slow the Allied advance and at the same time wreak further revenge on the treacherous [for turning against Mussolini and surrendering to the Allies] Italians.

Not long after the Italian surrender, the area was visited by Erich Martini and Ernst Rodenwaldt, two medical specialists in malaria who worked at the Military Medical Academy in Berlin. Both men were backed by Himmler’s Ancestral Heritage research organization in the SS; Martini was on the advisory board of its research institute at Dachau. The two men directed the German army to turn off the pumps that kept the former marshes dry, so that by the end of the winter they were covered in water to a depth of 30 centimetres once more. Then, ignoring the appeals of Italian medical scientists, they put the pumps into reverse, drawing sea-water into the area, and destroyed the tidal gates keeping the sea out at high tide.

On their orders German troops dynamited many of the pumps and carted off the rest to Germany, wrecked the equipment used to keep the drainage channels free of vegetation and mined the area around them, ensuring that the damage they caused would be long-lasting.

The purpose of these measures was above all to reintroduce malaria into the marshes, for Martini himself had discovered in 1931 that only one kind of mosquito could survive and breed equally well in salt, fresh or brackish water, namely anopheles labranchiae, the vector of malaria. As a result of the flooding, the freshwater species of mosquito in the Pontine marshes were destroyed; virtually all of the mosquitoes now breeding furiously in the 98,000 acres of flooded land were carriers of the disease, in contrast to the situation in 1940, when they were on the way to being eradicated.

Just to make sure the disease took hold, Martini and Rodenwaldt’s team had all the available stocks of quinine, the drug used to combat it, confiscated and taken to a secret location in Tuscany, far away from the marshes. In order to minimize the number of eyewitnesses, the Germans had evacuated the entire population of the marshlands, allowing them back only when their work had been completed. With their homes flooded or destroyed, many had to sleep in the open, where they quickly fell victim to the vast swarms of anopheles mosquitoes now breeding in the clogged drainage canals and bomb-craters of the area.

Officially registered cases of malaria spiralled from just over 1,200 in 1943 to nearly 55,000 the following year, and 43,000 in 1945: the true number in the area in 1944 was later reckoned to be nearly double the officially recorded figure. With no quinine available, and medical services in disarray because of the war and the effective collapse of the Italian state, the impoverished inhabitants of the area, now suffering from malnutrition as well because of the destruction of their farmland and food supplies, fell victim to malaria. It had been deliberately reintroduced as an act of biological warfare, directed not only at Allied troops who might pass through the region, but also against the quarter of a million Italians who lived there, people now treated by the Germans no longer as allies but as racial inferiors whose act of treachery in deserting the Axis cause deserved the severest possible punishment.

08

11 2012

Our future selves will mock this (I hope)

Smiling people holding hands. Walking on the beach. Inexplicable doves flying through blue skies. Terrible side effects discussed cheerily by a honey-voiced narrator…. That’s right, this post is about direct-to-consumer pharmaceutical advertising.

Niam Hardimh, writing at Crooked Timber, shares one of the odd things about living in the US — for those who aren’t used to our TV:

One thing that is striking, compared with European TV, is what is advertised and how. In particular,  I don’t think you see ads for prescription medicines in Europe, certainly not in Ireland or the UK. They seem to be all over American TV.

I am particularly struck by the way these ads are made. The visuals  typically show someone having a happy and trouble-free life while using these drugs, overlaid with soothing music and a reassuringly bland voice-over. But clearly the US FDA requires advertisers to include all the small print in their ads as well.

Do you read all the known downsides of the medicines you take? Don’t…

It’s easy to become habituated to these since they’re everywhere, but it hasn’t always been that way, and in most places it still isn’t — the US and New Zealand are the only two countries that allow direct advertising of drugs. Here’s an exemplary ad for Vioxx, which was pulled off the market because it caused health problems (which Merck systematically lied about):

Ice skating. A minor celebrity. Inspiring music. They even note that “Vioxx specifically targets the Cox2 enzyme.” How many Americans can even define what an enzyme is? I’m sure consumers are more likely to remember that than the mentioned side effects (“bleeding can occur without warning”)… Other lovely examples include this other ad for Vioxx, and one for Zocor.

For more examples and some background on how the ads came to be, check out “Sick of pharmaceutical ads: here’s why they won’t go away” on io9.

09

05 2012

Rights bleg

bleg: (Internet slang) An entry in a blog requesting information or contributions. (from Wiktionary)

This entry was prompted by an interesting post on religion and human rights by Kate Cronin-Furman over at Wronging Rights. My question here has little to do with the contents of that particular post other than having been prompted by it in my impossibly tangential brain, but I think it’s a great post that you should all read regardless. Now on to my question:

I’m not sure I believe in human rights. Don’t get me wrong; I’m not a monster, and I’m really more agnostic on them than a certain skeptic. I also happen to value very highly pretty much all the widely-believed human rights and most everything to which the title of a human right has been expanded. I’m not convinced that my personal normative valuation or preference is the same as actually believing in human rights (their existence and universality), or whether the rights framework is the most true or helpful one. The work I want to do overlaps a lot with rights practitioners and language — again with the valuation of those ends. I’ve also read quite a few things written by human rights activists, but mostly on the level of “we were trying to document or stop this atrocity” or otherwise using the language of rights towards an end which I support, but usually assuming from the beginning that the reader believed in human rights. It also seems that a lot of things that just seem good to many people, independent of a rights-based framework, are touted in that language because it is simply what is done. I also get the impression that there are a fair number of people working within the ‘human rights establishment’ who see the construct as more useful than true (or don’t distinguish between the two) but I have no way to verify that.

None of these hesitations are final, of course — this may simply be a shortcoming in my education that I need to rectify. I grew up very religious and went to a very conservative college that only employs professors who belong to a particular conservative evangelical denomination. I missed out on formal coursework or guided readings in secular philosophy or ethics, or at least any presentation of that material by people who actually believed it. Some of what I learned was heavily filtered through that strain of fundamentalist thought that looks at everything that is not itself and decries it as an un-moored, baseless fantasy. (Amongst others, blame Francis Schaeffer — one his books recounts the truly atrocious evangelistic technique of trying to convince a confused young person that there are only two intellectually honest ways to reconcile hopelessness resulting from the perceived failure of secular philosophy to find meaning; believe in God or commit suicide.)

There were certainly others who were more gentle in approach but the underlying thought was always there, that there can be no absolute statements — whether about morality or rights — without theistic belief. However, in college I took a skeptical turn and eventually came to disbelieve my theist roots altogether. My graduate work has been more technically-focused (which is what I wanted), for example considering how to achieve improvements in health rather than deep thinking about the foundational assumption that there is a right to health. Many of my peers who attended liberal arts schools or research universities have obviously focused on the study of human rights to a much greater extent, whereas my education bypassed it altogether. To some extent I want to believe in human rights because it seems to be the dominant framework and language and things would just be simpler if I did. But wanting to believe something because it’s helpful is not enough to me. It seems like it would be easier to believe in human rights if one did believe in a higher power, which may be one reason why liberal religious groups seem well-represented in human rights circles.

So finally, my bleg: what should I read? Is there a single primer on or defense of the foundations of human rights that you would recommend to a secular/skeptical person like me? This could be a book, an essay, a journal article —  whatever you think might be the most convincing case. I think this line of thinking deserves more than a simple read of a Wikipedia page; I’m hoping that you can distill the arguments that you’ve found most useful in thinking about rights into a few recommendations. Likewise, if you’re in the doubter camp or think there is a better secular alternative out there I’d be happy to hear counter-suggestions as well.

21

12 2011

Timing

This week in one of my classes we were scheduled to discuss humanitarian intervention and the “responsibility to protect” principle. Our case study is on Libya, and especially on the initial decision to intervene. Not coincidentally, one of the professors for the course is Anne-Marie Slaughter (see her NYT editorial in support of action, just days before UN Resolution 1973).

The news of Gadhafi’s death broke just before class. Then, after a session touching on these topics in the context of broader theories of international relations, I found myself in a computer lab with several of my classmates. We were mostly checking our email or printing assignments, but the conversation turned to Libya. Someone mentioned that a video had been posted of Gadhafi still alive when he was captured (see here), and we started pulling up different videos and trying to piece together what happened. What order, who did what, how we should react, and so forth.

Separate from the implications of Gadhafi’s death for the future of Libya, there’s a question of how quickly media has changed how we interact with world events, and how participants in those events seek to portray them. A century ago radio brought real-time news, followed a few decades later by TV. The last decade has seen the proliferation of digital video cameras and the rise of sites like YouTube where anyone can disseminate footage to the entire world, at first side-stepping the old media and then being amplified by it.

I don’t know how this situation would have played out a few decades ago, but here we were watching videos taken earlier the same day by rebel forces in Libya. Has there ever been faster turnaround between the fall of a despot, the spread of imagery to shape the narrative of what happened? As viewers and discussants we were participating in the immediate struggle to claim responsibility.

20

10 2011

Famine

I want to write something about Somalia, but I don’t feel qualified to add much to the discussion. Many smart people have already said much (read herehere, and here). One theme is that it’s important to recognize that famine is a human political and economic phenomenon, not a natural one. But others are making those arguments better than I can.

The more you know, the more you want to help, and the harder that can seem to do. I think the work I’ve done this summer in NYC with their Dept of Health has been valuable, but I also feel constrained by my imminent return to the classroom. My emotions say it would be great to assuage my feelings of helplessness now by going somewhere awful and doing whatever needs to be done, right now. But I’m in school because I believe that technical skills are really important when it comes to choosing the right things to do (and measuring their impact) … so for now I have to wait and let others do the doing.

By all accounts, the situation in Somalia is truly horrific and likely to get worse. Honestly, I’ve been avoiding reading too much about it because it makes me sad, and it makes me angry. If you’re looking for something to do too, the One campaign has compiled a list of organizations working on famine relief. I just made a donation to my charity of choice and hope you will too. My only recommendation is to make your donation to an organization’s main donation link, rather than one specific to famine response. Most of the best organizations were likely poised to respond precisely because they had unrestricted, non-earmarked funds from previous donors. They will likely spend as much as they can on these efforts, so your donation will go to Somalia if needed. Or it will go, alas, to the next calamity.

04

08 2011

The battle for hearts and minds

A major difference between the public health approach and the beliefs and strategies underlying fields such as human rights or medicine is that public health concerns the prioritization of limited resources. There is a limited pie. Even if you believe that pie can be expanded (it can, at times), it cannot be expanded infinitely, and so at some point in the policy process someone has to make a decision about how to prioritize the resources at hand.

This traditional public health approach overlaps with and gets blurred into human rights and medicine and politics such that the value judgments underlying different claims aren’t always apparent. We have a certain number of interventions that are known to work — they save lives and reduce suffering — but we don’t have enough resources to do all of those things in every place that needs them. If we choose option A, some people will be saved or helped, and some will die. If we choose option B, a different number of people will be saved or helped, and some other group of people will die. The discussion of who will be saved is often explicit, while the discussion of the opportunity cost, those who will not be saved is almost always lacking. Both groups are abstract, but the opportunity cost group is usually more abstract than the people you’re trying to help. These are generalities of course, and in reality there is uncertainty built into the claims about just how many lives could be saved or improved with any one approach.

The problem is this: pretty much everything we do in global health is good. Sure, we can argue specifics and there are glaring examples to the contrary, but for the most part we all want to save lives, prevent suffering, and improve health. No one is seriously against successful interventions when they stand alone: no one thinks people with HIV shouldn’t get antiretrovirals, or children with diarrhea shouldn’t get oral rehydration therapy. Rather, they may oppose spending money on HIV instead of on childhood diarrhea (or in reality, vice versa). Who is comfortable with making an argument against preventing childhood burns? Being against treating horrific cancers? Any takers? So we all argue for something that is good, and avoid the messy discussions of trade-offs.

Thus, much of the conflict in the global health fields is about spending money on X intervention versus intervention or approach Y. Or, better yet, traditional and known intervention A versus new and sexy and unproven-at-scale approach B. I don’t think I’d want to live in a world where all health decisions are made entirely by cost-benefit analysis, nor would I want to live in a world where all decisions on care and policy are made from a rights-based approach — both approaches result in absurdities when taken to their extremes and to the neglect of each other. My impression is that most professionals in global health draw insight from both poles, so that individuals fall somewhere on a continuum and disagree more with others who are furthest away. The tension exists not just between differing camps but within all of us who feel torn by hard choices.

So the differences between the mostly utilitarian public health old-guard and the more recent crop of rights-driven global health advocates aren’t always clear-cut, and they often talk right past each other … or they just work at different organizations, teach at different schools and attend different conferences so they won’t have to talk to each other. To some extent they’re fundraising from different audiences, but they also end up advocating that the same resources — often a slice of the US global health budget — get spent on their priorities. These tensions usually simmer under the surface or get coated in academic-speak, but sometimes they come out. Which brings me to an anecdote to leaven my generalities:

A few months ago I was having a private conversation with a professor, one who leans a bit towards the cost-benefit side of the continuum with a dose of contrarianism thrown in for good measure. Paul Farmer came up — I don’t remember how. I paraphrase:

Resource allocation is the central dilemma in public health. Period. If people don’t get that, they’re not public health. Paul Farmer? Fuck Paul Farmer. He just doesn’t get it.

You won’t hear that in a lecture or in a public speech, but it’s there. I’ve heard similar sentiments from the other side of the spectrum, those who see the number-crunching cost-benefiteers as soulless automatons who block the poor from getting the care they need.

These dilemmas are not going away any time soon. But I think being conscious of them and striving to be explicit about how our own values and biases shape our research and advocacy will help us to collectively reach a balance of heart and mind that makes more sense to everyone.

HIV/AIDS is one of the areas of global health where the raw passion of the heart most conflicts with the terrible dearth of resources we have to fight the demon. Decisions have ugly consequences either way you choose, and, rightly or wrongly, dispassionate research is often anything but. The recent news that pre-exposure prophylaxis (PrEP) can prevent HIV acquisition in sero-discordant heterosexual couples is huge in the news right now. Elizabeth Pisani (epidemiologist and author of The Wisdom of Whores) hits the nail on the head in this recent blog post. She notes that there are voices clamoring for widespread scale-up of PrEP — treating the HIV negative partner — but that PrEP prevents infection in 60% of cases while treating the HIV-positive partner cuts infection by 96%. Continuing:

That leaves us with the question: who should get PReP? Right now, there are not enough antiretrovirals to go around to treat all the sick people who need treatment. If we’re going to use them selectively for prevention, we should start with the most effective use, which appears to be early treatment of the infected partner in discordant couples. We could also give them to people who aren’t in a couple but who know that they’re likely to get around a bit and might want to stay safe without using condoms. That’s potentially a lot of people; it will stretch our purses. But more than that, it will stretch our political will.

So who is PReP for? We’ve got a better option for discordant couples. We’re not going to want to give it to randy adolescents. We know it works for gay men, but some of the countries where the trials took place would rather thump or jail gay men than protect their sexual health.[…] But I think we would be unwise to rush around talking about massive roll-out of PReP before we actually figure out who it works for in the real world.

Treating people with HIV is good. Preventing infection via treatment is good. Prevention infection via PrEP is good (assuming it doesn’t breed more drug resistant strains and make it harder to treat everyone… but that’s another story). But most voices in the debate have an agenda and are pushing for one thing above the rest. One of them — or a balance of them — is right, but you have to understand their values before that can be discerned. And I think many people in global health don’t even think explicitly about their own values, such as the mix of cost-benefit and rights-based approaches they find most appealing. Rather, we all want to promote whatever we’re working on that the moment. After all, it’s all good.

18

07 2011

CIA's despicable Pakistan vaccination ploy

Via Conflict Health, The Guardian reports that the “CIA organised fake vaccination drive to get Osama bin Laden’s family DNA”:

In March health workers administered the vaccine in a poor neighborhood on the edge of Abbottabad called Nawa Sher. The hepatitis B vaccine is usually given in three doses, the second a month after the first. But in April, instead of administering the second dose in Nawa Sher, the doctor returned to Abbottabad and moved the nurses on to Bilal Town, the suburb where Bin Laden lived.

Christopher Albon of Conflict Health writes:

If true, the CIA’s actions are irresponsible and utterly reprehensible. The quote above implies that the patients never received their second or third doses of the hepatitis B vaccine. And even if they did, there is absolutely no guarantee that the vaccines were real. The simple fact is that the health of the children of Abbottabad has been put at risk through a deceptive medical operations by the Central Intelligence Agency. Furthermore, the operation undermines future vaccination campaigns and Pakistani health workers by fueling conspiracy theories about their true purpose.

Albon notes that the Guardian’s source is Pakistan’s ISI… but this McClatchy story seems to confirm it via US sources:

The doctor’s role was to help American officials know with certainty that bin Laden was in the compound, according to security officials and residents here, all of whom spoke only on the condition of anonymity because they feared government retribution. U.S. officials in Washington confirmed the general outlines of the effort. They asked not to be identified because of the sensitivity of the topic.

The sensitivity of the topic? No kidding. This is absolutely terrible, and not just because the kids originally involved might not have gotten the second round of vaccine (which is bad) or because it will make the work of legitimate public health officials in Pakistan even harder (which is very bad). Vaccines are amazing innovations that save millions of lives, and they are so widely respected that combatants have gone to extraordinary lengths to allow vaccination campaigns to proceed in the midst of war. For instance, UNICEF has brokered ceasefires in Afghanistan and Pakistan for polio vaccine campaigns which are essential since those are two of the four countries where polio transmission has never been interrupted.

I hope I’m not overreacting, but I’m afraid this news may be bad for the kids of Pakistan, Afghanistan, and the rest of the world. Assuming the early reports are confirmed, this plot should be condemned by everyone. If US officials who support global vaccination efforts are going to control the damage as much as possible — though it’s likely much of it has already been done — then there need to be some very public repercussions for whoever authorized this or had any foreknowledge. What tragic stupidity: a few branches of the US government are spending millions and millions to promote vaccines, while another branch is doing this. The CIA is out of control. Sadly, I’m not optimistic that there will be any accountability, and I’m fuming that my own country breached this critical, neutral tool of peace and health. How incredibly short-sighted.

Update: In addition to the Guardian story, Conflict Health, and McClatchy stories linked above, this NYTimes article offers further confirmation and the CNN piece has some additional details. Tom Paulson at Humanosphere, Mark Leon Goldberg of UN Dispatch, Charles Kenny of CGD, and Seth Mnookin all offer commentary.

11

07 2011

History refresh: AZT and ethics

A professor pointed me to this online history and ethics lesson from the Harvard Kennedy School’s Program on Ethical Issues in International Research: The Debate Over Clinical Trials of AZT to Prevent Mother-to-Infant Transmission of HIV in Developing Nations. It’s surprisingly readable, and the issues debated are surprisingly current.

In 1994, researchers in the US and France announced stunning news of a rare victory in the battle against the AIDS pandemic. Studies conducted in both countries had shown conclusively that a regimen of the drug AZT, administered prenatally to HIV-positive pregnant women and then to their babies after birth, reduced the rate of mother-to-infant transmission of HIV by fully two-thirds. The results of the clinical trials constituted “one of the most dramatic discoveries of the AIDS epidemic,” the New York Times declared, and one of the most heartening as well.

The new regimen–known by its study name, AIDS Clinical Trials Group (ACTG) 076 or, often, simply “076”–offered the epidemic’s most vulnerable targets, newborns, their best hope thus far of a healthy childhood and a normal life span. The number of infants who might benefit from this research was significant: according to World Health Organization (WHO) figures, as many as five to ten million children born between 1990-2000 would be infected with HIV. In the mid-1990s, it was estimated that HIV-infected infants were being born at the rate of 1,000 a day worldwide.

So impressive were the findings of ACTG 076–and so substantial the difference in the transmission rate between subjects given AZT and those given a placebo (eight percent versus 25 percent)–that the clinical trials, which were still ongoing, were stopped early, and all participants in the studies were treated with AZT. In June 1994, after reviewing the study results, the US Public Health Service recommended that the 076 regimen be administered to HIV-infected pregnant women in the US as standard treatment to prevent transmission of the virus.

But while 076 was hailed as a major breakthrough, the celebration was somewhat muted. For a variety of reasons, the new treatment regimen would not likely reach those who most desperately needed it: pregnant women in the developing nations of the world and, most particularly, sub-Saharan Africa, where AIDS was wreaking devastation on a scale unimagined in the West.

I think one reason why graduate school can be so overwhelming is that you’re trying to learn the basic technical skills of a field or subfield, and also playing catch-up on everything that’s been written on your field, ever. True, some of it’s outdated, and there are reviews that bring you up to speed on questions that are basically settled. But there’s a lot of history that gets lost in the shuttle, and it’s easy to forget that something was once controversial. Something as universally agreed upon today as using antiretrovirals to prevent mother-to-child transmission of HIV was once the subject of massive, heart-wrenching debate. I tend to wax pessimistic and think we’re doomed to repeat the mistakes of the past regardless of whether we know our history, because we either can’t agree on what the mistakes of the past were, or because past conflicts represent unavoidable differences of opinion, certainty, and power. But getting a quick refresher on the history of a is valuable because it puts current debates in perspective.

10

02 2011

Gates and Media Funding

You may or may not have heard of this controversy: the Gates Foundation — a huge funding source in global health — has been paying various media sources to ramp up their coverage of global health and development issues. It seems to me that various voices in global health have tended to respond to this as you might expect them to, based on their more general reactions to the Gates Foundation. If you like most of Gates does, you probably see this as a boon, since global health and development (especially if you exclude disaster/aid stories) aren’t the hottest issues in the media landscape. If you’re skeptical of the typical Gates Foundation solutions (technological fixes, for example) then you might think this is more problematic.

I started off writing some lengthy thoughts on this, and realized Tom Paulson at Humanosphere has already said some of what I want to say. So I’ll quote from him a bit, and then finish with a few more of my own thoughts. First, here is an interview Paulson did with Kate James, head of communications at the Gates Foundation. An excerpt:

Q Why does the Gates Foundation fund media?

Kate James: It’s driven by our recognition of the changing media landscape. We’ve seen this big drop-off in the amount of coverage of global health and development issues. Even before that, there was a problem with a lack of quality, in-depth reporting on many of these issues so we don’t see this as being internally driven by any agenda on our part. We’re responding to a need.

Q Isn’t there a risk that by paying media to do these stories the Gates Foundation’s agenda will be favored, drowning out the dissenting voices and critics of your agenda?

KJ: When we establish these partnerships, everyone is very clear that there is total editorial independence. How these organizations choose to cover issues is completely up to them.

The most recent wave of controversy seems to stem from Gates funding going to an ABC documentary on global health that featured clips of Bill and Melinda Gates, among other things. Paulson writes about that as well. Reacting to a segment on Guatemala, Paulson writes:

For example, many would argue that part of the reason for Guatemala’s problem with malnutrition and poverty stems from a long history of inequitable international trade policies and American political interference (as well as corporate influence) in Central America.

The Gates Foundation steers clear of such hot-button political issues and we’ll see if ABC News does as well. Another example of a potential “blind spot” is the Seattle philanthropy’s tendency to favor technological solutions — such as vaccines or fortified foods — as opposed to messier issues involving governance, industry and economics.

A few additional thoughts:

Would this fly in another industry? Can you imagine a Citibank-financed investigative series on the financial industry? That’s probably a bad example for several reasons, including the Citibank-Gates comparison and the fact that the financial industry is not underreported. I’m having a hard time thinking of a comparable example: an industry that doesn’t get much news coverage, where a big actor funded the media — if you can think of an example, please let me know.

Obviously this induces a bias in the coverage. To say otherwise is pretty much indefensible to me. Think of it this way: if Noam Chomsky had a multi-billion dollar foundation that gave grants to the media to increase news coverage of international development, but did not have specific editorial control, would that not still bias the resulting coverage? Would an organization a) get those grants if it were not already likely to do the cover the subject with at last a gentle, overall bias towards Chomsky’s point of view, or b) continue to get grants for new projects if they widely ridiculed Chomsky’s approach? It doesn’t have to be Chomsky — take your pick of someone with clearly identifiable positions on international issues, and you get the same picture. Do the communications staffers at the Gates Foundation need to personally review the story lines for this sort of bias to creep in? Of course not.

Which matters more: the bias or the increased coverage? For now I lean towards increased coverage, but this is up for debate. It’s really important that the funding be disclosed (as I understand it has been). It would also be nice if there was enough public demand for coverage of international development that the media covered it in all its complexity and difficulty and nuance without needing support from a foundation, but that’s not the world we live in for now. And maybe the funded coverage will ultimately result in more discussion of the structural and systemic roots of international inequality, rather than just “quick fixes.”

[Other thoughts on Gates and media funding by Paul Fortner, the Chronicle of Philanthropy, and (older) LA Times.]