Fake drugs…


“Starch, wax most often found in the head cavities of sperm whales, and the flowering plant gentianae — these are the ingredients to a concoction that looks remarkably like the anti-malarial drug quinine. The difference being that it is cheaper and most definitely quite useless.”

Read the rest at Boingboing.

Image — source

Circumcising Africa…



When Zimbabwe’s most famous poet and musician, Albert Nyathi, decided to get circumcised, everyone had an opinion.

For Albert, poetry has always come first, but now he acts as a local champion of voluntary medical male circumcision (VMMC), hoping to inspire the men of his country — both sons and fathers alike — to undergo the procedure. When he was growing up, his father and uncle were polygamists, a characteristic of a much older society and one that flies in the face of a global HIV/AIDS epidemic.

Read the rest of my piece at HuffPo

Greece is a third world country…


Within a fridge in a clinic in Perama, Greece, medicines are stocked right next to the feta cheese.

Food collection and distribution never formed part of Medecins du Monde (Doctors of the World) projects, but more and more people have been asking their medical doctors for food along with medication. Doctors at Medecins du Monde have even been documenting people having to choose between insulin and food.

In 2012, Medecins du Monde ran 312 programmes in 79 countries, including over 160 health programmes across Europe. During that time what they witnessed was a staggering picture of a social health care ecosystem struggling to hold its head above water — an inevitable crisis signposted by soaring unemployment rates, people losing their homes due to insolvency, and large-scale migrations.

In recent years, increasing numbers of European citizens are being pushed to the edges and towards economic migration, both within Europe and beyond. The financial crisis has generated austerity measures that have had a deep impact on all social welfare and safety nets, including healthcare provision. And nowhere in Europe is that more apparent than in Greece.

Since the beginning of the financial crisis, Medecins du Monde has multiplied its areas of action and set up two new health centres in Perama and Patras. In Athens, homelessness is a new phenomenon — a direct result of the crisis. Their mobile units help out where they can with sleeping bags and food.

Today, Greece could almost be described as a third world country, with increasing numbers of people excluded from its healthcare system. Medecins du Monde reports that brutal attacks and hate crimes against ethnic minorities have become a daily phenomenon in Greece — the seriousness of the problem getting worse in the wake of Greece’s financial crisis — and exploited politically by xenophobic extreme right-wing groups. Hate groups that are getting away with it.

In the first nine months of 2012, 87 incidents of racist violence against refugees and migrants were documented — not by state or government officials but by a broad civil society coalition. The Human Rights Watch report, Hate on the streets: xenophobic violence in Greece, documents failure of the state — both police and justice systems — to prevent and punish the rising numbers of attacks on migrants.

Last year marked the country’s sixth consecutive year of economic contraction. In an economic climate where 2% growth is seen as anaemic, economic contraction has meant that Greece has sacrificed all in the name of austerity. In 2012, in an effort to achieve specific targets, the Greek Government surpassed their bailor’s requirement for cuts in hospital operating costs and pharmaceutical spending. Across Europe, Greece’s public spending for health is one of the lowest — with less than any of the other European Union members. The consequences are far reaching.

The other side of the coin — amidst an impending health crisis, two bailouts, turmoil, tripling unemployment — has been a deep and cutting austerity measure that has flung Greece back several decades. HIV infections among injecting drug users rose from 15 in 2009 to 484 in 2012. TB infections had also gone up. Greece had not recorded a case of malaria since 1974, in 2012 around 70 cases were reported. There was a 19% increase in the number of low birth weight babies, 21% rise in stillbirths between 2008 and 2011, which is attributed to reduced access to prenatal health services for pregnant women.

The result, apart from four health ministers in little over a year, is an unmet medical need — one that Medecins du Monde is currently struggling against — and one with no answer. Even as the financial crisis passes, it is unlikely to provide a respite. As most understand that the public-health system was broken long before the crisis by years by mismanagement and corruption.

Image — source.

Social media is bad news for bad drugs in China…


In the war against substandard drugs in China, social media has become a new battlefield.

In 2009, only two months after twitter and facebook were banned in China, the chinese microblog Sina Weibo came into existence, and is now having significant impacts on the quality of drugs sold on the chinese market. Sina Weibo has now become China’s most popular social media network and microblog platform, boasting 300 million registered users. In 2012, it was averaging 100 million posts per day.

In an autocratic China, people take to social media to vent frustrations and alert each other whenever they come across a bad drug.

Counterfeit and substandard drugs make up more than 10% of the global medicine market, and it’s an increasing problem — with up to 25% of fake drugs ending up in developing countries. The vast majority of counterfeit drugs originate in China — ending up in Africa, but some don’t make it out and circulate within the Chinese system.

Recent research has examined the impact of the introduction of Sina Weibo on the quality of drugs on the market. Scientists at the Institute for International Economic Studies at Stockholm University use the amount of bad drugs found by China’s Drug Administration (SFDA) as a proxy for drug quality. They explore the variation in bad drugs before and after Sina Weibo’s introduction to obtain the quantitative estimate of the impact of Sina Weibo.

Results suggest that introduction of the microblog significantly reduced the amount of bad drugs on the market, of which the size of the effect was substantial. Sina Weibo, as much of social media, is a relatively new occurrence, and the amount of drug data collected by the Chinese SFDA predates it. The introduction of the social media network in China coincided with a clear declining trend for the number of bad drugs found.

“Attention is power, and circusee is changing China”

The chinese use the word “circusee” to describe Sina Weibo, which refers to the power of Weibo to make millions of people to focus on one issue together.

In March of 2010, the Beijing-based China Economic Times reported that four children had died over the past four years from improperly stored vaccines. The vaccines had been improperly stored and distributed throughout Shanxi Province and resulted in the death of several children and seriously injured many others.

When the scandal broke, users took to Sina Weibo to vent frustrations. Information flooded the microblog across China, and thousands of parents called for joint action and refused to have their children vaccinated by official disease control centres.

The effect of increased attention has the added benefit of China’s Drug Administration putting in more effort and deters the production of bad drugs. The SFDA is found to work harder in checking drugs around where there is more social media buzz.

The SFDA samples and tests specific drugs from around 300 prefectures across China. Sampled drugs come from clinics, disease control and prevention center/anti-epidemic stations, drugstores and hospitals, wholesalers and intermediary drug companies. The users on Sina Weibo post information revealing the stores or producers of bad drugs. As information sparks on Sina Weibo, more bad drugs are brought to the attention of authorities and screened out — eventually deterring the producers from producing the bad drugs.

“Behind the great firewall of china, information wants to be shared”

Even within an autocratic society, Sina Weibo represents a cheap and readily accessible type of free media, that is relatively free from censorship. When information can circulate quickly, censorship struggles to keep up.

The day after the 2010 vaccine scandal, the State Information Office ordered the deletion of all newspaper stories that covered the scandal. The Central Propaganda Department required traditional media to only use official news releases from Xinhua News Agency. However, information was still freely flowing on social media.

In a country like China, a microblog is an especially cheap, accessible and relatively free type of media. Sina Weibo can circulate information among millions of users widely and quickly. Once a bad drug is found and posted on the microblog, followers and re-posts can spread the information immediately and informed consumers can respond.

Even with censorship a post can be read by thousands of people before it is deleted. The deeper truth is that China cares about social welfare and thus censorship has taken a back seat to using such information to rectify the problem of bad drugs — even if they unveil government corruption in the process.

Image — source

All the science that’s fit to print…


Between August 10, 1978 and November 5, 1978 a multi-union strike shut down the three major New York City newspapers — one of which was the New York Times. This blip in publishing history serves as an important data point for how the media plays an important role in science literacy and science communication.

For those few months, no editions of The New York Times were printed — outside of a parody rag “Not the New York Times” — a prank alternative that was handed out in big cities around the country full of news stories imagined by comedy’s liberal elite of the time.

Internally, the New York Times continued to prepare an “edition of record” that was not distributed and showed all the news stories that would have been fit to print during the strike. The newspaper kept a list of articles they intended to cover. And when you take a look at that list in the light of hindsight, what you see is how print media effects citations of scientific articles. An effect we don’t often hear about, and one we assume to work in the other direction.

New England Journal of Medicine articles covered by the New York Times received 72.8% more citations than articles that were not covered (one year after publication). This effect was not present for articles that the New York Times intended to cover (and couldn’t because of the strike).

It seems that media coverage encouraged and helped articles garner future citations. Something that can’t be fully attributed to the fact that, simply, the New York Times chose to cover more influential articles.

Today, with science communication heavily dependent on the press release, the question has to be asked as to how much does science reporting ultimately skews the playground — cementing ‘not-so-good-science’ not only in the eyes of the public but also in terms of the impact factors and citations of ‘not-so-good-science’.

My use the term ‘not-so-good-science’ is deliberate hyperbole. But recent research has shown that newspapers are more likely to cover observational studies and less likely to cover randomized trials. And when the media does cover observational studies, they select articles of inferior quality.

And in case you didn’t know

“The randomised controlled trial (RCT)  is one of the greatest inventions of modern science — a tool that allows you, more reliably than any other, to compare two or more interventions and determine which is more effective for a given purpose.”

The research covers 75 clinically-oriented journal articles that received coverage in the top five newspapers (by circulation) and compares them against 75 clinically-oriented journal articles that appeared in the top five medical journals (by impact factor) over a similar timespan.

The investigations receiving coverage from newspapers were less likely to be randomized controlled trials and more likely to be observational studies. The observational studies from the media frequently used smaller sample sizes and were more likely to be cross-sectional.

The crux is where weak reporting, or rather, reporting on weaker science, comes at the expense of the complex and throws out the nuance in favour of simplicity. The age-old debate of “dumbing down.” Science is hard in every sense of the word. The dazzling myriad of complexity in breaking everything down to its basic components and putting it back together to look at the grand scheme of all things cannot really be fully communicated to a lay audience.

Perhaps the better question would be how much of the science that reaches print and online media is an accurate reflection of science in its entirety?

Image — source

What had I twaught…


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