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A List…

2014. Gone. 2015’s story is yet to be written.

Turning the page is always a time for reflection and to take stock of events gone by. And a look forward to the year ahead.

The past twelve months, scienceleftuntitled has continued its move into different spaces. The beat stays the same but the audiences have changed. The blog may have seemed a little bit on the quiet side. That is, for the most part, because the blog has continued to move from an everyday blogging platform to something else.

Scienceleftuntitled spent 2014 talking to scientists and poets, and covered everything from fake drugs to guinea worm.

A list would not be complete without the highs and lows. A definite high was talking to Zimbabwe’s favourite poet, Albert Nyathi, on his decision to get circumcised — to inspire many others and to help a nation combat HIV/AIDS.

If there was to be a low it would be the death of inspiration. The inspiration for this blog has always been the words written by PD James who passed away this year.

“Science has been our god. In the variety of its power it has preserved, comforted, healed, warmed, fed and entertained us and we have felt free to criticize and occasionally reject it as men have always rejected their gods, but in the knowledge that despite our apostasy, this deity, our creature and our slave, would still provide for us; the anaesthetic for the pain, the spare heart, the new lung, the antibiotic, the moving wheels and the moving pictures. The light will always come on when we press the switch and if it doesn’t we can find out why.”

Personally, it reminds us that with every loss and setback, with every thing we do not understand, we can always strive to find out why.

Fake drugs…

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“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

Greece is a third world country…

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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…

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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

The Great Race of Mercy…

“How the boy said, ‘mama, I’m going to die,’ and how she knew enough to say, ‘no you aren’t honey, no you never will.’ How this boy could only stare back at his father and mother and why they lied.”

In the late decades of the 18th century and the early 19th century, unknown numbers of equally unknown children died from recurring epidemics of diphtheria across the United States. In those days, reminded of what creation and destruction is — and what it must be — whispered in the same breath, is the tale of the Great Race of Mercy, where a small town was saved through sheer perseverance.

The town of Nome, overlooks the Bering Sea, and is as extreme west of Alaska as you can get. In the winter of 1924, Curtis Welch was the town’s only doctor, entrenched within a severe winter that made the small community almost unreachable. Four native Iñupiaq children had died before the doctor could diagnose it as diphtheria — the bacteria that  invades the respiratory system, producing a toxin that invades the bloodstream and damages the heart, kidneys and nerves. In the days of sweeping epidemics, diphtheria was commonly known as the “strangling angel of children” — the angels that swell necks and leave gaping craters in the flesh of their victims.

By January 1925, it had already become clear that something needed to be done. If not, the worst could decimate the entire community. Despite a quarantine in place, many more cases would begin to show up, simply because of the way the bacteria is spread all too easily — person to person, coughing, sneezing. Diphtheria destroys the lining of the throat, commonly causing the throat and neck to swell, leading to difficulty breathing.

The problem was that the town had no stocks of antitoxin, one that can fight off the effects of the bacterial toxin that may have seeped into the blood. The only stocks the town had were six years old — too old to be useful. Dr Welch sent a telegram to the Alaska Territorial Governor, Scott Bone, who was in Juneau, and to the U.S. Public Health Service in Washington DC.

“An epidemic of diphtheria is almost inevitable here STOP I am in urgent need of one million units of diphtheria antitoxin STOP Mail is only form of transportation STOP I have made application to Commissioner of Health of the Territories for antitoxin already STOP There are about 3000¢White natives in the district.”

The only serum that could stop the outbreak was in Anchorage, nearly a thousand miles away. How to get it to Nome was the next problem that would eventually turn out to be essentially a race to vaccinate. Rail, air, and sea were all ruled out as not an option thanks to the harsh winter and the remoteness of Nome. A crisis recently experienced by the town only for thesecond time in its history.

The only option was to transport the antitoxin needed by dog sled — something that had not been attempted in mid-winter before. The antitoxins arrived by train at Nenana on January 27th, where it would then be transferred by dog sled — hopefully in time to sway the epidemic.

The ordeal and race to vaccinate was in the form of a relay — a 674 mile relay — much of it over uncharted Bering Sea ice, over five and a half days. When the serum finally arrived, it had to be thawed before it was used. Not long after the serum was in the hands of Dr Welch, plans were already underway to deliver a second batch.

The death toll could have been much worse if it wasn’t for the delivered serum. Dr Welch estimated at least another hundred cases amongst the native population. The following year over three dozen more cases were reported, but didn’t prove a major public health problem due to the stocks of serum.

In the end the quarantine on Nome ended on February 21. A stunning display of a public health effort. And since 1973, this effort is symbolized in theIditarod Trail Race — run annually in memory of the original sled dog relay. The Alaska Immunization Program uses the “Race to Vaccinate” to heighten awareness of the critical need for timely immunizations for children before they are two years old.


What had I twaught…


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