WHO wastes scarce health funds on fashionable diseases

It is probably no secret to regular visitors of this blog that I tend to speak in the most scathing terms about the UN system and its associated freeloading agencies and staff. My favorite target tends to be UNESCO, because its overpaid Paris based staff is more often than not particularly incompetent and useless, certainly in my area of expertise.

I have, in the past held my fire when it came to WHO, even though I knew from personal experience with that outfit, that they're not much better. By and large bioethicists (such as Alex Capron) have performed pretty well there, hence the ethics unit seems to have been more or less closed down (ie exists only on paper or its website). The leading medical journal THE LANCET published this week an analysis of the budget allocations WHO has decided upon, and correlated those with the (mostly developing) world's disease burdens. (LANCET 2008; 372: 1563-9)

It turns out, in the words of the authors, "Three-fifths of WHO funds were spent on communicable diseases excluding HIV, tuberculosis, and malaria, which accounted for roughly 11% of global mortality. Conversely, non-communicable disease accounted for more than half of global mortality and almost half of global DALYs, but received roughly a tenth of all WHO funds. We recorded a similar disparity with injuries, which claimed 9% of global mortality and 12% of global DALYs, but received less than 1% of global funds. Further inspection of the WHO budget showed that the resources used for communicable diseases excluding HIV, tuberculosis, and malaria were mainly driven by WHO extra-budgetary funds for immunisation and vaccine development. WHO’s regular budget allocated US$14·3 million to this area of work, corresponding to 6% of WHO’s regular budget. By contrast, WHO’s extra-budgetary funds allocated $512·4 million, roughly 36 times as much as in the regular budget, corresponding to about 30% of WHO’s extra-budgetary allocations for infectious disease control."

The upshot of this is that WHO is clearly setting its eyes on fashionable diseases such as AIDS (much like Greenpeace is in the habit of rescuing cuties like wales but not gazillions of pigs in mass breedings factories), despite objectively more important disease targets. The maximisation of QALYs and DALYs per invested health care dollar should be the only criterion for deciding how to spend scarce resources. It is unethical to waste funds available for health care delivery and research on outcomes that are foreseeably suboptimal in terms of QALYs and DALYs. The criticism leveled here against WHO can arguably be made against private funders such as the Gates Foundation.

This all reminds me of the insanely wasteful NIH Fogarty International ethics programs in my own field. There's endless research ethics training in developing countries the world all over, as if these countries did not have substantially bigger fish to fry in terms of health issues.

Up-date on Lutz Heilmann vs wikipedia.de

Mr Heilmann has told wikipedia.de that since most of the incriminating claims about him had been removed from his entry, he's happy for wikipedia.de to be available to everyone with immediate effect. No doubt the internet community's massive email campaign directed at his parliamentary faction has had the desired impact. Nice lil victory for freedom of expression I suppose.

Lutz Heilmann, The Left Member of Parliament, ex Stasi operative

Truly in line with the traditions of the former East German secret service, the Stasi, its ex-operative Lutz Heilmann (photo to the left) is resorting to censorship to prevent nasty information about his past from reaching the public eye. Heilmann today 'serves' as a member of parliament in the Left faction.

Censorship in the 21st century you might say? Not really. This posting here then is part of the process of keeping information flowing freely. Feel free to reproduce it and post it elsewhere. Thankfully there is little our ex-Stasi operative can do about it outside Germany!

Here's what happened. The German version of wikipedia.org (wikipedia.de) has/had an item on Heilmann that included unpleasant information about his past full-time service in the Stasi. The main point of criticism is not so much that he was a Stasi operative as that is true for very many people in Eastern Germany, but that he tried to hide that information when he ran for higher office. In fact, in fairness to Heilmann, he seems to have worked for the Stasi straight after high-school for about 5 years, in a department responsible for the safety of the East German leadership. This really isn't the problem probably, what is the problem is that instead of rectifying whatever objective errors there were in his wikipedia entry, using the usual means within wikipedia to do so, he chose not do so, and instead to bring down the whole site by way of going to court. Talking about throwing the baby out with the bathwater...

Heilmann is unhappy about information concerning his past that was uncovered by DER SPIEGEL. The magazine reports that Heilmann lied about his past by claiming that he served in the East German army from 1985 to 1990 when really he worked for the Stasi. This and other unpleasant tidbits about Heilmann have been put together in an entry in the German wikipedia version. Heilmann sued and in effect forced the German version of the wikipedia off-line. www.wikipedia.de is currently offering its visitors a placeholder, informing them that unless it removes the offending item (about Heilmann) it has been ordered by a German court to stop the redirect to the US based servers that host www.wikipedia.de. Thankfully the German courts have no jurisdiction in the USA, and freedom of expression is taken a bit more seriously in that country (thank you First Amendment). It is here where the entry about Mr Heilmann is still available in its full glory.

Censorship in the 21st century... you got to be kidding Mr Heilmann.

In case you value freedom of expression, you might wish to consider donating to the German branch of wikipedia in order to support it in its legal battles with Mr Heilmann.

Tough luck GM, Ford and Chrysler

Guess this shows that I am a philosopher. I truly can't get my head around governments thinking that it is sensible policy to throw good money after huge amounts of bad money (aka the 'big three', GM, Ford and Chrysler). These companies have spent decades building insane cars - an example is shown above. Their quality sucks big time, their fuel economy is a joke, yet for some bizarre reason more likely to do with national pride than anything else, they keep getting propped up by our tax monies. To readers outside Northamerica ... these dinosaurs masquerading as cars are really everywhere. The question surely arises whether we as taxpayers should at least be adding conditions to such madness? Like: you get our billions only if you meet certain standards of fuel efficiency, the utilization of recycled materials, etc? Surely the argument from jobs can't be sufficient to justify burning billions of $$. It probably would be cheaper at this stage to simply pay these people their salaries without asking them to build cars that nobody sane could possibly want to buy to begin with! Actually, here's my suggestion: add the GM, Chrysler, and Ford workers to the government payroll and require them not to produce any further cars. Use the saved money to develop industries aimed at generating efficient public transport systems. Welcome to the 21st century.

Why Some HIV Transmissions Should be Punished

I am reproducing here a commentary that I wrote for the Bioethics Forum of the Hastings Center.

The Canadian legal system is currently bracing for another case in which a man is prosecuted for allegedly infecting multiple unsuspecting women with the HIV virus who had unprotected sexual intercourse with him. Two of these women have died of AIDS. Various other cases have successfully been prosecuted, usually involving men who knew they were HIV infected and who chose to have unprotected sexual intercourse with a number of women. (See Matthew Weait, Intimacy and Responsibility: The Criminalisation of HIV Transmission, Routledge, 2007.) Some of these women became infected, others did not. Either way, the HIV-infected men knowingly subjected these women to the risk of infection with a life-threatening illness.

Many liberal democracies have made HIV transmission a criminal offense, including the United States, Canada, Sweden, Germany, Norway, Denmark, the Netherlands, and the United Kingdom. In most countries, HIV-infected people have been successfully prosecuted for transmitting HIV to their sexual partners. The main reason for this is – obviously – that an HIV infection is harmful to the carrier of the virus. At this point in time it means the infection with a delayed-onset serious chronic illness that results into an, all other things being equal, excess number of deaths among those infected.

Some AIDS activists and their academic allies insist that criminalizing HIV transmission and punishing the perpetrators is not a sensible way for us as society to say that such conduct is unacceptable. In a recent commentary in the Journal of the American Medical Association, Scott Burris and Edwin Cameron, both legal scholars, assert that “the use of criminal law to address HIV infection is inappropriate except in rare cases in which a person acts with conscious intent to transmit HIV and does so.” But the arguments brought against the criminalization of HIV transmission simply do not withstand critical scrutiny.

Silliest, perhaps, is the argument that criminalizing HIV transmission will not necessarily prevent people from transmitting the virus. On that logic we might as well do away with traffic regulations that punish people for speeding. Nobody is naive enough to assume that such rules prevent all people from speeding, but they might act as a deterrent in some or even many cases. It also sends a strong signal that we as a society think such harmful conduct is unacceptable. Another often-criticized argument is that the law is not an effective public health tool. Nobody in favor of criminalizing HIV transmission claims that it is, however. Criminalization might help in preventing some new infections, but we might also wish to deploy the law to punish behavior that led to significant harm to others.

Some have argued that there is no evidence of a deterrence effect from criminalization. It is difficult seeing how this evidence could be established to the point of it becoming uncontroversial, however. It has also been suggested that putting the onus of protecting their partners on an infected person, or even requiring them to advise their sexual partners of their HIV status, would have a detrimental effect on people’s willingness to get tested. The proposition here then is that that the criminalization of HIV transmission could actually yield harmful public health consequences. This argument might have had some currency when successful AIDS treatments did not exist. In those bygone times, people at high risk of HIV infection had little incentive to find out about their infection, given that there was very little that they could do about it if they tested positive. Today, however, life-preserving treatments exist. It strikes me as highly implausible that someone at risk of HIV infection would choose to forgo potential timely life-preserving care in order to be able to continue to have unsafe sex without worries about sanctions.

Another argument alleges that prosecutions of gay men who subjected their sexual long-term partners recklessly and knowingly to the risk of HIV infection demonstrates evidence of a homophobic legal system. This charge seems particularly baseless. A homophobic legal system would permit gay men to continue to engage in high-risk behavior. A society that cares about the well-being of its gay members will try to prevent new infections of gay men from occurring, even if it means prosecuting some of its gay citizens.

Then there is the racism charge. Having lived for a number of years in South Africa, I have come to appreciate that the prevalence of the virus is substantially different in different populations in different parts of the world. I am not surprised to see more African-born heterosexual men prosecuted than North American Caucasian men. The average South African heterosexual African male is substantially more likely to be infected with HIV than is the average Canadian-born, heterosexual Caucasian male. The prevalence of HIV in the former population is substantially higher. No big surprise then that among the few people prosecuted overall there should be an African face. None of that, in its own right, constitutes evidence of racism.

Another argument states that we should not criminalize HIV. Yes, the claim, published recently by legal minds in a leading American medical journal, is that we are criminalizing HIV if we punish people for transmitting it. This is a truly strange argument. If we punish people for transmitting HIV to their partners, who had no reason to assume that they were consenting to that risk when they had unsafe sex, what we criminalize is what people do with the virus, not the virus itself or even the people who happen to be infected.

There are reportedly about 60,000 HIV-positive people in Canada and about 1,000,000 HIV infected people in the USA. So far, very few have been prosecuted for allegedly transmitting HIV. The same is true for most other countries. I do not believe that we are sliding down a slippery slope, at the bottom of which we will launch legal proceedings against most infected people. One reason is that most infected people behave very ethically. The HIV-infected people I know personally prefer to forgo sex than to engage in unsafe sexual activities, even if their sexual partners insist. The thought of harming their sexual partners horrifies them. And so it should.

There is a much smaller number of infected people out there, however, who clearly could not care less about the well-being of people they profess and pretend to love and care about. It seems to me that virtually all of the cases that have been prosecuted so far, both in Canada and elsewhere, are about those sorts of cases, and not about people who acquired the virus during one-time sexual encounters with partners they knew little to nothing about. Most infections occur under the latter circumstances, and they are fairly straightforward cases of harm to self. The ethical and legal maxim volenti non fit iniuria should be applied here: if you consent, you cannot complain. There is little doubt in my mind this explains more than anything else why we have seen few prosecutions. The successful prosecutions so far in the United States, Canada, and Britain have focused on egregious cases of tremendously harmful wrong-doing.

It is the role of the state to use the criminal law to punish such wrong-doing.

Udo Schuklenk, professor of Philosophy at Queen’s University, holds the Ontario Research Chair in Bioethics and is Joint Editor-in-Chief of Bioethics, the publication of the International Association of Bioethics.

sez it all

Disabled kid can't sue the doctor responsible for the disability - in Canada

This is one of those 'I'm not a lawyer, but ...' type posts. Today's GLOBE&MAIL has a report about a court case in Canada. Basically a doctor prescribed an acne medicine that was known to lead to birth defects to a pregnant woman. The woman eventually gave birth to a disabled newborn (an ear missing, part of the newborn's face is paralysed).

The court's judgment rests on two claims: 1) 'because the woman and her fetus are one - both physically and legally - it is the woman whom the doctor advises and who makes the treatment decisions affecting herself and her future child.' This doesn't seem entirely unreasonable. 2) The second claim is that 'granting a child the right to sure doctors for damage caused before birth would also interfere with a woman's right to an abortion'. This seems truly implausible. One can hold consistently that fetuses do not have a right to be (ie grant women a right to abort for whatever reason they see fit), and at the same time that if the pregnant woman decides knowingly and voluntarily to carry it to term that certain duties of care are owed to it, eg the duty to offer it the best possible shot at a life worth living. Anita Kleinsmidt and I have advanced this argument (admittedly in a different context) in the American Journal of Public Health.

There is no contradiction in this point of view, because one can hold the view that moral standing begins at the moment of birth (or viability). However, if the pregnant woman decides not to avail herself of the option of abortion, it's highly probably that a viable child will be born. Any action undertaken by the mother that would reduce such off-spring's best possible shot at a life worth living would require very good reasons (eg the mother's life and future well-being at risk).

The doctor should have inquired whether or not there was a pregnancy prior to prescribing the medicine and/or it would have been necessary for him/her to inform the pregnant woman of the risk of birth defects in case the medicine is taken during pregnancy. The GLOBE&MAIL article seems to imply that the pregnant women did not give informed consent to this risk, because she wasn't informed as she should have been. The doctor clearly erred in his professional obligations both to the mother as well as to the fetus she decided to carry to term (unaware of the risk she subjected the fetus to, due to the doctor's negligence) if she/he failed to elicit informed consent from the pregnant woman at the time. For that reason it is surprising that the Court should have ruled that the child has no case against the doctor.

Christian weirdos in Kingston

Guess what, I went for a walk with two guys (one gay, one straight) along the shoreline of Lake Ontario in Kingston. Here is how we became victims of a vicious Christian ambush. Three youngish women (perhaps teenagers) surrounded us.

They had been thoroughly trained to identify 'sinners' and make them repent. So, they asked us whether we all believe in God (at which point my slightly smarter and faster German friend quietly disappeared in the direction of the water, aiming to demonstrate that he can walk on the same).

Well, I have lived in anglosaxon countries for a bit too long, so I am a tad bit politer, even when I interact with weirdos. Anyhow, the God gals went over their cue cards and explained to us that God loves us. They knew that they were speaking to gay guys, and we all know what God thinks of gay guys, don't we? Well, God supposedly loves us because God loves all sinners (to be fair, that makes sense to me, because - from what I gather - sinners live kinda more interesting lives then those who manage to live without sin, so why shouldn't God love the more adventurous crowd?). Well, eventually the God girls decided to go for the kill. They realised that probably the self-identified atheist gay guy (your's truly) might run away, screaming in mental anguish. So they resorted to grabbing my friend's and my hand. There we stood in a circle holding hands. (Honestly... I was looking for a hidden camera somewhere as it was all too farcical to be true!) Straight guys would probably have loved that scene, reasonably attractive young women holding hands with two guys they never met before in their whole lives, at the Lake shore, the sun going down, you get the picture. Back to the God squad going for the kill... - One of the girls started reading a kind of confession, and asked God for forgiveness from another one of her cue cards. She asked us every few lines to repeat after her. It was truly hilarious. I duly repeated after her the stuff about sinners and forgiveness and God loving me (I never met God, but they seemed quite certain that God really loves me, so who was I to argue with them???).

So, beware, if you're wandering along Lake Ontario in Kingston, Ontario, and you go peacefully about your business (eg enjoying the tranquility of the lake), there's odd Christian weirdos out there hassling you for no particular reason. They also think it's perfectly appropriate to invade your space and privacy. No big surprise in that, I suppose, seeing that were on a mission. They invited me and my friend to meet the rest of their forgiving crowd during church times. It didn't seem to occur to them that their sanctimonious self-rightous bull*#@# could sensibly be construed as highly offensive by halfway educated people who don't think about sex among consenting adults in terms of sin but in terms of fun. As most selfrighteous people, however, they seemed very comfortable about their own holiness.

Kingston beware! Nobody knows how many of them have been let loose by their local pastor. I think Tourism Kingston ought to warn visitors coming to town that there is Christians out and about that are on a mission. May be some kind of Christians-on-a-mission alert? Telling tourists that there is no need to call the mental health services or the police. These Christians are harmless. They will leave eventually.

Farewell to the genocidal duo

Good bye to Thabo Mbeki and his health prevention side-kick Manto Tshabalala-Msimang, formerly health minister of South Africa. Manto, like AIDS denialist Thabo was kicked out of the Presidency, was shafted from the health ministry during the ANCs recall of 'comrade Mbeki'. A lot of South Africans are worried about what might come unter Jacob Zuma, a shady Zulu warrior tainted by a substantial number of scandals including corruption and sexual conduct. But truth be told, what can be much worse than the AIDS policies of the Mbeki government, policies responsible for hundredthousands of preventable AIDS deaths among the impoverished Black majority population in the country. Mbeki also presided over the systematic undermining of state institutions (including the security services, the courts and the national broadcaster) into mouthpieces of his administration. Many South Africans seem to have forgotten already that the president of the South African Medical Association called - justifiably so - these Mbeki/Tshabalala Msimang policies 'genocidal'. It's a shame - as South Africans of all shades are fond of saying - that the country doesn't seem to have more competent politicians prepared to step up to the serious challenges the country faces. That being the case it seems somewhat inevitable that a vindictive paranoid (arguably antidemocratic) character such as Mbeki was replaced by a washed-up populist ala Jacob Zuma. Interesting times ahead for the rainbow nation... - Only the future will tell though whether Zuma really will do much worse than Mbeki.

Being gay in Iraq isn't fun these days...

I reproduce here a circular human rights activist and fellow humanist Peter Tatchell has send me. You might want to consider supporting the cause. There is information about donations at the end of his post.

Sexual cleansing in Iraq

Islamist death squads are hunting down gay Iraqis and summarily executing them

WATCH the video link below – and weep

http://uk.youtube.com/watch?v=uB7TcPGXlHY

By Peter Tatchell

The Guardian – Comment Is Free – 25 September 2008

http://www.guardian.co.uk/commentisfree/2008/sep/25/iraq.humanrights

STOP PRESS: This morning, after this article was published, news came from Iraq that the coordinator of Iraqi LGBT in Baghdad, Bashar, aged 27, has been assassinated in a barber shop. Militias burst in and sprayed his body with bullets.

The so-called improved security situation in Iraq is not benefiting all Iraqis, especially not gay ones. Islamist death squads are engaged in a homophobic killing spree, with the active encouragement of leading Muslim clerics, such as Moqtada al-Sadr, as Newsweek recently revealed.

http://www.newsweek.com/id/155656

One of these clerics, Grand Ayatollah Ali al-Sistani, the spiritual leader of Shia Islam, issued a fatwa urging the killing of lesbians and gays in the "worst, most severe way possible."

http://gaycitynews.com/site/index.cfm?newsid=18202189&BRD=2729&PAG=461&dept_id=568864&rfi=8

The short film, Queer Fear - Gay Life, Gay Death in Iraq, produced by David Grey for Village Film, documents the tragic fates of a several individual gay Iraqis. You can view it here:

http://uk.youtube.com/watch?v=uB7TcPGXlHY

Watch and weep. A truly poignant and moving revelation about the terrorisation and murder of Iraqi lesbian, gay, bisexual and transgender people.

Since this film was made, the killings have continued and, many say, got worse.

http://edition.cnn.com/2008/WORLD/meast/07/24/gay.iraqis/index.html

For gay Iraqis there is little evidence of the transition to democracy. They don't experience any new-found respect human rights. Life for them is even worse than under the tyrant Saddam Hussein.

It is a death sentence in today's "liberated" Iraq to love a person of the same-sex, or for a woman to have sex outside of marriage, or for a Muslim to give up his / her faith or embrace another religion.

The reality on the ground is that theocracy is taking hold of the country, including in Basra, which was abandoned by the British military. In place of foreign occupation, the city's inhabitants now endure the terror of fundamentalist militias and death squads. Those who are deemed insufficiently devout and pure are liable to be assassinated.

The death squads of the Badr Brigades and the Madhi Army are targeting gays and lesbians, according to UN reports, in a systematic campaign of sexual cleansing. They proudly boast of their success, claiming that they have already exterminated all "perverts and sodomites" in many of the major cities.

http://articles.latimes.com/2007/aug/05/world/fg-iraqgay5

http://gaycitynews.com/site/index.cfm?newsid=17008100&BRD=2729&PAG=461&dept_id=568864&rfi=8

http://gaycitynews.com/site/index.cfm?newsid=17008200&BRD=2729&PAG=461&dept_id=568864&rfi=8

http://gaycitynews.com/site/index.cfm?newsid=18605093&BRD=2729&PAG=461&dept_id=568864&rfi=8

You can view photos of a few of the LGBT victims of these summary executions here:

http://www.flickr.com/photos/outrage/sets/72157600042494571/

http://www.flickr.com/photos/outrage/sets/72057594087304767/

My friends in Iraq have relayed to me the tragic story of five gay activists, who belonged to the underground movement gay rights movement, Iraqi LGBT (lesbian, gay, bisexual and transgender).

Eye-witnesses confirm that they saw the men being led out of a house at gun-point by officers in police uniform. Yes, Iraqi police! Nothing has been heard of the five victims since then. In all probability, they have been executed by the police - or by Islamist death squads who have infiltrated the Iraqi police and who are using their uniforms to carry out so-called honour killings of gay people, unchaste women and many others.

The arrested and disappeared men were Amjad 27, Rafid 29, Hassan 24, Ayman 19 and Ali 21. As members of Iraq's covert gay rights movement, for the previous few months they had been documenting the killing of lesbians and gays, relaying details of the murders to the outside world, and providing safe houses and support to other gay people fleeing the death squads.

Their abduction is just one of many outrages by anti-gay death squads. lslamist killers burst into the home of two lesbians in city of Najaf. They shot them dead, slashed their throats, and also murdered a young child who the women had rescued from the sex trade. The two women, both in their mid-30s, were members of Iraqi LGBT. They were providing a safe house for gay men on the run from death squads. By sheer luck, none of the men who were being given shelter in the house were at home when the assassins struck. They have since fled to Baghdad and are hiding in an Iraqi LGBT safe house there.

Large parts of Iraq are now under the de facto control of the militias and their death squad units. They enforce a harsh interpretation of Sharia law, summarily executing people for what they denounce as "crimes against Islam." These "crimes" include listening to western pop music, wearing shorts or jeans, drinking alcohol, selling videos, working in a barber's shop, homosexuality, dancing, having a Sunni name, adultery and, in the case of women, not being veiled or walking in the street unaccompanied by a male relative.

Two militias are doing most of the killing. They are the armed wings of major parties in the Bush and Brown-backed Iraqi government. Madhi is the militia of Muqtada al-Sadr, and Badr is the militia of the Supreme Council for Islamic Revolution in Iraq (SCIRI), which is the leading political force in Baghdad's governing coalition. Both militias want to establish an Iranian-style religious dictatorship. The allied occupation of Iraq is bad enough. But if the Madhi or Badr militias gain in influence and strength, as seems likely in the long-term, it could result in a reign of religious terror many times worse.

Saddam Hussein was a bloody tyrant. I campaigned against his blood-stained misrule for nearly 30 years. But while Saddam was President, there was certainly no danger of gay people being assassinated in their homes and in the street by religious fanatics.

http://gaycitynews.com/site/index.cfm?newsid=17008362&BRD=2729&PAG=461&dept_id=568864&rfi=8

Since his overthrow, the violent persecution of lesbians and gays is much worse.

http://iraqilgbtuk.blogspot.com/2007/08/for-gays-in-iraq-life-of-constant-fear.html

Even children suspected of being gay are abducted and later found shot in the head.

http://gaycitynews.com/site/index.cfm?newsid=17008362&BRD=2729&PAG=461&dept_id=568864&rfi=8

Lesbian and gay Iraqis cannot seek the protection of the police, since the police are heavily infiltrated by fundamentalists, especially the Badr militia. The death squads can kill with impunity. Pro-fundamentalist ministers in the Iraqi government are turning a blind eye to the killings, and helping to protect the killers. Some "liberation".

* Iraqi LGBT is appealing for funds to help the work of their members in Iraq. Since they don't yet have a bank account, they request that cheques should be made payable to "OutRage!", with a cover note marked "For Iraqi LGBT", and sent to OutRage!, PO Box 17816, London SW14 8WT.

More information on Iraqi LGBT or to make a donation by PayPal: http://iraqilgbtuk.blogspot.com/

Ben Goldacre: 1 - Matthias Rath: 0

Victory for Ben Goldacre, Guardian columnist and regular debunker of bad science. Humiliating defeat for Matthias Rath, the German born vitamin peddler. What happened? At a cost of 500,000 GBP the Guardian defended a libel suit the vitamin salesman had brought against the newspaper for a series of articles Goldacre wrote some time back about his activities. He withdrew the case eventually and the court awarded initial cost of 200,000 GBP to the paper.

Goldacre published a series of three articles in the paper that reported in some detail the disgraceful activities Rath was involved in in South Africa where he tried to convince AIDS patients to use his vitamins instead of AIDS drugs. Rath made claims about the poisonous effects of mainstream AIDS medicines and reportedly conducted unapproved clinical trials with impoverished AIDS patients in South African townships. Here is how he tried to persuade AIDS patients to stop taking life preserving drugs and to use his alternative concoctions instead. Supported covertly and not so covertly by South Africa's incompetent health minister Manta Tshabalala Msimang he managed to go about his business for far too long. You can see him making out on the photo I posted above to the left of Anthony Mbewu, Manto's principal medical research honcho and head of the country's Medical Research Council. But then, hey, don't be too surprised, the country is rapidly becoming a banana republic. No surprised that these sorts of characters find each other quickly.

Reportedly Rath has since begun advertising campaigns in Russia where the incidence of new AIDS cases is increasing quite dramatically. Read here Goldacre's take on the issue. Sarah Boseley, the newspaper's health editor tracks Rath's 'career' here. Here is an analysis of deaths that occurred in his illegal trials in South African townhips.

What is remarkable about this guy is that he has pretty much disregarded all principles of medical professionalism and instead used (uses) his medical degree to convince lay people that his quackery is based on sound science. It is remarkable that he is still permitted to call himself a medical doctor.

Helping Alla Krasavica

Do you know Alla Krasavica? I don't. She's looking for 'love' (and, no doubt cash), and she's from Russia. She wrote to me... a nice letter, ending with a request for my details. She also wants me to pick her up at an Australian airport (it's unclear to me why she would have written to a South African email address used by a gay guy to achieve that objective, but hey, like her Nigerian counterparts... brain is usually not the strongest feature of these scam artists).

Well, in case you feel like getting fleeced by Alla, here's her message to me ('her' contact details are at the end):

Greetings from Russia to you dear friend!!!
I hope, that this letter will cause you interest.
It is possible this letter will change our destinies... I ask you to give some minutes and to read my history.
For the First! This letter from agency of dating of the internet.
I have given them this letter and to me has told, that they will send it to the Australia.
My name - Alla. I - from Russia, Saint Petersburg.
I’m - 27 years old woman. My Birthday March, 14 1981.
I want to tell you that was happened with me. Some time ago I have got acquainted through Internet with the man. His name is Patrick from Sidney. We began to correspond with each other. Shortly we had sympathies to each other. I would not tell that it there was a love, but the sympathy was big. We have thought that our relations should leave on a new stage and both wished a meeting. I have collected all necessary documents, and in September I receive the visa.
But that there was further it awfully. Patrick has written to me that is not ready to serious relations with me and would not want that I came. It has very strongly shaken me, I did not expect that he can do it... I cried and did not know what to do, I was deceived.
I want to forget this awful liar faster. And to use the chance which has dropped out to me.

The purpose of my letter: I shall receive the Visa of the Visitor of the Australia on September.
I want to arrive to the Australia, but I have no any friends or familiar who
can meet me on airport. I really hope, that you can do it for me.

But if you will answer to me I will write more about me and about my life.
Probably we can develop our relations also.
So, please, write to me on my E-mail:
I hope, that you will have interest after reading my letter.
Also I have interest too. Please inform me:
1 - your name?
2 - your city?
3 - your age?
4 - to send me your photo also?
5 - would you like to meet the woman for love?

Please reply only my personal e-mail: allakrasavica@gmail.com

Ok, I will close for now, but I will wait your answer so much!!!
I really hope that you will give me chance to have meeting!!!
Waiting for your answer,
Yours friend Alla from Russia.

Poor Canadians - voting on two non-starters

It's funny living in Canada these days. The next federal elections are probably closer than those in the USA yet the gun-toting Alaskan governor and her five children are higher on the Canadian agenda than local politics. There's no big surprise in this.

The current conservative minority government is run by a mean-spirited populist politician (Stephen Harper). His main claim to fame are a failed foreign minister (he left secret documents with his that time girlfriend, a woman with reported links to a local biker gang), a health minister whose main claim to fame are attacks on a harm reduction facility in Vancouver (the facility offers drug addicts access to clean needles as a means to reduce the occurrence of infectious diseases among drug users), cuts of federal arts programs, and other populist this-n-that. While these sorts of activities undoubtedly are designed to rally his redneck base, Harper would not stand a chance in hell to get a larger share of the vote in the upcoming elections (the economy is tanking...), the Liberals have kindly come to his help.

They elected Stephane Dion, a likeable but inept academic turned politician. In the middle of a serious economic crisis in the country, sky-high energy prices just ahead of another long Canadian winter his main claim to fame is to have proposed a tax increasing environmental policy. Our environment is important, very important, the policy is comprehensive and pretty good to my mind, BUT it isn't a straightforward bread-and-butter issue for most voters, so he's on to a losing streak. Indeed, that's what all the polls are showing. Dion's Liberals have also kept the Conservatives in power by means of not voting down their legislative program in the parliament for the last year or so.

So, the Canadians are faced with a mean spirited redneck who offers some kind of leadership versus a kind spirited liberal unable to offer any kind of leadership skills. No wonder they're watching CNN to see how things pan out south of the border...

Thank goodness the farce is over: Olympic World Doping Orgy has successfully concluded

Ok folks, fair enough, I am a NERD, you could not pay me to watch sports events. I tried, but truly, any third rate crime caper is more likely to catch my attention than athletes high on chemicals running faster than their compatriots hundred years ago who were not able to access similarly undetectable hi-tech stuff.

I mean, the French Tour de Farce has long ceased to be taken seriously by anyone other than pharma reps trying to sell anabolica to farmers.

Just look at some of the Olympic outcomes...

• 51 gold medals for the PR of China - the Chinese anti-doping folks claim that 99.5% of all athletes were not doped, seems China benefited neatly from this clearly delusional assessment.
  
• The same Jamaican bloke broke three world records in three days - overall the runners form that island state managed to grab 6 gold medals and nothing much else
• A US American bloke broke 7 world records among his 8 gold medals in 8 days

How likely is it, even if we grant top fitness and - in the case of Chinese athletes a lot of local support - that this happened without pharmaceutical ... ummm ... sponsorship?

Wouldn't it be fairer if the sponsor also received - in retrospect - a medal for concocting chemicals that propelled athletes ahead of the more naturally inclined crowd without the doping tests detecting anything? I think it would be so much fairer to celebrate the chemists, too. Why can't we have a separate competition for chemists supplying drugs to Olympic athletes? I would like to know what makes them faster, so next time I go on a bike trip I can grab some of that juice, too!

I won't event talk much about the civil rights violations committed by China so the world could have its sporting farce. Some of those folks who had a life and their own little houses were made homeless in the process of building those pompous architectural monstrosities conjured up by some architect suffering likely from penis envy or some other inferiority complex. Reportedly many of these people still live under bridges and the like. They will never be able to return to their homes as they have been bulldozed into the ground so doped athletes could have nice shower facilities. But hey, even this pales in comparison to the PR of China's international track record: it supports dictators and mass murderers in Zimbabwe and Sudan, it executed about 10,000 of its own (Chinese) citizens during the last year alone... and I could go on. Still, at least we know now that they're capable of building giant ugly things (no surprise in this really: give an architect a pile of dosh and she will invariably come up with something giant or other - gives em an opportunity to pass by their legacy every other day and say 'I did this - world, admire me!') and conjuring up nice fireworks on the land stolen from those folks now 'housed' under bridges. I still think it's remarkable how happily well-paid engineers and architects rose to the challenge of building giant chunks of concrete and steel on land they knew was stolen from its original owners by a totalitarian regime. No questions asked, as long as the pay is right. Professionalism in action... - Great games. Thank goodness it's over.

And now, go, flame me, I don't care :). I'm just glad these days there's cable and one can choose to watch something else. When I was younger we had the choice between Olympic games and Olympic games on our tellie (chosen by our dad for the rest of the - otherwise bored - family).

Voices of Disbelief - Sunday PM Marketing

I am all fired about about a really cool book Russell Blackford and I have been working on during the last couple of months. Wiley-Blackwell will publish it some time next year. It's great for us to have found such a large and prestigious international publisher for the book as this will give us quite a bit of marketing muscle to deploy!

Basically what Russell and I decided to do is to ask people on our respective electronic rolodexes why it is that they don't believe in an omniscient, omnipotent 'good' God running the universe. Call it a humanist/atheist coming out party if you wish. And you know what, I am well and truly thrilled about what we've got so far (which is 27 chapters out of about 50 or so - with some time to go for our deadline). Remarkable philosophers, science fiction writers, medical doctors, newspaper columnists, political activists from around the globe have gathered to tell the world in a way not only why they don't believe in God, but arguably also why you shouldn't buy into that clap-trap either. Very moving personal accounts, entertaining stories, philosophical analyses and so on and so forth will result in a most enlightening, entertaining and challenging book. I'm truthfully over the moon, seeing how great this project is coming together. I won't be mentioning any of the names of the contributors yet, but rest assured, most of them are household names in their respective fields of work.

Viva California

Both houses of the Californian legislature have passed a resolution that requests

all relevant California agencies to notify California-licensed health professionals (doctors, psychologists, and others) about their obligations under international law relating to torture,

those health professionals to be notified that if they participate in torture they may be subject to prosecution,

the Department of Defense and the Central Intelligence Agency to remove all California-licensed health professionals from participating in prisoner and detainee interrogations.

This comes in the wake of uncontrovertible evidence unearthed by US medical doctor Steve Miles, a bioethicist at the University of Minnesota, that health care professionals were involved in torturing prisoners in Guantanamo Bay. Here's a brief excerpt from an article Miles wrote in a bioethics journal, describing the torture of one detainee in Guantanamo Bay (based on heavily censored US army records):

The Interrogation of Prisoner 063

Two government documents detail medical and psychological participation with the interrogation of Prisoner 063, Mohammed al-Qahtani, at Guantanamo Bay between November 23, 2002 and January 11, 2003 (Zagorin and Duffy 2005). The first is an 83-page interrogation log (ORCON 2003). The second is an Army investigation of complaints of mistreatment of prisoners at Guantanamo Bay, including Prisoner 063 (United States Army 2005, 13–21). The third and fourth are notes taken in relation to that Army investigation (CTD Fly Team 2006; GITMO Investigation 2004). The second set of these notes extensively describes medical collaboration with one or more interrogations but the record is so heavily redacted that it is not possible to determine which, if any, of this material described the interrogation of Prisoner 063 (GITMO Investigation 2004).

According to the Army investigation, the log covers a period in the middle of al-Qahtani’s interrogation that began in the summer of 2002 and continued into 2003. For eleven days, beginning November 23, al-Qahtani was interrogated for twenty hours each day by interrogators working in shifts. He was kept awake with music, yelling, loud white noise or brief opportunities to stand. He then was subjected to eighty hours of nearly continuous interrogation until what was intended to be a 24-hour “recuperation.” This recuperation was entirely occupied by a hospitalization for hypothermia that had resulted from deliberately abusive use of an air conditioner. Army investigators reported that al-Qahtani’s body temperature had been cooled to 95 to 97 degrees Fahrenheit (35 to 36.1 degrees Celsius) and that his heart rate had slowed to thirty-five beats per minute. While hospitalized, his electrolytes were corrected and an ultrasound did not find venous thrombosis as a cause for the swelling of his leg. The prisoner slept through most of the 42-hour hospitalization after which he was hooded, shackled, put on a litter and taken by ambulance to an interrogation room for twelve more days of interrogation, punctuated by a few brief naps. He was then allowed to sleep for four hours before being interrogated for ten more days, except for naps of up to an hour. He was allowed 12 hours of sleep on January 1, but for the next eleven days, the exhausted and increasingly non-communicative prisoner was only allowed naps of one to four hours as he was interrogated. The log ends with a discharge for another “sleep period.”

Medical Treatment during Interrogation

Clinicians regularly visited the interrogation cell to assess and treat the prisoner. Medics and a female “medical representative” checked vital signs several times per day; they assessed for dehydration and suggested enemas for constipation or intravenous fluids for dehydration. The prisoner’s hands and feet became swollen as he was restrained in a chair. These extremities were inspected and wrapped by medics and a physician. One entry describes a physician checking “for abrasions from sitting in the metal chair for long periods of time. The doctor said everything was good.” Guards, medics and a physician offered palliative medications such as aspirin to treat his swollen feet.

Intravenous fluids were regular administered over the prisoner’s objection. For example, on November 24, the prisoner refused water. A Captain-interrogator advised him that the medic “can administer IV [sic: the log’s contraction for intravenous fluids of an unspecified volume is used throughout this article] fluids once the Captain and the Doctor on duty are notified and agree to it.” Nine hours later, after taking vital signs, medical personnel administered “two bags” of intravenous fluids. Later that day, a physician evaluated al-Qahtani in the interrogation room and told him that he could not refuse medications or intravenous fluids, and that he would not be allowed to die.

The next day, interrogators told the prisoner that he would not be allowed to pray if he would not drink water. Neither a medic nor a physician could insert a standard intravenous catheter, so a physician inserted a “temporary shunt” to allow an intravenous infusion. The restrained prisoner asked to go the bathroom and was given a urinal instead. Thirty minutes later, he was given “three and one-half bags of IV [sic]” and he urinated twice in his pants. The next day, the physician came to the interrogation room and checked the restrained prisoner’s swollen extremities and the shunt. The shunt was removed and a soldier told al-Qahtani that he could pray on the floor where he had urinated.

From December 12 to 14, al-Qahtani’s weight went from 119 to 130 pounds (54 to 59 kilograms) after being given six IVs. On December 14, al-Qahtani’s pulse was 42 beats per minute. A physician was consulted by phone and said that “operations” could continue since there had been no significant change. Al-Qahtani received three more IVs on the December 15 and complained of costophrenic pain. A physician came to the interrogation cell, examined him, made a presumptive diagnosis of kidney stones and instructed the prisoner to take fluids. The next day blood was drawn in the cell.

Of course, treatment such as this is prohibited by the Geneva Convention which requires that prisoners be treated at all times humanely, not be tortured, and so on and so forth. While one can argue whether ot not the described actions of health care personnel constituted torture (they did not, to my mind), they did at a minimum enable the continuation of torture by means of keeping prisoners sufficiently fit to be able to be tortured again. They also enabled torture by way of declaring the prisoner fit enough to be tortured again.

Is it not remarkable that the American Medical Association has not come out with a strong statement condemning the participation of US medical doctors in the torturing of prisoners of war in Guantanamo Bay? Perhaps this is due to the fact that the AMA is always a little bit slow. It took the organisation only more than a hundred years to apologise for institutionalised racism that it practised for many years.Local AMA chapter had rules discriminating against black doctors as recent as the late 1960s. To be fair, it is not only the AMA that is dragging its feet on the issue, the American Psychological Association also can't decide where it stands on the issue. Very much unlike the American Psychiatric Association (ie medical professionals) which regulated against the participation of US psychiatrists in such activities in 2006. Since then the US military has replaced psychiatrists with psychologists to assist them in developing sound torture techniques. The US military is one of the the largest employers of psychologists in that country.

Correlation and causation

Just a correlation or possibly causation? Neither South Africa nor Canada, both countries I lived in, have managed so far to grab an Olympic medal. The wailing about their failing national teams is great in both these great nations. Let us hope that not too many people will commit suicide due to Olympic failures. Let us also hope that nobody thinks that there's more to this then just a correlation.

Hey, come to think of it, perhaps causality related suspicions might be the underlying rationale for the theft of my bike yesterday. Perhaps someone tried to punish me for the Canadian failure. I kind of doubt it, after all, had I not left it unlocked under a tree outside my house, quite likely it would still be there.

Does correct spelling matter?

There's an interesting debate raging in the UK currently, between a 'new' university lecturer, a Dr Smith and an 'old' university professor, a Dr Grayling. It is probably not entirely unfair to say that 'new' universities in the UK are organisations that are traditionally weak on the research side of things and strong on the teaching side of things. Equally, 'new' universities (ie usually ex polytechnics) tend to be less competitive institutions, attracting more often than not academically less gifted students or students coming to universities through less traditional routes (eg they mid attend university mid-career).

Well, the 'raging' (I am exaggerating!) debate is about the question of whether or not we as academics should punish students for spelling errors and such or whether we should accept those as legitimate 'variants' of English as 'new' university Dr Smith suggests. 'Old' university Dr Grayling duly makes a mockery of Dr Smith's views by producing a coherent commentary relying on proper English that rapidly disintegrates into incoherent ramblings and random accumulations of letters that don't make sense at all anymore. His point: proper English matters. In a way you'd say that probably he is a snob, albeit a leftish one (writing for the GUARDIAN). Surely there is a big difference between someone who ignores minor spelling mistakes students make (yes, there's plenty of them in 'new' and 'old' universities alike) and someone who passes essays even though they are incomprehensible because the words can't be made sense of any longer as they do not resemble existing words; or someone who passes essays where the sentence structure is such that the meaning cannot be ascertained any longer.

Mind you, this is not just a problem in English speaking countries. Long suffering colleagues in Germany tell similar tales. German language instruction that focuses these days more on 'interpretation' of poems and 'critical thinking' skills then grammar and spelling seems to have wrecked many students ability to express themselves properly in that language.

Difficult one: I have to be honest, with English not being my first language, it annoys me hugely having to read essays by students whose first language is English, yet whose English is MUCH worse than mine. And yes, I have come across essays by students whose first language is English that were to a large extent incomprehensible, because the English was so terrible. - I have no idea how those folks managed to get through high-school, and indeed how they managed to sail through their undergraduate years, but yes, such students do exist! - My take on this has always been to ignore mistakes that do not impact on content, but I can see that that might be problematic. After all, prospective employers of our graduates have every reason to assume that students we graduate have a proper command of the language of instruction that we use in our teaching, or don't they? On the other hand, should I really give a higher grade to a native English speaker over an English-as-second language speaker just because the latter's English is worse, while the actual critical content of both essays is of fairly comparable quality?

What's your take on this?

Intl AIDS Conference Calls for Decriminalisation of HIV Transmission

Various activists, academics and politicians during the International AIDS Conference criticized that many countries these days criminalize HIV transmission. The argument is essentially that the law is a bad means to deploy in order to achieve public health objectives. One reason for criminalizing HIV transmission is of course the hope that one might be able to deter some infected people from having unsafe sex. The folks wanting to decriminalize HIV transmission believe that the deterrence effect doesn't work. Frankly, I cannot see how that could be demonstrated one way or another. The deterrence effect of the criminal law has been demonstrated time and again, so I wonder why we should buy into the claim that in the case of sex it doesn't work.

Hey, perhaps it doesn't, but if that is so, what's so terribly wrong with society deciding to punish someone who knowingly subjected someone else to the risk of catching a serious chronic illness? I could see that an argument could probably be made for sexual encounters among consenting adults that, say, pick each other up in a bar some night, where both volunteer to have unsafe sex, no deception re one's HIV status takes place, no questions are being asked and a transmission takes place. I think here we'd probably have a case of harm to self. At the very least we have a case where someone arguably consented to the risk of catching a sexually transmitted illness (as AIDS is). These sorts of happenstances seem to make up the bulk of transmissions and I have not yet seen anyone running to police in order to get their one-night-stand encounter prosecuted. By and large people accept responsibility for their conduct in such circumstances, and so they should.

Truth be told the few cases that have been prosecuted across the world had to do with folks who behaved overwhelmingly truly appallingly to their partners (and not in the sense of one-night stand partner, but in the sense of husband, wife, long-term boyfriend, long-term girlfriend). You know, stories like a 25 year old guy who knew to be HIV infected and insisted on not using condoms with his 15 year old girlfriend. I am at a loss why human rights types folks think that it is a bad idea to criminalize such conduct. For the sake of the argument, even if the deterrence effect of such punishment would really fail, why would it be so unjust to punish such conduct? What's so different about HIV and AIDS that we should not aim to police such harm to others?

One thing I find truly annoying about these campaigners: With a straight face they'd pronounce variously that we shouldn't 'criminalize HIV' or we shouldn't 'criminalize people with HIV'. It goes without saying that nobody anywhere in the world has as yet attempted to either criminalize HIV or people living with the virus. What people in most countries have been saying is this: if you got the bug and you behave in harmful ways towards uninfected people by means of subjecting them to unreasonable risks through reckless behavior, we will punish you. So, what is punished is the harmful conduct, not the virus itself or anyone who happens to be infected but behaves sensibly.