Coca Cola dreams

Today my intellectual fantasies of seeing some of the best most interesting people in my field was fulfilled. Although I was excited to see Helene D. Gayle, MD, MPH, (President and CEO of CARE USA), I have to say I wasn't all that impressed. Not the best public speaker and she didn't say anything new.

However, Jim Yong Kim, MD, PhD (Harvard, WHO, Partners in Health) was a charismatic, innovative and inspiring lecturer. I am not surprised that in 2003, he received a MacArthur Foundation "genius" grant, and in 2005, he was recognized as one of America's Best Leaders and in 2006, he was listed as one of the top 100 most influential people by Time Magazine http://www.time.com/time/magazine/article/0,9171,1187277,00.html.

He started his lecture by discussing HIV and MDR-Tb and the newer XDR-Tb which is even more drug resistant. This XDR-Tb is very dangerous. In a sample of people near Lesotho 41% had MDR-Tb and 10% of those people had the XDR. 100% of the X'ers were HIV positive and the average time from diagnosis to death for this study was 16 days. Almost all the people had the exact same strain meaning it is passing from individual to individual He gave the normal stats and photos and talked about some of the successes of DOTS-Plus. He showed the famous photo of recovering HIV/TB patients.

He reinforced that a focus on Basic science research (4-5 new drugs are needed for TB), Clinical Research (we need to know what works), and Technology (what is the best way to get this out and coordinate it) needs to be strong. However, will it help to add these new innovations on top of a heap of old, ineffective/semi-effective programs already in place?

The innovative part of his lecture was a proposal of a new discipline that will seal the gap in Public Health. This is DELIVERY SCIENCE. It looks specifically and how things are implemented and imposes a business modelling system into health.

He suggests compiling information using the case study approach to look at successes and failures. He recommends lessening the focus on outcomes and refocusing on how we get the outcomes to learn from practice. He made a very good case for this and after a few years with WHO's failed 3 by 5 goal (3 Million people by 2005-Universal access to anti-retroviral therapy for all living with HIV/AIDS), he knows his fair share of bureaucracy and the dangers and complacency it imposes in the eyes of many visionaries.

My only hesitation on his plan however, is when we are at critical epidemic rate of increasing co-morbidity from HIV/Tb, for example, where are we going to get the TIME and Funding for us to compile this information and then test and test and try and try? I understand a need to identify an effective way to have people globally access primary health care, but do we have time for trial and error? Error in some countries is genius in others.

Using financial resources and business models for health care product dissemination is frankly amazing. As he said, if every person in the developing countries can get a coke in their hand, then why can't we use that same marketing model to apply to health. Getting this information from the coke PR firm and blending and molding it to many of the challenges faced by global health workers may present itself to be a bigger challenge than some of the global health challenges we face today

At any rate, it was an amazingly thought provoking lecture and I will post a link as soon as its available.

If the efficiency of marketing and globalization could be used to better the health of the world, hell, even i will drink a coke and cheer to that.

Feliz Dia del Amor y Amnistad

Today is the commercialized day of love.

In my mind, everyday should be a day of love. But some people need a reminder from Hallmark. That's ok. We all have our flaws :)

After my mini-rant yesterday, how's a girl to complain when this beautiful bouquet is on my doorstep when I come home for lunch.

Love cannot endure indifference. It needs to be wanted. Like a lamp, it needs to be fed out of the oil of another's heart, or its flame burns low. ~ Henry Ward Beecher

I prefer the Latin American version of Valentine's day; its a day of love and friendship. So, to all my loves and friends out there, I wish you a soul tickling valentines day. I love you all (today and everyday :) and all of you have contributed deeply to who I am.

Valentine's day flowers-Blooming some thoughts

What is the cost on the environment for sending a bouquet of flowers to your sweetie to say you love them. Who are you impacting and how? You know, I'm a firm believer in your dollar being your biggest vote in this world.

A May 2002 cover story in Environmental Health Perspectives, published bythe U.S. Department of Health, pulled together current research on workerand environmental health in the cut flower industry. Holland remains theworld's largest producer of cut flowers, but Colombia is now a close second.One of every two flowers sold in the U.S. is grown in the Colombian savannahsurrounding Bogota. Colombia flower workers number 80,000, with another50,000 in packaging and transportation. China, Costa Rica, Ecuador, India,Malaysia, Mexico, Kenya, Tanzania and Zimbabwe all now export cut flowers.According to a report by the International Union of Food, Agricultural,Hotel, Restaurant, Catering, Tobacco and Allied Workers and Food FirstInformation and Action Network (FIAN), 190,000 people in developingcountries work in the flower business.

Well, here in the U.S. many of our roses come from either Ecuador or Colombia depending. Also, we get flowers from Holland and I'm sure other countries.

These issues exist here, but for the sake of argument, I want to look a little at the U.k. Thirty percent of their flowers come from Kenya, specifically around Lake Naivasha. Which is worse, using a large amount of fuel to fly over flowers from Kenya or importing flowers from Holland.

Preliminary results on a study done by a University in U.K. says it is actually a less negative (5 times less) impact on the environment if you get them from Africa. There they are grown in the natural, hot sun opposed to the artificial environment created in Holland in Hot houses that happens this time of the year.

I suppose you must also look and the use of pesticides, treatment of workers, sustainability (Lake Naivasha is drying up quickly and once it's gone, this will no longer be an option), and overall how much of this land could be used to produce nutritious foods instead of cash crops.

All in the name of those of us more fortunate-needing a little symbol of love. I would prefer a hand drawn photo of a flower, but how's a girl not to smile, when he thinks of you and sends you flowers.

After all, the Earth laughs in flowers. (Ralph Waldo Emerson) and who doesn't want to share a laugh with the one they love.

http://shopping.guardian.co.uk/valentinesday/story/0,,1708468,00.html

Wanderlust and drugs

As my wander lust grows, I find myself bogged down by more and more things. I keep telling myself these things are an anchor that will eventually sprout wings and carry me away with them. Till then, I do what I can sitting behind an electronic box making letters dance into words and sending them across many oceans.

Recently, I have been following the pivotal lawsuit in India involving TRiPS (WTO's International Agreement on Patent rights which generic drug production falls under via intellectual property rights). Generics and access to generics in the developing world is a big, crazy mess.

People are dying from not having access to drugs. Pharmaceutical companies are companies after all and can not do anything but what brings them good PR and helps them sell drugs. They have a bottom line to keep stock holders happy and investing and keep research flourishing. Unfortunately, healthiness, especially in the developing world, is the bastard love child at the mercy of the tryrannical abusive pharmaceutical company-father and his guilty late night indulgences with an insecurely confident ministry of health mother. Ahhh when will health become a human right. Am I only dreaming that this will ever happen.

As I research this more, I am sure I will start to sort out some of the fine ethical points of the discussion.

Till then, back to making letters dance...........