Clinical trials. Research findings. Data. Metrics. Numbers.


Visualizing gun deaths – Comparing the U.S. to rest of the world | 

JohnWayneWhen it comes to gun violence, the United States stands out.

President Obama’s nominee for surgeon general, Vivek Murthy, a renowned Boston-based physician, has advocated for stricter gun-control laws and referred to the U.S. rates of gun violence as a public health threat.  Murthy’s views have ignited opposition from the gun lobby and politicians on both sides of the aisle, virtually assuring an end to his bid to become the U.S.’s top public health official.

In any debate about gun control and violence prevention, it is useful to examine data on gun deaths.

How does the US stack up against other countries when it comes to homicides involving guns? The screen grab below, which uses findings from the Global Burden of Disease Study 2010, illustrates the  difference in firearm homicide rates between the US and other high-income countries. Adjusting for differences in population size, rates of homicides from guns were  6.6 times larger in the US than in Portugal, the country with one of the highest rates in Western Europe.

Firearm homicide rates in selected high-income countries, 2010

Gun Violence

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Seattle Biomed pioneering ‘rational’ approach to vaccines | 

Early anti-vaccine hysteria. Cartoon of Edward Jenner administering cowpox vaccine to frightened young women, and cows emerging from different parts of people's bodies.
Early anti-vaccine hysteria. Cartoon of Edward Jenner administering cowpox vaccine to frightened young women, and cows emerging from different parts of people’s bodies.
Wikipedia, James Gilray

Vaccines are widely, legitimately, hailed as one of medicine’s most powerful weapons in the fight against infectious disease. Millions of lives are saved, deaths prevented, every year using this simple tool that can cost as little as a handful of pennies.

Holy bang for the buck, batman!

So it’s unfortunate we know so little about how vaccines actually work. Not knowing has spawned a persistent anti-vaccine movement by those who fear, based on little hard evidence, the potential for harm caused by tweaking our immune system.

But not knowing is also causing some problems for the biomedical community.

“I don’t see how we’re going to ever develop effective vaccines against AIDS, TB or malaria without first gaining a lot more insight into how the immune system works – and how vaccines promote immunity,” said Alan Aderem, president of Seattle Biomed, a research organization that has been working on matters of global health since Bill Gates was a teenager. Continue reading

The Dark Heart of Global Health? | 

Guest post by Johanna Crane, a medical anthropologist and assistant professor at the University of Washington and author of “Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science.”

Researchers collecting genetic data from Khomani Bushmen community in southern Africa.
Researchers collecting genetic data from Khomani Bushmen community in southern Africa.

Global poverty isn’t just a tragedy. For the biomedical research community, it’s also an opportunity.

Last week, two of my students approached me wanting advice about how to get experience “doing” global health.  This happens to me all the time.  I teach classes on bioethics, science and society, the history of AIDS, and medicine across cultures.

Many of my students want to become doctors.  Some of them care deeply about global health inequalities, while others are primarily concerned with how to get accepted to medical school. Either way, they’re already figuring out what so many North American universities have figured out in the last decade:

Global health is a hot commodity. That is both good and bad news. Continue reading

Data love: The risk of humanitarians acting like scientists | 

Mad Scientist WikimediaWarning: Reductionism can result in distorted vision, poor judgment and difficulty in operating a humanitarian project.

There’s a popular trend today among many humanitarians, aka the aid and development sector, to try to show the benefit of their projects – be it digging a well, feeding kids or improving access to basic health care – with scientific data.

That’s good in principle, if you have a well-designed study that produces meaningful data. But that can be a big if when what you are trying to test is a reduction in poverty, social and economic improvements, healthy behavior change or many of the other aims of aid and development.

It’s much easier for scientists to test a more isolated intervention, like say taking a pill, than it is to even figure out how best to track and attribute the potential impact of many humanitatian efforts. And it’s worth noting that the scientific community is finally acknowledging that even their most refined efforts in reductionist deduction, peer review and attribution often fail.

NY Times Scientific Pride and Prejudice

Economist Trouble at the Lab

Forbes NIH Promises to Make Science Less Wrong

The mainstream scientific community likes to call this a ‘reproducibility’ problem, saying the overall reliability and self-correcting nature of the scientific method(s) remain intact. But when it is noted, as in the NYTimes op-ed, that a team of scientists could only confirm the findings in six of more than 50 ‘landmark’ cancer studies, there is cause for concern.

Meanwhile, the humanitarian sector has a different problem. It tends to suffer from a lack of data or consensus on how best to measure the impact of various initiatives aimed at fighting poverty, diseases of poverty or other kinds of human inequity. The field did not arise, like science, from a desire to know so much as from a desire to help.

So will it help if humanitarians become more like scientists? Maybe. Maybe not. Continue reading

Visualizing health in the Arab world | 

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

Mohamed Bouazizi
Mohamed Bouazizi

In Tunisia in December 2010, a poor, unemployed college graduate named Mohamed Bouazizi, set himself aflame after the contents of his fruit stand were confiscated by police because he was operating without a license. Bouazizi’s frustration about his inability to earn a living struck a chord with many other young people in the country, prompting mass protests against a government many viewed as guilty of keeping people in poverty.

Thus began the so-called Arab Spring, a revolutionary wave of anti-government protests that spread from Tunisia to neighboring countries such as Egypt, Libya, Syria, and Yemen. Most of the protesters were similarly motivated by frustration with oppressive governments perceived as indifferent to the suffering and inequity experienced by most citizens.

The protests continue, having in many cases exploded into deadly clashes and outright civil war. Many of those in the conflict are unemployed young people like Bouazizi who have taken to the streets – or even taken up arms – to demand a better life. It’s worth noting that 77% of the Arab world is under age 40.

What did the health landscape look like in these countries leading up to the uprisings? To answer this question, we’ll use data from the Global Burden of Disease Study 2010 and a recently-published study on health in the Arab world. Continue reading

Science, vaccines and women’s health suffer deadly setbacks in India | 

Flickr, pugetive

If you think the debate over vaccines in the United States can sometimes be a little wacky, take a look at India.

And if you think irresponsible politicking and journalism can’t kill, think again.

Seattle-based PATH, which in 2009 attempted to test the logistics of expanding the use of HPV (human papilloma virus) vaccine in girls to prevent cervical cancer, has been castigated by critics for ‘unethical human experimentation’ – even though the vaccine is hardly experimental – and is now the target of two lawsuits in India.

One politician, capitalizing on the controversy, even called for PATH to be entirely expelled from India.

Meanwhile, the international biomedical research community, including the U.S. National Institutes of Health, and the pharmaceutical industry have suspended more than a hundred clinical trials throughout India because of the government’s new rules that require those running the trials to compensate any study volunteers who later suffer injury or death – whether the injury or death is directly caused by the study or not.

Vivien Tsu
Vivien Tsu

“This has become very harmful,” said Vivien Tsu, a women’s health expert at PATH who led the HPV study in India. “The HPV controversy and the arguments over clinical trials in India have ended up fueling each other in a way that undermines public health, not to mention India’s role in biomedical research.”

Humanosphere has followed the dispute over the PATH HPV study for a few years now. Many perhaps expected the controversy would subside over time as the evidence accumulated to show it was both beneficial and well-intended. Just the opposite has happened. Continue reading

Scientists say using DDT against malaria could be fueling global obesity | 

Could the fight against malaria be making us fat?

That’s what one scientist who studies an increasingly important, if counterintuitive, branch of genetics thinks.

Spraying DDT in Italy, during World War II
Spraying DDT in Italy, during World War II
Flickr, otisarchives4

The pesticide DDT, though banned for use throughout much of the rich world because of its environmental persistence and potential for harm, is still widely used throughout the developing world to fight malaria. On balance, the World Health Organization thinks the health benefit from reducing malaria outweighs – in these countries anyway – the potential health and environmental safety risks of DDT.

Michael Skinner, a geneticist and founder of the Center for Reproductive Biology at Washington State University, thinks the potential harm of DDT needs to be looked at not just in terms of its immediate impact but across generations.

“The potential transgenerational actions of DDT need to be considered in the risk-benefit analysis of its use,” says Skinner.

You probably know that genes make proteins which do the work in living creatures. And that bad genes make bad proteins, which can cause disease or perhaps make us prone to mix plaids or drink red wine with fish … or some other kind of deleterious outcome. Scientists know this as the central dogma of molecular biology and it implies a simple, linear formula in which our genes operate in one deterministic direction.

But science, if it teaches you anything, teaches that what we don’t know is usually much greater than what we do. Continue reading

Measuring health progress in Afghanistan | 

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

In an Atlantic article last week, Justin Sandefur, a research fellow at the Center for Global Development, wrote about how US foreign aid for health to the government of Afghanistan is currently under threat due to scrutiny from auditors. Read Here’s the Best Thing the U.S. has Done in Afghanistan

Sandefur argues that US funds channeled to the Afghan government have played a major role in driving down child mortality in the country, and that these achievements could be jeopardized if the US cuts this funding as a result of auditors’ concerns.

How much progress has Afghanistan made in improving child health over time? According to estimates from the Global Burden of Disease Study (GBD) 2010, mortality rates in children under five in Afghanistan fell 48% between 1990 and 2010 (download the data here). Life expectancy at birth increased from 51.7 in 1990 to 57.3 in 2010 for females and 52.2 to 58.2 for males (below is the screen grab based on the data).

Chart: Healthy years lost to disability vs. life expectancy in Afghanistan, females, 1990-2010

Afghanistan Life Expectancy1

You can also view life expectancy estimates for Afghan females and males in our online tool and compare the country’s progress to that of other nations. Continue reading