Readers may wonder how this new business-driven aid substantially improves on the old—which to date has eradicated smallpox, exterminated malaria from 18 countries and nearly eradicated polio. To achieve its goals, old-style aid may have sometimes exaggerated the depth of the problems it sought to address. But the new aid, as depicted in “Lifeblood,” seems to exaggerate the value of its interventions.

Having closely followed all efforts malaria, I’m inclined to think her observations are right on the mark.

For the first claim no citation, efficacy or parasite clearance time data, or evidence of any sort are mentioned including who these researchers might be. The (presented) basis for the second claim lies in the screening of just 2,782 persons (it is unclear if this was a mass survey or several months of active case detection) in which only 2 P. falciparum cases were found. I realize this is not a scientific paper, but the ‘screening’ of a few thousand people in a border population of millions before the main malaria transmission season over the upcoming months seems little to be excited about. What was the need for this? The project just began in 2009. Why not wait another two years before making any public pronouncements? Alternatively, only provide regular updates through a somber and detailed format such as an annual project summary.

I believe in WHO. First, WHO has an unique mandate for supranational coordination. Second, WHO operates by consensus which, while time-consuming and difficult at times, allows countries large and small to have a voice at the table. And finally (related to the previous point), they maintain the trust of ministries of health in a way no other organization does – at least for now… They are losing their reputation by continuing to release shoddy statements backed by limited or poor quality data.

I’ve already complained about science and public health by press release. I understand it though from NGOs but I do not understand this trend from an organization which prides itself as a leader in developing quality health recommendations and soliciting technical excellence.

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On one hand issuing press releases rapidly disseminates findings, generates interest, and helps reach new audiences. Every institution, whether a university, NGO, or even a multilateral, has to maintain a supportive constituency and most will seek to ever expand this base. The pressure to leverage every piece of potential news is therefore great.

On the other hand many press releases are about early stage findings which may not matter. Everyday I see new articles about malaria drug targets or bed net distribution which are heralded as ‘breakthroughs’ in the effort to cure or control malaria. They may be right but we won’t know for many years. It seems that  the deluge of press releases, which often in their original form or in their retelling misstate the research, unduly raise expectations. It also raises overall noise level of information vying for our attention – making it harder to find and focus on the news which really matters. In the end, too much public relations spin risks credibility.

Effect Measure, a terrific public health blog, wrote the following three years back:

Science is a slow business, unfortunately and we will need time. So I don’t understand why NIH has to issue a press release about it. It’s not exactly breaking news that will make an immediate difference if it makes a difference at all. I understand why various biotech companies pull this kind of PR stunt. They are trying to raise venture capital and reassure stockholders. But why does NIH need to do this?

Recently, I browsed through a malaria journal article (open access!) whose potential I have difficulty understanding. Can someone explain to me how research on variation in chromosomal inversions and their relationship with stress responses will improve malaria control? Looking carefully through the manuscript, the sole rationale that I could find was:

Polymorphism for the 2La inversion creates heterogeneity in the stress response within A.gambiae, which could directly or indirectly reduce the efficacy of vector control measures, and influence the reaction of vector populations to environmental variation including climate change.

I find this single sentence advanced by the authors both incomplete and unsatisfying. It tells you very little. So let’s think through the rationale ourselves. Understanding the ability of a vector to exploit different habitats is certainly useful – we could predict how mosquito ranges and other characteristics may change with the climate. Understanding the molecular basis of that ability might further help – if the molecular changes had a clear association with a phenotype of interest (i.e. real world characteristics of the mosquito) and were such that they could easily be monitored. Understanding polymorphisms in those molecular mechanisms and their relationship to stress response variation however is not intuitively valuable (perhaps for modelling purposes?). To be clear, my aim is not cast the research as meaningless (though it may be). Sometimes the impact of basic science take years or decades to be realized. Rather, I’m surprised the authors, and especially the reviewers, did not seek to clearly convey the value of the work. If the purpose of public health research is to improve health, then the communication of such research should describe its relevance in explicit and detailed language.

• MalERA – The malaria eradication research agenda – it’s arranged according to programmatic areas with all relevant documents made available, lists upcoming events, and has a forum to provide feedback! Well thought, transparent and progressive, I’m impressed.
• Every day is Malaria Day – a gem of an article. With a brilliant tongue-in-cheek first paragraph lamenting single disease and the stifling positivity of today’s adovacy, Paul goes on to guard against magic bullets, creating false hopes, and the consequences of failure.
• Gates, Lancet, priority setting in global health – a random hodgepodge of topics but noteworthy for not only mentioning that Ranbaxy plans to move forward with an antimalarial trial (which many news sources carried) but pointing out that Medicines for Malaria Ventures pulled out of that project after previous trial results.
• Sharing experiences in vivax control – a) it is news on vivax b) I simply did not see this conference covered anywhere else
• China and malaria elimination in the Solomons – a fascinating story about an scaled up malaria control effort and the controversy it has generated. The tone of the discussion (in the original news source, not the Tropika article) is disturbing and I hope to write more about this soon.

Note: Posts have been sparse but this will likely continue with USMLE exams and work in India coming up

True, but so could swatting enough mosquitoes with your hands. The existence of an intervention does not mean its viable. Media communication of science research or public health news (previously discussed here) is consistently poor. To be fair, the environmental control of malaria can be an appropriate tool.  Historically, Brazil, Italy, Panama and a few other countries have used it with good success. Why did it work there? First, reducing mosquito density will have little effect on transmission in highly endemic areas, but these countries had the right ecotype. Second, environmental control is labor intensive and requires strong management, both of which were provided through military-style campaigns.

Here are my favorites:

1. NY Times article on the clash of science egos over rival malaria vaccines
2. Comments on GSK credit for the advancement of a malaria vaccine
3. The malaria vaccine and Dr Ruth Nussenzweig of New York University
4. FDA priority review “prize” vouchers and the RTS,S vaccine
5. Interview with Dr Francois Nosten of the Thai-Burma border Shoklo malaria unit