This Week:

Quote of the Week

Off the Front Page: 4 Million Newborns (and Mothers) Dying Needlessly

Bird Flu, Regular Flu, and Empty Tool Boxes

Greetings,

My apologies for the long lag time between the last issue of Nygaard Notes and this one.  Spring is a very busy time over here at Nygaard Notes, and I also went up to northwestern Minnesota last week to look at birds.  (Boy, did we see a lot of birds!  Write to me if you want to hear more about birds...)  Anyhow, I hope to have the next issue out by the end of this week, for what it's worth.

This week's issue is Part 1 of a look at how philosophy and ideology shape public policy.  It may seem obvious that the ideas that people have shape how they think a society should function, but I don't think it really is that obvious, at least not to progressive people.  If it were obvious, then I think we would spend as much time promoting a progressive philosophy and ideology as the so-called "right wing" does in promoting theirs.  But we don't, do we?

I think the reason may have something to do with a failure to understand the importance of knowing what philosophy and ideology actually ARE, and how, exactly, they connect to tangible policies and programs that affect our lives.  If I'm right, then this series--which may be two parts, or three, or maybe four--will be very useful as people try to understand why so many people (73 percent according to the latest Associated Press poll) now think that "things in this country are off on  the wrong track."  Hopefully, it will help people see how important it is to think strategically about a vision for the future, and stop complaining so much about the way things are now.

Even if none of that happens, I think it's pretty interesting to try to figure out the thinking behind some of these wacky, crazy, and zany ideas that people keep coming up with to address these very real problems we have.  So, for the next couple of issues I'll take a look at this stuff.  It should be fun.

Also, welcome to the new subscribers to Nygaard Notes!  I really enjoy feedback and comments on the things you read here (and not just from new readers, either!).  So, send in your letters and emails.  I read and respond to them all.  It's a great way to support the project.

Until next time,

Nygaard

"Quote" of the Week:

A paired set of "Quotes" this week, with the second one explaining the first...

#1:  On April 12, USA TODAY interviewed Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, about bird flu.  They asked him, "Is part of the reason so few companies are in the vaccine business because of the economic uncertainty?"  And he said:

"The vaccine industry is a tenuous enterprise because the incentive for companies who have a lot of money to invest in research and development and production is very low when you're dealing with a product that is not used every day and which the American culture views almost as an entitlement.  Americans are willing to pay $3,600 a year for Lipitor and $2,700 a year for Viagra, yet they become very concerned when they're asked to pay any more than $20 for a one-time vaccine.  This does not escape the companies' perception.  Then add all of the other disincentives.  So companies don't want to get involved a) in vaccine or b) in influenza vaccine."

#2:  That was a little verbose, so here is a much shorter quotation, this one from the Seattle Post-Intelligencer of March 23, 2001, in an article discussing the reasons why "Vaccines Are Often Low on Industry's Agenda:"

"Vaccines need to be cheap.  Industry needs to make money."

Off the Front Page: 4 Million Newborns (and Mothers) Dying Needlessly

On May 8th the global service organization Save The Children released its State of the World's Mothers 2006 report.  I couldn't find any newspapers that placed it on the front page, despite some important findings.  The page 8 story in the New York Times (All The News That's Fit To Print!) of May 9th chose to highlight the fact that "More than four million newborns worldwide die each year in their first month of life" despite the fact that "Many of those infants could be saved with simple, inexpensive items, like sterile blades to cut the umbilical cord, antibiotics for pneumonia and knit caps to keep them warm..."  That seems like front-page news to me.

Neither the Times nor any other paper I could find bothered to point out that the "international community" could provide "a recommended package of low-cost, low-tech newborn and maternal health interventions" in the world's poorest countries at a cost of $4.1 billion per year, on top of current spending of $2 billion.  This relatively paltry sum could save up to 70 percent of those needlessly-lost lives, about 2.8 million souls every year.

Also not in the news reports in this country were some of the telling, and shameful, details about the performance of the World's Only Superpower in terms of maternal and child survival.  For example, the Report points out that the United States "is tied for second-to-last place" in infant mortality among industrial countries with Hungary, Malta, Poland and Slovakia.  We're better than Latvia, though!

Despite the fact that the Report is called "The State of the World's Mothers," the Times (and others) chose to focus on the deaths of newborns.  That's an important part of the Report, but that focus led to a failure to mention that "60 million women give birth at home with no skilled care" and "more than 500,000 women die from complications of pregnancy and childbirth" every year.

The Report notes that the U.S. is worse than "Canada, Australia and all the Western and Northern European countries" in terms of maternal mortality.  The Report then pointedly notes that "The United States is also lagging behind [other industrial countries] with regard to the political status of women.  Only 15 percent of seats in the national government in the U.S. are held by women, compared to 45 percent in Sweden and 37 percent in Denmark and Finland."  Hmmm... High maternal death rate, low political status for women.  Coincidence?

There's lots more in this Report that never made it onto the front pages or--in my city--any pages.  See the 58-page document for yourself at http://www.savethechildren.org/publications/SOWM_2006_final.pdf .

Bird Flu, Regular Flu, and Empty Tool Boxes

In the last issue of Nygaard Notes, I quoted the State of the News Media 2006 report talking about the many media people who "worry that the publicly traded corporation may not be positioned to address the problems of journalism to the satisfaction of society."  It's not just journalism we should be worried about, believe me!  This week I want to talk about what the publicly traded corporation has to do with health care.  The subject of bird flu seems like a good place to start.

Bird flu is one example of what are known among public health workers as "vaccine-preventable" diseases.  That is, diseases that don't need to happen, if only people would--and could--get vaccinated.

The media has been filled with reports in recent months about the possibility--some say the likelihood--that there will be a global pandemic of bird flu in the not-too-distant future.  The World Health Organization estimates that such a pandemic could kill more than 7 million people worldwide.  Despite the fact that "Vaccination is one of the most effective ways to minimize suffering and death from influenza" (official U.S. government statement), the media has also been filled with reports on the severe shortage of the vaccines that could be used to protect people in the case of a pandemic.

(Before we go any further, I should add that there is a significant dissident position which claims that vaccinations are not at all effective, and in fact are dangerous and misguided.  The number of adherents to this position seems to be limited, but that doesn't mean they are wrong.  There is, after all, every reason to be skeptical about the claims of the pharmaceutical industry in this area, based upon the industry's unethical and dishonest conduct in other areas.  But, for the purposes of this essay, we'll go with the conventional wisdom that says that vaccines are effective.  In any case, the shortages of vaccines that are the focus of this essay are not the result of a principled stance in which the industry refuses to produce unsafe or unproven products.  Principle has nothing to do with it, as I hope will soon be clear.)

Back in November the Milwaukee Journal Sentinel ran a three-part series on the predicted bird flu  pandemic that began with these words: "If a deadly bird flu hits the United States, health officials will have two lines of defense against a catastrophe that could kill nearly 2 million Americans: vaccines and anti-viral drugs.  Despite years of warnings, the country is woefully ill-prepared to use either weapon.  An approved vaccine does not exist, and mass-producing any experimental vaccines could take years."

While bird flu gets the headlines, readers may not know that every year 36,000 United Statesians die from the regular old flu (that is, not avian flu). And 200,000 people every year are hospitalized with the regular old flu.  Yet, in recent years, the supply of regular old flu vaccines has been insufficient.  The U.S. Centers for Disease Control tells us that "During the 2000-01 influenza season, vaccine shortage or unavailability was noted for the first time as an important reason for nonvaccination."  Vaccine shortages have been reported in every year since.

Vaccines "Falling Out of Fashion"

The Milwaukee newspaper article I mentioned above quoted Shelley Hearne, executive director of the non-profit Trust for America's Health, who says that, although "vaccines have been one of the greatest weapons against disease and a public health success story ... making them has fallen out of fashion."  Journal Sentinel reporters John Fauber and Susanne Rust point out that "the U.S. vaccine industry is a shell of its former self, a low-profit operation that uses 1950s technology.  As recently as the 1970s, there were 27 vaccine makers in the United States," they tell us, but "today, there are only two vaccine plants in the U.S., and one is owned by a French company."
The reason?  "It's more lucrative to make Viagra than to make vaccines."

The point of that Viagra comment was explained neatly in an article in the Seattle Post-Intelligencer from March 23, 2001.  The article explained that the Bill Gates-funded Global Alliance for Vaccines and Immunization is "aimed at correcting the distortion the marketplace has had on global public health spending priorities."  And the nature of that "distortion" is this: "Vaccines, unlike many drugs, are seldom big moneymakers for industry.  There's a lot more profit in treating disease than in preventing it."  The old saying that "An ounce of prevention is worth a pound of cure" may be true for sick people, but the opposite is the case for the corporations that are, in the U.S. health care "system," largely responsible for the well-being of those people.

Poor-People's Diseases

A possible bird flu pandemic, if it happens at all, is still in the future.  However, in the present, more than two million people die needlessly every year around the world due to a chronic shortage of vaccines for a variety of so-called "poor-people's diseases" that are already rampant, such as malaria, sleeping sickness, Chagas disease, leishmaniasis, and a bunch of other "vaccine-preventable" diseases.  (See Nygaard Notes #220, "Orphaned by Industry," for more on this particular "distortion" of global health priorities.)  And the reason for the shortage of these vaccines, as spelled out by Andrew T. Pavia of the Infectious Diseases Society of America (IDSA), sounds familiar: "The infectious diseases market is simply not as attractive to manufacturers as is the market for chronic diseases, like diabetes or high cholesterol, where patients take a drug for life."  He calls them "patients," but a more accurate term might be "customers."

A past president of IDSA, Walter E. Stamm, points out that "Vaccines and antibiotics have been among our chief tools for preventing and treating infectious diseases.  How can we, as infectious disease physicians, tell our patients that our tool box is empty?  Market forces alone are not going to solve this problem.  We need innovative federal policy to protect public health."

The empty "tool box" to which Mr. Stamm refers is the box that should contain easily-manufactured vaccines that could save millions of lives.  Unfortunately, the best IDSA and others feel they can do is to ask, as they do in their "Policy Rx for Influenza Vaccine Shortage," for "new incentives--such as tax credits, strengthened intellectual property rights, liability protections, or some type of federally guaranteed purchase program--to make the infectious diseases market more attractive to industry."  Hmmm....  "Attractive to industry," eh?

It may not be obvious to readers the degree to which the ideology of the so-called "right wing"--the people I refer to as "IC" for "Individualist and Competitive"--has limited our options for coming up with truly "innovative federal policy."  When an ideology becomes as dominant as the IC ideology has become in this country, one of the effects is to severely limit the imagination of even the best-intentioned people.  In the next issue of Nygaard Notes I'll take a shot at explaining how this works, in an article that might be called "How Ideology Affects Policy: Vaccines, Incentives, and Human Nature."  Stay tuned.