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Of COVID and condoms

OK, it’s been ten thousand years since I’ve posted on The Wisdom site; I apologise for the long silence, which is explained by my being AWOL doing other things. For a while, I went totally off topic, spent a year on tramp steamers, and wrote a book about Indonesia. For the last four or five years, I’ve been back in public health, but haven’t been working much on the sex, drugs and HIV issues which interest readers of this blog. Instead, I’ve been working on fake and substandard medicines, including how they drive antimicrobial resistance. Needless to say, the whole COVID situation creates a paradise for the crooks who make fake medicines, but it’s also going to eat in to the quality of medicines — for cancer, depression, diabetes, and more or less everything else — made by legit manufacturers, too.

Our research team has just started blogging (and, rather more diligently, tweeting) at https://MedsWatch.org and @MedsWatch, so if you’re interested, please follow us there. For now, I’m cross-posting our second ever post, because, well, it’s also “on topic” for Wisdom readers.

Covid and condoms: the MedsWatch view

COVID-19 continues to slash through international supply chains that were previously much lauded for playing to the comparative advantage of different economies, increasing efficiency, and generally laying rich offerings on the altars of shareholder value.

The pandemic has underlined not just the fragility of our supply lines, but their interdependence. So I couldn’t help but smile, as I walked through the aisles of a large chain pharmacy in the suburbs of New York last week, at the juxtaposition of the shelves either side of me.

On my right, despite panicked reports from Malaysia that coronavirus will cause a global shortage of condoms, a dizzying array of rubbers to suit every taste. With the bars empty and even Tinder warning people off meeting in real life demand for condoms, at least in the suburbs of New York, seems to be slowing.

Meanwhile, on my left, directly opposite the shelves groaning with condoms:

Supply chains for baby products are clearly struggling to keep up with demand, even now. That rather begs the question: if there’s no run on condoms and other contraceptives, will it mean that nine months from now, the shelves that should hold nappies will be swept barer still ? It seems likely that the reverse could hold equally true: shelves and pharmacies cleared of contraceptives might reinforce the pressure on wet-wipes and baby powder. Data analysed by The Economist, which offset the birth rate by nine months from the time of a major epidemic, suggest an “N” curve: major epidemics seem to lead to a fall, then a rise, in babies.

The shutdown will probably also have a knock-on effect on demand for treatments for other sexually transmitted infections. My own guess is that COVID will lead to a rapid fall in STIs, followed by a rapid rise, the moment restrictions on movement are lifted. Unless, of course, the shelf on my right very quickly begins to look like the one on my left.

08/04/20, 03:40. Comments Off on Of COVID and condoms

Sex in the sewers: Paris in summer

musee-des-egouts-de--4ba73ffb6550e

Most people spend long summer evenings in Paris strolling arm in arm around the boulevards, sitting in cafes or lolling in parks. I spent this weekend in the sewers. Am I odd in finding drains a sexy subject? Perhaps. But they’re my number one candidate for a Song of Contagion.

I’m lobbying for a diarrhoea story that starts in 1830 and tells the story of poo-related deaths in London and Calcutta. The British and the Indian music will start off at the same volume because back then, diarrhoea was killing roughly the same proportion of the population in those cities. Then in the 1850s the British music gets deafening — that was the Big Stink and the cholera epidemic that followed. This rattles the Victorians into action, and they start to build drains — represented by the introduction of a didgeridoo as a bass-line to the British music (I’m hoping for a dij because it both looks and sounds like a drain…) As a result, diarrhoea deaths in London plummet. While the dij bass-line carries on, the rest of the British music gets quieter and falls silent. The Indian music, on the other hand, never gets a bass-line. Neither the colonial government nor the many subsequent Indian governments have invested sufficiently in basic sanitation, and tens of thousands of children continue to die of diarrhoea in Indian cities to this day.

Whether this story gets selected or not is up to Tony Haynes and his song-writers and musicians in the Grand Union Orchestra. But it is also up to you, and whether you have better ideas about which diseases would best illustrate the different social, political and physical forces that shape our perception of the importance of a specific illness. In our current thinking, the list of parameters which affect our perception of disease fall into four categories. They look like this:
Parameters affecting the percevied importance of diseases

Other candidate diseases to be turned into a great musical stage show include HIV, shellshock-to-post-traumatic-stress, Zika-vs-dengue and rhuematism-vs-erectile-dysfunction. If you’ve got ideas for diseases that would make a good, data-driven song, e-mail us at info@songofcontagion.com. Or if you are in Oxford on June 20th, come to the Wig and Pen between 17.30 and 19.30 to share a pint and your ideas. If you’re in London on Monday July 11th 2016, Elizabeth is offering beer, pizza and a chance to get your disease on stage to anyone who wants to come along for an evening of brain-storm-draining. E-mail info@songofcontagion.com for time and place.

19/06/16, 10:18. Comments Off on Sex in the sewers: Paris in summer

Po-faced presentations don’t change thinking

solar_system

I’ve just emerged from three days buried in a bunker at the Geneva Health Forum, which focuses on health in lower income countries. There was a great cartoonist, but otherwise it was all quite po-faced: power-point presentations, incomprehensible posters and much thanking of sponsors. LOTS of rather earnest, mostly white people suffered from the Public Health Fallacy: the idea that if only they had the (technical) evidence, all governments would do the best thing for their poorest and most neglected. Despite all of the (historical, political, social) evidence (.pdf) that the poorest and most neglected mostly get, well, neglected by those that govern them.

I propose adding this to the evidence base: po-faced conferences with power point presentations to an audience that has seen them all before do not generate new ideas about inequality in health. And I propose trying something different: let’s put the technical evidence up against the historical, political and social evidence in a piece of music, and see what gets drowned out.

Does that sound crazy? Maybe. Will it change the world? Of course not. Will it allow us to think a bit more creatively than another powerpoint presentation in a bunker conference? Probably. Will it be a lot of fun? Certainly!

Come along tomorrow, Saturday April 23, and add your voice to the project, which we’re calling Song of Contagion. (It’s supported by the Wellcome Trust, and most of what they support turns out pretty well.) We’re meeting in Hackney, East London, to begin to decide which diseases to songify, and what, besides the technical evidence, we should be adding to the musical mix. The fact that the Minister of Health’s wife owns a Pharma company, maybe? We didn’t hear THAT at the Geneva Health Forum…

If you’re wondering about the illustration, I was in Geneva to discuss with colleagues how we might turn the asteroid field of public health data sharing into a nice, tidy solar system. Right now, if you played public health data sharing in music, it would sound so cacophonous that many people would just switch it off. To turn it into a symphony, we need to appoint someone to act as conductor, and start investing in more players in the orchestra. But that’s a whole separate post…

22/04/16, 09:30. Comments Off on Po-faced presentations don’t change thinking

World Health Day: healthy for lobbyists

Today is World Health Day. Judging from what’s in the Song of Contagion Twitter stream (@songfocontagion), this is above all an opportunity for a lot of lobbyists and marketing specialists to promote their specific cause. Greenpeace has been quite active, because of course you can always make a health issue out of the environment.

Screen Shot 2016-04-07 at 10.16.06

There’s quite a bit from the Indian government, a lot of it focusing on diabetes (the prevalence of which, we will learn from The Lancet tonight, has more than doubled in India since 1980). But there are also Indian companies trying to convince us that ghee, or clarified butter, is good for us after all.

Screen Shot 2016-04-07 at 10.09.30

We’ve got single-disease NGOs all clamouring for our attention to “their” disease, often with recourse to statistics. This from the Mental Health Foundation for example:

Screen Shot 2016-04-07 at 10.04.29

Finally, you’ve got marketers of fads and gizmos, all capitalising on World Health Day.

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All of this is part of the clamour that leads to really important decisions about what research gets done and which interventions get funded. (Oddly, I’ve seen little today from Big Pharma, who I thought would be all over Twitter — maybe they are promoting their wares through the NGOs and foundations they fund?) If you want to help us make sense of how much influence initiatives such as World Health Day really have, then turn the results into music, please join us on the Song of Contagion project. Details here of our April 23rd launch workshop — which will discuss how priorities are set in global health.

07/04/16, 10:23. Comments Off on World Health Day: healthy for lobbyists

Madness in music

The "raving madness" statue from the gates of the Bedlam mental hospital

Yesterday, during a visit to the thought-provoking Museum of the Mind, on the premises of the Bethlem hospital (still active but now renamed), I was reminded both how far we have come in the treatment of mental illness since the ‘Bedlam madhouse’ was first opened, and how far there is still to go.

At the entrance to the new museum stand the two statues which sat over the gates to the old hospital from 1676 to 1815: “Raving Madness” (pitcures above) and “Melancholy”.
When they were carved, these just about covered the range of diagnoses for mental illness. Many centuries later, we have a far better understanding of all the ways in which the mind can be ‘broken’, as well as the different manifestations of mental illness. Today, for example, is World Autism Awareness Day; although first coined by a Swiss psychiatrist in 1911, the word autism wasn’t used in its current sense until the 1940s, long after the building that houses the latest iteration of the Bethlem Hospital was built.

It made me wonder: how has the divvying up of mental illness into infinitesimally narrow diagnoses affected those who live with it? Have some types of mental illness or their manifestations become more ‘acceptable’ than others? Does that affect how much research we do into them, or how much treatment is available?

These are the sorts of questions we’ll be discussing at Song of Contagion as we try to turn different diseases and illnesses into music. Please come and join us at the launch workshop on April 23rd, 2016, or any time along our musical journey.

03/04/16, 12:53. Comments Off on Madness in music

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