June 2005 Archives

In the summer of 2003, at yet another symposium dedicated to struggling with the reality of the tenacious poverty and diseases of the millennia, the Bellagio Study Group on Child Survival estimated that each year, 6 million children in 42 countries where 90% of child deaths occurred in 2000 could be saved; if only 23 proven health interventions for common ailments and diseases were deployed.

But this month, as pleas for more aid echo throughout the world, the UN reports that the basic development goals are still not being met:

"Slow economic growth, poor trade performance, continuing environmental degradation, debilitating HIV/AIDS pandemic, discouraging foreign direct investment and unmet ODA (overseas development assistance) commitments, compounded by a host of new challenges in a globalizing world make the development tasks of these countries extremely difficult," UN Under-Secretary-General Anwarul K. Chowdhury told a symposium on the global development agenda at UN Headquarters [June 1, 2005].

But while at the UN and conferences like Bellagio see the feasibility of improving childhood morbidity and mortality, not everyone's so sure. "Can the world afford to save the lives of 6 million children each year?", the medical journal Lancet (subscription) asks in a follow-up to the Bellagio study in their June 25th issue. And what's the cost to developed countries?

"US$5.1 billion in new resources is needed annually to save [the] 6 million child lives in the 42 countries [of the Bellagio Report]. This cost represents $1.23 per head in these countries, or an average cost per child life saved of $887. Sensitivity analyses for salary levels for community delivery agents, drug costs, and coverage rates for 2000 were used to develop uncertainty estimates around the US$5.1 billion annual price tag that range from about $3.1 billion to $8.0 billion."

$887 cost per child life saved. The article assesses the Millenium Development Goals (MDG) of (among other things) reducing child mortality by two-thirds by 2015, and determines that "child survival is affordable for donors and developing countries". The hurdles will be the "lack of funds" and "scaling up health delivery".

In related news, The Ellison Medical Foundation has been announcing that they will give $100 million dollars to Harvard University to start a global monitoring research center, which will independently measure global health expenditures, delivery of services, and the impact on population health.

The Ellison Foundation was dedicated to aging and global infectious diseases however they have dropped the global infectious diseases focus to target areas that are 'less well-funded'. [Headline philanthropy may be even more competitive than the software industry].

There have always been debates about aid for development and disagreements about the ideal aid mechanism. For now, aid and global health initiatives are routinely justified via different sorts of cost-benefit analyses. Unfortunately the models, though necessary, are sometimes necessarily limited -- a vaccinated child does not only save himself, for instance, but the costs of care for those he may infect if unvaccinated.

Even more ponderous then methodological questions are the ethical considerations of this type of economics. For example, within the apparently burgeoning cost-benefit analysis industry, how are the cut offs discerned? At what point is a certain life, to some, just not worth donating to? Perhaps it's not the $887 determined by the Lancet study, but something more - $889? - or less? - Despite proclamations about a culture of life? Or will we be consoled by ever more precisely balancing the cost of others lives- in order to ever so quietly bear with poverty and death on other continents? Do the goals behind the millions that will be spent for cost benefit analyses dare to propose to change anything?

In a recent article; "Brain Chips and Other Dreams of the Cyber-Evangelists", John Horgan dispatches a scathing critique of recent books that take up the topic of enhancement of human capabilities via technology. The article was published in the June 3, 2005 issue of The Chronicle of Higher Education, a weekly publication that can be found lying around campus offices, or read on-line with a subscription.

He takes authors and texts to task, among them Digital People From Bionic Humans to Androids by Sidney Perkowitz, and Flesh and Machines: How Robots Will Change Us", by Rodney A. Brooks. He finds the whole genre entertaining but irrelevant - fiction, he argues. He cites evidence from the book Rebuilt: How Becoming Part Computer Made Me More Human, by Michael Chorost that describes the limitations prosthetic research.

Horgan also comments on "brain chips", the technology and ethics discussed in Citizen Cyborg: Why Democratic Societies Must Respond to the Redesigned Human of the Future", by James Hughes. Hughes suggests that the brain chips (that would store actionable information for the brain) could be provided to all and monitored for moral decency by a benign global government. Says Horgan:

"[Hughes] proposes equipping dolphins and monkeys with brain chips so that we can communicate with them. You would think someone who entertains such notions would be a fun guy...But Citizen Cyborg has the deadly earnestness of an Al Gore white paper on toxic waste. Hughes wants us to take this cyborg stuff very, very seriously."

Of I, Cyborg, by Kevin Warwick, he says: "a masterpiece of naive, unwittingly comic narration", by a "flamboyant" and relentlessly self-aggrandizing- authorial persona"...who has "transformed himself into a kind of neurobionic performance artist".

"Warwick recounts how in 2002 he persuaded a surgeon to implant a chip in his forearm and another chip in the forearm of his hapless wife, Irena...who 'remained brave', 'shrieking on a couple of occasions when it was particularly painful.'"

"After the implantations, when Warwick made a fist, his chip picked up the minute electrical surge in his arm and sent a signal to his wife's chip, which buzzed her. She then flexed her hand, and he felt 'a beautiful, sweet, deliciously sexy charge..'"

"Warwick...calls his stunt, 'the most incredible scientific project imaginable, one that is sure to change, incalculably, humankind and the future'"

Horgan scoffs; "[T]he Warwicks could have achieved an equivalent intimacy with vibrating cellphones: the fact that the chips were embedded in their bodies made no functional difference.." He concludes that Warwick is either, in the words of another scientist, "a buffoon" or a "charlatan". He illustrates a point. "Warwick does seem to have a knack for mixing tales of draconian torture with banal Harlequin romance dialogue with the egomanical rambles of a principle investigator, a delivery style that does little to inspire confidence in his vision for science."

Horgan also doubts the concepts of "singularity", discussed by Ray Kurzweil (and many others) in a couple of books. Moreover he pans the solution offered in Kurzweil's most recent book; Fantastic Voyage: Live Long Enough to Live Forever". Not without reason. Could one really eat organic veggies and drink alkaline water long enough to extend ones life to experience "the singularity"- where ones neuronal code could be uploaded into a computer to allow one to live forever? Quite probably a preposterous proposition.

Horgan charges that such futuristic predictions fail to take into account the actual progress and limitations of scientific research. The authors take irrational leaps of faith about technology [not to mention politics and government] in order to construct their bionic worlds. Horgan correctly points out that in the past couple of decades research has made relatively small steps towards neural prostheses and artificial intelligence. Cochlear implants have made great advances, but as Chorost points out in Rebuilt, they still offer a rudimentary solution to hearing loss. Retinal implants allow patients to sense no more than random flashes of light.

Horgan is a science writer, a former editor of Scientific American and author of several books. In one of his previous books; "The End of Science" (1996) (some of the concepts are updated and reiterated here), he suggests that the major questions of science have been answered. Accordingly, there won't be any more major revolutions in scientific theory, he says, like discoveries in the realm of DNA comprising the coding blocks of life, Darwin's natural selection, or quantum mechanics.

His book drew hearty, biting criticism from various scientists as well as his fellow science authors/philosophers. Apparently at ease inciting controversy, he glibly reciprocated the heated points of his would be detractors. Interestingly, almost ten years later, in the light of notable scientific achievement, it appears that "Brain Chips and Other Dreams of the Cyber-Evangelists", reflects the same sentiments about the limited future of scientific research. Do Horgan's criticisms of these authors may be bounded by his insistence on limited scientific progress. His prognosis then, is predictable:

"[N]ow and for the foreseeable future, cyber-evangelism is best understood as an escapist, quasi-religious fantasy, which reflects an oddly dated, Jetxons-esque faith in scientific progress and it potential to cure all that ails us."

"Not only is each person's code [sic] probably idiosyncratic, the product of his or her unique biology, but our individual codes may also constantly evolve in response to new experiences. For all those reasons, some neuroscientists suspect that uploading, downloading, telepathic conversations, and other scenarios that involve precise reading and manipulation of thoughts may never be possible - no matter how far brain-chip technology advances."

His points are valid, but seem to draw from rigid thinking employed to assess an obviously changing physical world. This is ironic because he strongly reasons that it is the changing world of neurobiology that nimbly morphs, forever defying a scientific understanding that could lead to the actualization of some of the more edgy ideas posed by the authors. Horgan's blind spot may be that he refuses to imagine a world where the framework is vastly different from the current one, so in the end, the "end of science" suits only his "lack of imagination".

Man's history is miniscule relative to that of the universe and to many other organisms. So the idea that humans are capable of evolving indefinitely as suggested by cyborg theories is clearly debatable. But his is an imperfect lens. Many imaginative ideas are not scientifically tenable, but all discovery is fueled by a sense of possibility and imagination by those who dare to challenge current paradigms.

Avian Bird Flu has broken out again in China, this time in the Qinghai and Xinjiang provinces, killing migratory birds, ducks and geese. The continued outbreaks are worrisome because of the large numbers of domestic birds in China and because of the potential for the disease to spread via the migration of the birds. The strain of avian flu that has proven lethal across Asia has been traced to the same strain that was isolated in a goose in China in 1996.

The World Health Organization (WHO) has reported 107 incidences of the disease and 54 deaths in humans throughout Asia, and though China has not yet reported any human cases, other animals in China such as pigs have been affected. Furthermore it seems as though the virus is affecting birds that were once resistance to the disease, suggesting that the virus may be mutating to a more resistant and lethal form.

The WHO is now concerned about reports that Chinese farmers are using the the antiviral Amantadine prophalactically for their chickens, putting it in feed and mixing it with herbs and other drugs as if it were a vaccine. This class of antiviral drug is prescribed by doctors to combat influenza (including avian strains) in humans and is not recommended for use as a vaccine, as it is not cost effective and widespread use promotes drug resistance. However the Washington Post reported that the government has been advancing use of the antiviral for chickens over many years:

"The Chinese Agriculture Ministry approved the production and sale of the drug for use in chickens, according to officials from the Chinese pharmaceutical industry and the government, although such use is barred in the United States and many other countries."

According to the Washington Post:

"A popular Chinese handbook, titled Medicine Pamphlet for Animals and Poultry, provides farmers and livestock officials with specific prescriptions for amantadine use to treat chickens and ferrets with respiratory viruses. The manual, written by a professor at the People's Liberation Army Agriculture and Husbandry University and issued by a military-owned publishing company, prescribes 0.025 grams of amantadine for each kilogram of chicken body weight."

However the China's Ministry of Agriculture said in a press release that International Herald Tribune such reports were "totally groundless and counter to the facts."

Acquired resistance by microbes is often associated with bacteria and antibiotics, but the widespread use of this antiviral is problematic and suspected to have contributed to its current lack of potency against the virus in humans. The Washington Post reported that in 1987 the U.S. Department of Agriculture laboratory conducted experiments showing that when chickens were given Amantadine "bird flu viruses developed drug resistance within a matter of days". As increased resistance of the virus to this antiviral renders the treatment inaffective the threat of avian flu virus outbreaks or epidemics lingers.

Two recent articles; "Hacker Hunters", a recent front page Business Week article, and "Black Market in Stolen Credit Card Data Thrives on Internet", a New York Times article published today, focus on internet trafficking of stolen credit card data. Vivid descriptions of the fast paced lucrative on-line market for stolen credit card data vie for consumers fear. The articles detail some of the data collection tactics of burgeoning networks of multi-national credit thieves. On-line transactions of the moonlighting crooks are revealed - a shadowy international network deals in stolen data using the internet for transactions that are often tracked to servers hosted in places like Russia, where criminals evade authorities easily.

The Business Week article recounts the previous efforts of "Operation Firewall", an elaborate sleuthing collaboration by the Secret Service and Justice Department that successfully uncovered the inner workings and leaders of a New Jersey based credit theft ring last fall and led to the arrest of 28 suspects and provided enough evidence to arrest many more.

The tone of both articles is foreboding; gangs of sophisticated technologists. Slick. Elusive. Evil. The authors warn that although "Operation Firewall" was a success, future Firewall-like operations are less likely to succeed because the thieves are growing ever more sophisticated and daring. Meanwhile, cybersecurity forces are underfunded and undermined by weak institutional support in foreign countries. The articles spin a riveting account of the "hacker hunters" as they struggle to out-wit the ever audacious technical prowess of the thieves. The internet plays an ominous role by amplifying the cunning of the perpetrators. It is a feckless, fenceless Wild-West of lawlessness. With its dangerous anonymity, the internet provides the masks that the men will don before galloping down from the hills of Russia, or China, or Bulgaria, swooping in on the gentle townsfolk and destroying the very fabric of our oh-so-civilized civilization, ruthlessly compromising our commerce and banking systems.

"Hacker hunters" are using sophisticated technology but resort to traditional anti-crime methods in this battle:

"..they're marshaling their forces and using gumshoe tactics to fight back -- infiltrating hacker groups, monitoring their chatter on underground networks, and when they can, busting the baddies [sic] before they do any more damage."

The cloak and dagger accounts can divert attention from the issue of how so much of the data in the recent compromises has entered the illegal market. Here are some recent data losses:

• CitiFinancial's 3.9 million customer records were lost off the back of the truck on the way to a data processing center in Allen, Texas.
• Choicepoint "accidentally sold" data on 145,000 consumers to thieves.
• Wachovia Bank's and Bank of America's customer financial records were stolen by bank employees and sold.
• Ameritrade Holding Corporation lost a backup computer tape with 200,000 customers data.
• Time Warner Inc. said Social Security numbers and other employee data were lost off a truck on the way to Iron Mountain Inc., a data storage company.
• University of California applicant data, unencrypted, was lost when a laptop was stolen from an unlocked room on campus.
• Lexis-Nexis reported that someone had gained access to personal information...somehow...the data had - "fallen into the hands of thieves."
• A recent heist of 4 million records from a CardSystems Solutions occured because credit card numbers, identifiers, and security codes were not only left in a database, they were unencrypted; infractions of data storage protocols.

In each of these cases, the losses occurred because of cavalier and reckless behavior on the part of individuals, companies or organizations that were entrusted with personal data. Human error was responsible, not high tech shenanigans. In some cases, the public was assured that the "employee was fired", in other cases the employees were kept on because there were no rules to enforce data safety. If an organization can't be trusted to purge data, or to encrypt data as required, or to keep it on a truck as it travels about town, can we possibly be assuaged by incredible assurances that the data will still 'probably be safe' when its compromised ?

While our system of numeric identifiers and pin numbers has perhaps outlived it's usefulness, until a better system is operable, people and companies who process and "safekeep" data need to be held accountable to some standards. If data didn't fall off trucks, gumshoes wouldn't be so critical.

Anyone who's traveled to Nepal or Africa has probably been amazed at the loads that porters and villagers carry on their heads. Not only is the balance precarious, but I cringe at the loads carried with ease and grace on the head neck and spine. But it's not as hard as it looks. Really! Researchers studying the biomechanics of locomotion under load bearing find that people who routinely carry very heavy loads do so more efficiently by supporting the weight on their the head. In fact, only in the Europe and the U.S. do people predominantly carry the weight on their back.

A recent report studied women in Africa, and found that they can carry 20% of their body weight without increasing metabolic output, and up to 70% of their body weight while expending far less energy than Western European or Americans, for instance military personnel, would use to carry the same load on their back.

How? The researchers studying the African women found that they adjust their gait to accommodate the increased load without commensurate energy expenditure. Norman Heglund et al., explains the energetics of gait:

"When a person (or animal) walks, their body goes up and down, and goes faster and slower, within each step. The energy changes associated with these fluctuations in height and speed are out of phase and therefore tend to cancel each other, minimizing the energy required to keep the movements going, much like in a pendulum. But in walking the energy fluctuations are not completely cancelled (as would occur in a perfect pendulum); at most about 65% of the energy fluctuations are cancelled, leaving at least 35% of the energy fluctuations which must be supported by the muscles each step, requiring metabolic energy input."

As the loads increased, the African women in the study managed to cancel more of the energy fluctuations, therefore requiring relatively less muscular energy for each step with the heavier load, then would have been predicted if there was a linear relationship between increased load and effort to carry the load.

The same research group recently studied porters in Nepal, and found that these porters are even more biomechanically efficient then the African women. Scientists conducted the study by hanging out on the outskirts of Namche Bazaar, the small town which sits at about 3500 meters (~11,500) feet in Nepal, known as the gateway to Mount Everest.

The researchers counted 545 male and 97 female porters who trekked by them during the daylight hours one day before the weekly bazaar. The researchers averaged the distances the porters had walked and estimated that each porter had traveled on average 9 days to reach the market, over 100 horizontal kilometers (~62 miles), had ascended about 8000m (~26,250 feet) and descended about 6300m (~20,669 feet) en route. The authors estimate that more than 30 tons of products were carried by porters to the market that day.

Eight participants were randomly chosen to be in the study. These porters walked around a track carrying various loads at different speeds. The researchers measured the amount of energy they used by calculating the differential between oxygen intake and CO2 output.

They found that the Nepalese porters aged 11 to 67 can carry loads of up to 187% of their weight - 20% carried loads more then 125% of their body weight. For heavier loads, their metabolic efficiency increased, but at the "optimal" load weight they used less energy then either western backpackers or the African women. Which explains in part the guy able to carry tanks of fuel over the 18,000 foot pass.

Part of the efficiency in carrying these extreme weights over difficult terrain (11,000-18,000 feet) -- in bare feet -- is explained by the gait energetics. However the particular gait that the African women use, theorized to economize energy use is absent with the Nepalese porters, so part of the efficiency has yet to be explained. Perhaps it comes from cardiovascular strength, training, the mechanics of load placement during locomotion - or patience. With very very heavy loads porters walk very slowly and rest frequently.

The Food and Drug Administration (FDA) has tentatively approved the generic versions of Lamivudine manufactured by Aurobindo Pharma Ltd. of Hyderabad, India and Ranbaxy of India. The generics are a version of Epivir manufactured by Glaxo Smith Kline. These approvals will allow the drugs to be used in developing countries as part of the United States AIDS initiatives which provide fast-track approval process opportunities for promising AIDS drugs. This drug is used in combination with other antiretrovirals.

Health Partners Research Foundation published a study on ethical research conduct with the University of Minnesota in this months journal Nature (subscription) (435, p737). The researchers surveyed 3,247 scientists who received support from National Institute of Health (NIH) grants. Gross scientific conduct is considered plagiarism, fabrication or falsification of results. The studied confirmed previous data that showed that this type of misconduct is infrequent, however the study found that there are other behaviors that are considered 'less problematic' that nevertheless seriously compromise the integrity of science:

"Thirty-three percent of our survey respondents admit[ted] to one or more of the top-10 behaviors. [T]he scientific community can no longer remain complacent about such behaviors..."

The "top ten behaviors" included changing data, failing to present oposing data, and unethical use of ones own data. Other behaviors in the 'top 16' included inappropriate research design and inappropriate assignment of authorship as well as inadequate record keeping. 27% of study respondants said they kept inadequate research records.

The study has been criticized by several scientists for asking questions where the responses were difficult to interpret, for instance the San Francisco Chronicle quoted David Magnus, director of the Center for Biomedical Ethics at Stanford who was critical of two questions, as were other scientists.

His point is well taken. Since the respondants were limited to "yes" or "no", its hard to evaluate certain answers. For instance about fifteen percent of the total cohort (about half of those surveyed returned usable surveys) said they had changed "the design methodology, or results of a study in response to pressure from a funding source." But what exactly does this mean? Science research is a collaborative process. Since research is peer reviewed, it is rare that a study is published without revision since often additional experiments are required to further test or validate a result. Editors and peer researchers review studies according to variable critera, but the process is generally rigorous. As well, grants come under tremendous scrutiny before approval. Again, this *can be* political, however the intense competition makes well thought out grant writing essential. Sometimes grants need to be scaled back to accomodate funding restrictions, or sometimes researchers will decide to come at a problem slightly differently due to feedback or if they get a particular preliminary result. However this is part of the process. It shouldn't be looked at askance.

On the other hand, all the behaviors in the survey potentially skew the presentation and interpretation of research, so while scientists may understandably defend their discipline, the results are problematic. One interesting trend in addition to the fact that 33% of the scientists admitted to at least one of the behaviors is that there wer significant differences between the younger and older cohorts, in the number of scientists who admitted to each behavior. 38% of the mid-career scientists admitted at least one of the behaviors, compared to 28% of the early career scientists.

Africa's AIDS Campaigns - Time for Optimism?

It's hard to be optimistic about the subject of HIV/AIDS. India, Russia and China, are in various stages of epidemics and denial. Caribbean and Africa populations and economies are devastated by the disease. Statistics on South Africa's AIDS epidemic show that by 2003, 5,300,000 people were living with HIV/AIDS and 1,100,000 children were orphaned as a result of the disease. The statistics, however, are too low. 370,000 AIDS deaths were predicted for 2003, but the actual registered deaths turned out to be 456.7 thousand. Although statistics show that 21.5% adults (15-49) in South Africa are infected with the HIV virus, in some regions and among child-bearing women the rate is as high as 37%.

Most people acknowledge the news as depressing. However David Brooks, columnist for the New York Times is more optimistic. Brooks recently traveled through Africa, toured hospitals and sent his observations from Windhoek, Namibia. Brooks was cheered, he wrote in his editorial, to "run across health care workers", or "run into people like the 6-year-old daughter of AIDS afflicted parents who named her "Haunapawa" (which means 'there's no good in the world'), or "run into scenes..[where] patients can wait eight hours..to receive medical care and counseling."

But despite what seems like overwhelming misery Brooks says: "..you expect, or at least I expected, to find unrelieved sadness. But something positive has happened recently because of the confluence of three factors...The first is the spread of antiretroviral treatment programs." Mr. Brooks notes that "...the U.S. and other countries are pouring in money to pay for treatments". He's right to note the improvements. But overreaches by suggesting: "there's something perversely akin here to Silicon Valley in the early 1990's..."

Brooks paints a new picture of Sub-Saharan Africa, not of a grim land of poverty, 40% unemployment and whole villages being wiped out from AIDS, but a of a place like Silicon Valley, where money flows in the streets, AIDS drugs for all. Just like free soda and snacks during the dot com era?

Reality, An Uphill Battle

Contrary to Brooks' comparison however, there's little to associate the flood of dollars looking for lucrative investment during the dotcom with AIDS aid to Africa. Only 8% of people who are infected have access to anti-retrovirals, while millions have no access to medication.

Brooks says:"African governments have gone on the offensive against the disease." However in some places, such as South Africa the opposite is true. Health minister Manto Tshabalala-Msimang went on the offensive not on behalf of AIDS patients, but against pharmaceutical companies with drugs. Under intense pressure nationally and internationally, she reasoned in August 2004, just months ago, after years of denial about HIV and AIDS, that the government was "soberly considering" the use of AIDS medicines.

Last month, in a typical flip flop, she resisted urging from the UNAIDS and the World Health Organization(WHO) for more widespread use of antiretrovirals, suggesting instead that people eat well and use "garlic and lemon", olive oil and beetroot. She has repeatedly condemned the "unknown side effects" of AIDS medicines and so convinced populations not to use them.

Other countries have been far more proactive developing an AIDS campaign. Uganda combated the disease head-on, designing a comprehensive strategy that was pushed at the highest levels of government. The "ABC" counted on -- 'Abstinence', 'Be faithful', and 'Condoms', three legs, two of which formed the cornerstone of the Bush AIDS policy.

However a recent study suggested that it wasn't A & B, 'abstinence' and 'be faithful' that were responsible for the decrease in infection rate, rather it was C & - condoms, and even more dire, D - death. The authors note that so many had died in the first wave of the epidemic, a fact that that would make the infection rate decrease the population fell due to mortality.

Brooks observes that the money is flowing in. But many people would argue the opposite conclusion, that the money has not been forthcoming enough. In 2003 Bush pledged $15 billion ($10 billion "new") over the next 5 years for the AIDS crisis. But in 2004, the first budget year of his pledge, Bush asked for only 2 billion dollars from Congress. Congress overwrote the president and approved $2.4 billion. In 2005, Bush sought only $2.4 billion, Congress overwrote that and awarded $2.9 billion.

Not only has the money been parceled out sparingly, aid is stymied by debates around ideological issues. Some dispute the focus of President Bush's money dispersal -- now 20% of funds are funneled to abstinence programs, half of which are explicitly slated for religious organizations.

Organizations that promote condom use have had funding shut off. In a move that has drawn intense criticism, the U.S. has tied aid to pledges against prostitution, which would leave a large percentage of AIDS afflicted populations without care has drawn intense criticism. Donations cannot generally be used to buy generic drugs, only Federal Drug Administration (FDA) approved drugs can be used, and American companies are favored.

AIDs Aid

A recent UNAIDS report about Africa stresses that aid and government action need to be intense and thoughtful. The report outlines three scenarios that would yield possible HIV/AIDS outcomes by 2025. The first would focus on prevention for the least effective outcome, and would cost the U.S. $5-6 billion per year. Another would focus on ART but ignore other pressing issues and the U.S. would spend up to $4 billion a year. The last would attempt to implement what it takes to decrease the numbers of deaths and orphans and the incidence of disease- which would cost the U.S. $10 billion dollars per year.

There are many theories about aid in general, some disagree that aid is affective, some believe that we should spend more - post-haste. Hospitals, hospital wings, and staff is essential. One could reasonably argue that there is an "AIDS industry". However, for those who believe there is too much money going to Africa, Jeffrey Sachs of Columbia University's Earth Institute responds:

"The U.S. is not pulling its weight right now." "[There is] a great myth in the US [about aid], the problem is it's on such a small scale that it's not commensurate with the challenge."

The U.S. provides the smallest amount 'of development aid of the world's 22 wealthy nations, about 15 cents per day per American'.

Often economic considerations such as return on investment ROI couch aid as some kind of sweet business deal that's plugged in pithy marketing campaigns with a dollar signs scattered throughout as often as periods. Like any complex problem, the outcomes of the AIDS epidemics are complicated. While they can be modeled economically such analysis too often ends up as a spending debate, shall we spend this money or not? Let's not. Action on climate change suffers a similar fate.

Optimism?

Do we have reason to be optimistic when places like South Africa struggle with "crumbs" of international private investment. Despite the depressing picture, the history of HIV/AIDS shows that in the endless series of set-backs, punctuated by halting steps forward, optimism is essential -- even though it might not be Brook's brand. Here are some reasons to be optimistic:

• Three years ago antiretroviral treatment (ART) was still shunned in favor of abstinence, on cost and ideological grounds. That's slowly changing.
• Four years ago treatment costs became feasible, largely because of generic drugs manufactured in countries like India and Brazil, often in defiance of US and international patent regimes. The generics are easier to administer as well as being more affordable.
• South Africa's president Mbeki is slowly being convinced that the HIV virus does cause AIDS, although from the sounds of it maybe the Health Minister is now shilling for him.
• In 2001 South Africa won a major lawsuit against U.S. pharmaceuticals over patent rights for essential medications.
• Brazil's experience keeping its AIDS epidemic in check in the 1990's and early 21st century via universal treatment programs and staunch national and international political determination was a beacon of hope for developing countries.
• Strong leadership from NGO's and organizations like the Clinton Foundation, paved the way for acceptance of ART treatment, even as many apologists claimed treatment wouldn't work because of transportation hurdles, costs, culture, protocol adherance, corruption, health infrastructure and lack of training.
• Brazil, Thailand, Uganda and Senegal, geographically distinct countries with very different challenges and populations, each managed a level of success because at the highest presidential and cabinet levels there were strong commitments to their programs. There was a sustained determination to combat AIDS. Their heads were out of the sand. Women were an integral part of the solution, as was treatment for all populations, testing, education, and money.
• The United States is contributing money, expertise and counsel to the efforts.

Brooks concludes at the end of his article:

"[I] now realize we should be redoubling our efforts out of a sense of opportunity. I came aware of controversies about abstinence versus condoms in AIDS prevention programs, about U.S. aid versus multilateral aid, and now realize that all that nonsense is irrelevant on the ground."

This is hopeful. Its easy to be discouraged to the point of ineffectiveness because the grim facts lead people to dismiss Africa as a lost cause. The endless spectacle - "orphaned AIDS victims" - tug endlessly at our heart and purse strings. The effect is numbing. However the solution requires our full-fledged, reality based commitment. It has been said that HIV/AIDS is one of the biggest challenges of our century. Optimism feeds determination, feeds activism, feeds success.

Genetically modified plants (and GMO's- genetically modified organisms) have long been controversial. Scientists use molecular biology to modify the genomes of plants in order to make them more hardy -- to give them resistance to pests or fungi for instance. Plasmids are developed and used to insert a desired resistance gene into the plant. When researchers attempt (sometimes it doesn't work) to insert fungicide or pesticide genes into plants via the plasmids, they add an antibiotic ("Ampicillin") gene on the plasmid along with the pest resistance genes. The Ampicillin gene is commonly used as a marker in these types of experiments because it allows scientists to identify the plants in which the experiment worked -- the plants that carry the desired gene.

However not only is the use of pest or fungus resistance genes controversial, the use of Ampicillin in the environment is also controversial because it potentially increases the risk of widespread antibiotic resistance. Some scientists defend the practice and argue that Ampicillin is no longer a relevant antibiotic for livestock and humans because it is now so prevalent in the intestinal flora of "untreated" humans and livestock. However other scientists disagree with this stance, and argue that the antibiotic should not be further dispersed in the environment via transgenic crops. They argue that Ampicillin is still effective against some species and that the antibiotic's effectiveness depends on conserving its use for therapy. Policy advocates and governments also disagree, with various parties taking different positions.

Europe and the U.K. (as well as Africa and Asia) have always been more squeamish than the U.S. about transgenic crops. The European Food Safety Authority has advised EU governments that Ampicillin containing strains should only be used in test fields. Other agencies and NGO's concur that Ampicillin should not be commonly used especially in the food system. Yet the journal Nature (subscription) uncovered a case of alarming and perhaps inadvertent Ampicillin carrying GMO seed propagation in its recent report: "Stray Seeds had Antibiotic-Resistance Genes" (Colin Macilwain: 434, p.548 March 31, 2005).

For the past 4 years the Swiss firm Syngenta sold corn seed that contained a gene that codes for antibiotic (Ampicillin) resistance. One strain of maize (Bt10) that contained the Ampicillin gene was sold instead of another (Bt11). Bt10 had originally been a control strain to show the lack of the Ampicillin gene in Bt11. "Hundreds of tonnes" of the seed were planted and farmed by American and European farmers from 2001-2004, years before the error was apparently noticed, the investigation reported.

The issue hasn't been resolved. In a June 2nd editorial; "Don't rely on Uncle Sam" (Nature 434, p. 807), the journal notes the lax regulatory agency response. Nature analyzed the responsibilities of three U.S. agencies who would be responsible for discovering and correcting the error. Why didn't the US Department of Agriculture (USDA), the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA), catch error for four years? Each had a media ready excuse:

• The FDA reasoned that since the intended pesticide gene was not a food safety issue, they weren't responsible.
• The USDA claimed that its "system was working"...despite the fact that it never caught the transgression. They gave a bureaucratic shrug (actually Nature suggested that it might have been more corporate dismissal) and fined the company $375,000. A very very soft slap on the wrist?
• The EPA claimed that it was short on resources, which prompted Nature to quote The Onion's satirical take, that the EPA had renamed itself "The Agency" -- since the "Environment" part of its title didn’t seem appropriate for its role of "not protecting anything"

In addition to collective shirking on the part of the U.S., Nature also commented on the rather limp European reaction. Back in April 2004, the European Food Safety Association (EFSA), published a directive on the use of antibiotic resistance marker genes in genetically modified plants, decreeing that genetically modified plants intended for food or feed should avoid genes that "confer resistance to antibiotics of clinical importance..." The authors at Nature wonder why European regulators haven't seemed to address Syngenta's 4 year oversight. After all, the editors reasoned, the company is a European one (even if Switzerland is not really in the EU). The Nature editorial concluded - "Thankfully, on this occasion we're not dealing with a threat to public health."

Most recently, in Nature's June 2, 2005 issue (435, 561: Correspondance), UK Scientist Gundula Azeez of the Soil Association responded to this Nature editorial:

"We are concerned by the suggestion, in your Editorial "Don't rely on Uncle Sam", that the US Food and Drug Administration does not consider the presence of the ampicillin-resistance gene in Syngenta's unapproved variety of genetically modified Bt10 maize to represent a safety problem.."

That's not exactly what the original editorial said, although government agencies across the board certainly did seem to support this opinion. The letter to Nature author takes a stance:

"This is not the view of the UK government's scientific advisers... The risk of horizontal gene transfer from genetically modified organisms genetically modified organisms (GMOs) is not a theoretical one."

The author cites a study that showed that the plasmids can survive certain conditions and go on to transform bacteria. He adds that not enough research has been done on the potential effects for horizontal gene transfer, as issue that pertains not only to Ampicillin resistance genes but to the toxin resistance genes in GMO's as well. The author also criticized the U.S. agencies' "case-by-case" approval mechanism for transgenic crops, saying that overall the technology hasn't been adequately researched.

While we can't comment on EU agencies' impetus, but the lack of vigorous U.S. response is not accidental. The U.S. has always supported and promoted the use of transgenic crops since the day when vice president Dan Quayle, in the name of business competitiveness, declared that GMO's and non-GMO's were the same.

Will there be more research and will it bridge the EU/US divide? For the U.S., it seems that when doing research would potentially protect public health would interrupt industry's speed in selling products research is eschewed. However when research could potentially show the detrimental affects of industry to public health and the environment, then the call is interminably for more research. Interestingly, while Europe and the U.S. continue to squabble over policies and science results; the potential effected customers are millions of farmers and consumers across the globe.

Anyone following the growth in consumption of fast food over the past 10 or 20 years knows the influence that industry has on our eating habits and lifestyles. No matter how tasty, salty, fatty, sugary, and generally satisfying junk food may be, too much is damaging to health, and it's many people consume too much. Public health experts know this, as do producers of popular books such as "Fast Food Nation" and movies such as "Supersize Me", as do politicians, as do the soda drinking public. If it's so obvious, then, why isn't government more proactive?

Sometimes we don't recognize clout of the industry in the debate. For instance when the US threatened to withdraw from the FTA (Free Trade Agreement) with the Dominican Republic in September 2004 over a proposed bill to tax sodas, the event barely made news. But when it comes to sugar and fast food consumption of our nations children, let the fighting begin.

Beverage, corn, sugar and grain industries have a lot to gain or lose over soda sales. Coca-Cola's ever increasing sales in the U.S. are surpassed only by it's sales in Mexico. Coca-Cola sales revenues worldwide were $21,000,000 in 2004. Fast food, soda, and junk are mainstays for investors, and there's no limit to market potential.

The U.S., in turn, has a lot to gain from preventing obesity and diabetes. In 2003 the nation spent $11,000,000,000 on obesity related medical costs according to information in a bill (S.799), "Prevention of Childhood Obesity", that will fund research, now being considered by the Senate. The bill notes:

• Obesity rates have doubled in preschool children and tripled in adolescents in the past 25 years
• 9,000,000 young people are considered overweight
• 60% eat too much fat.
• Fast food outlets spend $3,000,000,000 in advertisements targeting children.

Fat and sugar, often considered the pyramid building blocks of the American diet, especially for kids, have increased dramatically with the help of product endorsements.

Last May, a brouhaha erupted when the American Diabetes Association (ADA) "partnered" with Cadbury Schweppes, allowing the company to advertise its association on diet drinks. Corporate Crime Reporter (CCR) later interviewed Robert Kahn, the director of the American Association for Diabetes (ADA), and took him to task for accepting money from Cadbury Schweppes, albeit for education programs.

Kahn repeatedly asserted in the interview that sugar cannot necessarily be linked to diabetes and that excess weight is the result of greater intakes of calories vs. a lesser output of calories. CCR pursued Kahn's arguments with tenacity.

CCR: "I'm saying that liquid candy [soda] is a major issue."
KAHN: "I don't know if it is a major issue. What's turning out to be a major issue is excess caloric consumption. That's the major issue. That has to be much more of a major issue than sugared drinks. Look at all of the weight loss companies."
CCR: "Let's focus on children. If in fact a big chunk of their calories come from sugared drinks"
KAHN: "I don't know whether in fact that is the case. Do you know it is a fact?"
CCR: "I don't know, but if in fact."
KAHN: "I don't want to go down that line if I don't know that it is true...."

Soda consumption is about 2 sodas per day for youth, 20% of total calories...10% is recommended. The American Pediatric Association states that "Each 12-ounce soft drink contains approximately 10 teaspoons of sugar and 150 calories. Drinking just one can of soda a day increases a child's risk of obesity by 60%". Therefore increased sugar intake leads to obesity, leads to increased risk of diabetes.

CCR tried to get Kahn to acknowledge that ADA's partnership with a large candy maker may not be in the public interest-

CCR: "Is there an epidemic of that type of diabetes?"
KAHN: "Absolutely".
CCR: "And what is causing it?"
KAHN: "People in this country are gaining too much weight."
CCR: "Why are people gaining too much weight"
KAHN: "Because total caloric intake exceeds total caloric expenditure."
CCR: "Does sugar have anything to do with that?"
KAHN: "If you are eating only sugar, yes."
CCR: "No, does sugar have anything to do with that kind of weight related diabetes?"
KAHN: "No more than fat or protein does."
CCR: "Do sugary drinks have something to do with it?"
KAHN: "No one has a clue of whether they do or don't."

Kahn is superficially correct. Sugar, protein and carbohydrates are all metabolized by the body to provide predictable sources caloric energy. Weight loss does depend on lowering the ratio of caloric intake (food) to caloric expenditure (exercise, heat generation, metabolism). However Kahn chooses to ignore studies that consistently connect increased soft drink consumption with decreased quality nutrient consumption, weight gain and diabetes risk. A meta-study published by the Journal of Pediatrics in June reviewed previous research and confirmed the link between excessive sugar, obesity, and diabetes. Another study published in August of 2004, researchers at Brigham and Women's in Boston of 90,000 woman found that drinking a soda a day can increase the risk of diabetes 83 percent, as summarized by the San Francisco Chronicle.

Is Kahn sounding like an industry apologist, as the CCR interviewers later pointed out in "All Fall Down"? Indeed his points do echo that of industry rhetoric. For instance the SF Chronicle reported the response of the sugar industry to the the Brigham and Women's study:

"the[y] disputed the conclusion, arguing that the study was flawed and that it was impossible to single out one type of food or drink and blame it for the obesity crisis...A careful reading of the paper reveals that it was an unhealthy lifestyle, not consumption of a particular food or beverage, that increased the women's risk for type 2 diabetes.."

The Chronicle quoted Richard Adamson, vice president for *scientific and technical affairs* at the American Beverage Association, who cautioned:

"A careful reading of the paper reveals that it was an unhealthy lifestyle, not consumption of a particular food or beverage, that increased the women's risk for type 2 diabetes."

CCR continues, and tries to encourage Kahn to consider the idea that a tax on sugar might help people reduce their sugar intake. Kahn balks.

CCR: "Are you saying that unless we can tax all high calorie foods, we should tax no high calorie foods?...There are a handful of states that already tax soda."
KAHN: "I don't know that they do it or not. If they do, I would wonder - should I single out soda, or should I single out the donuts? If I single out the donuts, shouldn't I single out the pies, and cakes and pastries...[t]he epidemic is the result of too many calories in, fewer calories out. That is it."

While the controversy roils, New Jersey passed a comprehensive bill banning the sale of high sugar and fat content foods in schools by 2007. Connecticut has a similar bill pending governor approval and 17 states also have legislation pending. While sugar may not be the only cause, it seems that many agree that it is contributory to the extent that action can be taken against it.

For decades, the Coca-Cola company has ventured into villages around the globe, so that every man, woman and child can consume the sugary, fun, hip, bubbly, fizzy, somewhat corrosive drink: Coke©. This cheap, simple but top secret recipe is a phenomena.

But the company has also been under fire in the past few years for its business practices. Allegedly the beverages contain pesticides. The company's excessive water use at bottling plants has exacerbated drought conditions in Kerala, India and elsewhere, (Coke uses 4 liters of fresh water to produce 1 liters of drink). The company has also been accused of disposing toxic wastes into the environment, and has been to court to address charges of labor abuses in Columbia. If that weren't enough troubles, a recent press release by Corporate Accountability International" linked the corporation with murders in Columbia. (The press release was "corrected", but the company or its franchised bottling plants have been linked to murders of union leaders in Colombia).

Widespread protests against the company continue in India, a movement that has been picked up on college campuses and in the investment community. The protests sparked the interest of the Wall Street Journal, which published a lengthy piece about the conflicts on the front page today. The article, "How a Global Web of Activists Gives Coke© Problems in India" (byline Steve Stecklow, June 7, 2005)-currently available here --, highlights work spearheaded by Amit Srivasta of India Resource Center. Srivasta drew attention to Coca-Cola© when he wrote an article for Corporate Watch, July 10, 2003 that alleging that the company was polluting and draining water resources in Kerala, India and other places.

The Wall Street Journal article takes an interesting approach in its article. The intended audience seems to be the corporate world when the author writes about exagerations made by exuberant NGOs (Non-Government Organizations). The Wall Street Journal informs readers in the second paragraph that Mr. Srivasta is a "pony-tailed, 39-year old college dropout."

However turning off the front page, you learn that the Wall Street Journal visited the bottling company in Kerala where Coke© was accused of dumping toxic waste and found that required soil sample testing was not routinely done. Reporters noticed the Coca-Cola© corporate website virtuously announced the results of a study that claimed Kerala plant's waste material was not hazardous. But independent studies concluded the opposite:

"two other government studies of the Kerala waste material, including one by India's highest environmental regulatory authority...found that the material contained high enough levels of cadium, a highly toxic metal, to deem it hazardous."

Mr. Srivasta has been on a college circuit lecturing to college students about Coca-Cola's practices in India. Coke© products have been banned at Oberlin College in Ohio, Carlton College in Minnesota, Bard College in New York and "two colleges in Ireland". A website dedicated to this campaign called www.corporatecampaign.org lists about 60 universities and colleges that are active in boycotting Coke©, and announces that both Hofstra University, Union Theological Seminary, and Rutgers have not renewed contracts with the company. The University of Michigan has found evidence for many of the allegations and will renew its month to month contract if and when Coca-Cola improves its human rights record.

For it's part Coca-Cola complains that sometimes it's not invited to the campuses, although the schools hold that the company has not engaged them in meaningful discussions.

Coca-Cola will undoubtably come under more scrutiny. A while ago, the Kerala village council (panchayata) ordered a Coke© manufacturing unit off-line in order to conserve water. A court overruled this decision, undermining grassroots villagers efforts to control their own water supply, but more strife will no doubt plague the company. Recently a Rajasthan High Court ruled that Coca-Cola (and Pepsi) need to declare pesticide content of their beverages on their labels. This could could influence sales. As well, protests against Coca-Cola's bottling plants have spread to other Indian states - Uttar Pradesh, Rajasthan, Tamil Nadu and Maharashtra.

The movement against Coca-Cola cannot be attributed to one man with a pony-tail and a website, although that's what both the Wall Street Journal article and certain Coca-Cola marketing professionals would have you believe. David Cox, a commmunications director for Asia was quoted by the WSJ saying: "the moral high ground seems to be anyone with a Web site". Cox apparently spent "months in India trying to combat the NGOs allegations with little apparent success."

Despite Cox's nod to futility, the company is astutely attuned to its image challenges. Coca-Cola defends itself against allegations here. It sponsored the Asia Corporate Social Forum in 2003, and often speaks to global issues like water. As one Coca-Cola spokesman at at recent environmental conference put it:

"All living systems need water. People need it. The climate needs it. Plants and wildlife need it. We are all part of the same living system and we all need water...In 2003 alone, we worked with our bottlers to improve water use efficiency system-wide by 7% -- that is, our volume grew by 4% and our use declined 3%...That means that The Coca-Cola Company is able to refresh and hydrate consumers, while also supporting sustainable access to water within communities."

There is another type of corporate activism brewing against Coca-Cola that was highlighted in a story last year by the Guardian on Max Keiser, of KarmaBanque. The man and the company were started when "[a] former stockbroker join[ed] forces with billionaire's son". KarmaBanque is an on-line hedge fund that will purportedly "donate the profits from short-sales in Coke's stock to the 'victims of Coca-Cola's business model in places like India and Colombia." At the time of the article "The aim was to reduce Coca-Cola shares from their current value of [$41 to $22]. Will it work?

Coca-Cola presented at Deutsh Bank yesterday to remind investors that it leads the ready-serve drink industry. It ranks #1 in sales of carbonated beverage, coffee and juice, #2 in sales of tea and sports drinks sales, and #3 in water sales. It posted about 21 billion in sales last year for it's 400 brands, up over 4% from the year before. The stock price is currently $43.87, greater then the highest ever mark of organizations betting against it. Despite Mr. Cox's dour statements about NGO's and the market in India, Coca-Cola is on top of the world and smiling.

The Financial Times reports that US hotel telecommunication revenue dropped 50.3% between 2000 and 2003. Long distance revenue fell by 59.3% while local revenue fell by 26.2%. Revenue from internet and fax access rose by 9.1%. Profits on hotel phone surcharges during the 1990's were as much as 50%. Dramatic, but not surprising.

Codon Devices is a new biotechnology start-up that was recently profiled in Forbes Magazine. The company proposes to design bioengineering systems that will allow scientists to edit DNA sequences to create synthetic sequences for research and easier protein generation. Currently, molecular biology ressearch involves time consuming processes of cutting and ligating sequences together then transforming cells that will hopefully express the desired protein.

The founders recognize the challenge of their proposal but are optimistic about the potential of the technology, as are investors. One co-founder, Jay Keasling of the University of California, Berkeley, has recieved $42.6 million from the Bill & Melinda Gates Foundation via One World Health, to develop an anti-malarial medicine.

People talk of the multitude of environmental skeptics who insist that the earth's atmosphere, weather, biodiversity and living things are not affected by human activity, but it's easy to reason that these skeptics are the outlyers. As a society, we are surrounded by mounds of scientific evidence detailing the affects of our petroleum burning cars, mining, or deforestation. How could there still be skeptics? Moreover, it's easy to suss out that many of those who remain "skeptical" are on industry payrolls. Their profit motives and corporate affiliations are no secret. So how could people not suspect their rhetoric? How could they find the speil of a chemical or oil company public relations executive, more compelling then a scientific publication?

Nevertheless, flying in the face of apparent reason, the influence of the naysayers persists and is propagated in the media. Even those who have no transparent industrial agenda loudly deny that man induces harmful environmental change. A Financial Times editor recently wrote in "The Boom in Organic Food Sales Defies Science and Sense" (May 18, 2005) that organic food was a waste of money. He says that he drinks tapwater because it's tastes the same as bottled water. (OK, but surely his tap water can't taste like that in some cities, which may as well be ladled from a city pool overflowing with kids and plastic balls on a hot summer day- and chlorinated liberally for the challenge to boot.) He then extends similiar logic to his choice of non-organic food.

He questions his readers: why spend money on organic food when there is no evidence to prove it's more healthy? He talks about his own choice to eshew organic food:

"There is absolutely no evidence organic food is better for you - as I was startled to learn when the Financial Times published an interview recently with Sir John Krebs, chairman of the Food Standards Agency.

Looking into the matter, I was slightly ashamed of how long it took me to discover this, given that Sir John has been saying it for years...So when he says that scientific evidence does not show organic food is safer or more nutritious, I am inclined to believe him -- particularly as the French and Swedish food agencies say the same.

The UK agency says there is nothing wrong with pesticides or veterinary medicines, provided the levels are low, which they are...

Organic food is no better and no worse for you. It is just more expensive"

Granted John Sir Krebs doesn't happen to be the most neutral judge and the Financial Times is of course a business paper, business paper are generally reluctant to criticize industry. One could argue that the author either chose to ignore conflicting evidence because of his own bias or that he wasn't necessarily qualified to assess the evidence opposing his assertions. Michael Skapinker's area of journalistic expertise after all is employee management, not science. However the article is typical of a genre of science coverage that attracts fervent followers. Certainly some letters to the editor the following week echoed the same saucy and uncritical decision making process. And the article probably served to assuage some budget minded readers that all their food and water sources were healthy. Yet since there are choices, it's baffling that people capitulate to the pressure of anti-environmental reason, especially in light of reports like this:

A study published today in Science magazine, reported that researchers at Washington State University at Pullman found that two fertilizer compounds permanently affect the germline. Vinclozolin; an anti-androgenic compound, and methoxychlor; an estrogenic compound, used to make pesticides and fungicides were found to affect fertility in male offspring born to exposed females. Rats in the study were exposed to the toxicant during the period of embryogenesis when sex determination occurs. It was found that; "The male offspring had lower sperm counts and abnormal sperm production. 10% of the animals were completely infertile".

The males passed these lower fertility traits to their offspring, who then passed them on to their successive offspring and so on. 90% of the trans-generational males were affected. The authors postulate that the trans-generational changes are epigenetic and caused by abnormal methylation of the DNA, since they know of no known DNA sequences that cause such a trans-generational pattern.

This is not the first study to show the effects of pesticides on health. A government clinical trials site lists studies that are recruiting volunteers to participate in infertility trials involving lead, PCB's, mercury, cadium, and a variety of pesticides, all established environmental toxicants.

Many people balk at compelling evidence from scientists who write books like Jared Diamond's "Collapse", or Red Sky in The Morning, by James Seth, Dean of Yale U. School of Forestry and Environmental Studies, or One With Nineveh: Politics, Consumption, and the Human Future, by Stanford biologists Paul and Anne Ehrlich. These same people revel in the fiction of novelists instead.

Are the media and their approving readers too entrenched in cozy plastic lifesyles to question the fictional assurances? Or perhaps fiction is appealing precisely because it's fiction. Our jobs are stressful, taxes are high, the news is depressing, our cars break down, and the kids are sick. Maybe it's just easier to eschew facts and frame our belief systems in the non-challenging happy or at least forgetable endings of fiction, footnotes or not. If it's agreeable entertainment encapsulated into a one and a half hour movie then all the better.

It was only a few decades ago that Jonas Salk's research led to the use of the deactivated polio virus to inoculate and immunize children. It was a medical breakthrough, but Western leaders were suspicious of the vaccine's safety. So the first large scale vaccinations took place in Cuba, where Fidel Castro welcomed the vaccine.

Since then, the polio vaccination effort has progressed in fits and spurts. In the 1960's researchers discovered SV40 contamination of the vaccination, that elicited more fear. But over time the effort steadily gained popularity and trust. In 1988 the World Health Assembly led a worldwide program to eradicate the disease that for the most worked. In 2003, the World Health Organization (WHO) reported fewer than 700 cases worldwide, down from 350,000 in 1988.

Yet the history of polio has shown that infectious disease eradication is challenging even with an effective vaccination. The majority of polio cases occur in remote regions of the world,where people have little access to running water, sanitation, food, or basic health provisions. Poorer countries are challenged trying to distributed vaccines because of lack of refrigeration. Ice packs chill the vaccines effectively, but need to be refrozen and in many rural areas where basic amenities like electricity are scarce. Transportation to distribute the vaccines is also difficult in remote terrain. Communication also proves challenging. Accurate records of vaccinations need to be maintained and villages need to be notified of upcoming vaccinations and convinced that the medicine is safe for their children.

Despite these challenges, the World Health Organization (WHO) reports that from 1998 to 2003, "the world's largest public health campaign" the Global Polio Eradication Initiative spanned 200 countries and employed 20 million volunteers, costing $3 billion dollars. When WHO wrote the report, they were confident the effort would pay off since only six countries remained polio-endemic: Nigeria, India, Pakistan, Niger, Afghanistan and Egypt. Doctors predicted that polio would be successfully eradicated by December 2005 (a postponement from 2002, which was a postponement from 2000). But today polio has re-emerged in eleven countries. In four of these countries outbreaks were imported virus due to migration or travel. Yemen reported 179 new cases and Indonesia 2 new cases in the past week.

The new outbreak is being traced to Africa where several countries blocked vaccination programs in 2003-2004. Officials in Nigeria for instance, began to suspect polio vaccines were a plot of Western countries against the fertility of Muslim girls and halted their vaccination campaign. In Mali 11 officials were jailed for not allowing citizens to be immunized or religious reasons.

The latest initiative was to be the last push of the campaign before the deadline. The good news is still that the number of cases worldwide is small. But at this stage of the campaign, the cost to treat each subsequent case increases significantly. And, as the recent outbreaks show, successful eradication could only be accomplished with constant vigilance. In India, where polio is indigent, 24 million or so births per year require that many new vaccinations. Adding to the difficulty, India's resources allow less than $4 per person to be spent on health care -- other African countries can spend half that much.

The high costs of the current effort invites cost benefit analysis by health economists and public health officials, who estimate that as many as 5 million cases have been prevented, however; the remaining cases could cost as much as $600/case. Some argue that the money to treat these remaining cases could be spent on basics like electricity or sewers (sewage is often the source of the virus).

Sometimes eradication via vaccination seems elusive, always 6 months out of reach. But ridding the world of polio -- crippling scourge of a virus that it is, will always be worthwhile goal.