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The poorest people are not only poor. They are also chronically sick, making it harder for them to escape poverty. A new global initiative may break the vicious cycle
Note: This story was originally printed with the title "A Plan to Defeat Neglected Tropical Diseases"
Peter Jay Hotez became interested in medicine as child when he read Paul De Kruif's classic book Microbe Hunters and asked his parents for a microscope. He went on to obtain both a Ph.D. and an M.D., specializing in parasitology. He now chairs the department of microbiology, immunology and tropical medicine at George Washington University. Hotez is president of the Sabin Vaccine Institute, a member of the Institute of Medicine of the National Academies of Science, and co-founder of the Global Network for Neglected Tropical Diseases.
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29 Comments
Add CommentOn the other hand... this is one of natures most effective ways of keeping populations in check.
Reply | Report Abuse | Link to thisIf we keep saving everybody from the consequences of overpopulation, 1, is it ethical to do so? 2, are we just raising the stakes?
We all have compassion for our own species, & especially when faced with the suffering of the helpless children. We're biologically wired to on a primal level. However, at some point, bowing to these primal reproductive instincts of "reproduce and survive at any cost" (even though it could be said it is the meaning of life) compounds the loss as billions of lives' saved multiply yet again.
Hotblack,
Reply | Report Abuse | Link to thisWhy not just set up camps and crematoriums for these people? Isn't that a bit more compassionate than allowing them to suffer with these diseases? You seem to have what it takes to lead such an effort, since you've moved beyond your primal wiring to feel compassion.
Of course as one American has about the same "environmental cost" as 50 Africans, perhaps we should concentrate on reducing the number of Americans. But then the NRA is making quite a good job of that already; perhaps they should get the Nobel Peace Prize next time round.
Reply | Report Abuse | Link to thisand cure Leptospirosis while your at it. I do agree about population issues. If everyone is healthy we all die.
Reply | Report Abuse | Link to thisThere actually is a benign, viable population control: educate females. Women who know how to read and write have fewer children than those who don't. For several reasons, this is a revolutionary step in some cultures and countries. But we have little choice.
Reply | Report Abuse | Link to thisYe Gods, how can a reasonable question asked by a thoughtful author lead to such self-centred comments. Ah well, be that as it may, there is a criticism of the article in that it addresses the drug-based answers to NTDs. A great many of these diseases are capable of being dealt with by environmental means, better sanitation, clean water, wearing shoes etc.The quickest and cheapest way of getting a result is no doubt through drugs, but to give long-term improvement and avoid difficulties caused by resistance or unreliable supplies is best dealt with using environmental health measures. This would not only deal with NTDs, but empower the local people as they would be in control of their own healthy conditions.
Reply | Report Abuse | Link to thisNTDs don't generally lower population numbers, but they do reduce the ability of the population to feed and look after itself. The real worry in the article is that it assumes a medical intervention (drug based) is the only way forward. For most of the diseases mentioned there are good environmental interventions especially in terms of sanitation, drinking water, hygiene and footwear. For a rapid effect at low initial cost there is no doubt that drug treatments will be good. However, they do not deal with more than one problem at a time, there are dangers from resistance or failure of supply and they teach people that good health comes from overseas. Environmental health interventions would give long term benefits, improve the quality of life and empower local people.
Reply | Report Abuse | Link to thisNo, NTDs do lower population numbers through knock-on effects. A person who is weaker won't survive as well, period. Mostly, they will have fewer children and short lives.
Reply | Report Abuse | Link to thisI must confess that I have had similar thoughts sometimes, and I am someone is plowing the sea as we speak, trying to come up with ways to cure diseases in the developing world. Anyone with a sound biology background will think about it. And events bear this out.
You see, where they effort did not come from within, and so is not a signal itself of improved education and massive cultural change, it is never stable. We want to believe it will be stable, but it is not. Over and over, there is a cycle of a massive population explosion followed by famine and war. And those wars are far, far worse in their impact on people than the neglected tropical diseases.
We are seeing this in Congwo, we have seen it in Rwanda, Uganda, all over. The worst is when there is a population explosion followed by an AIDS plague that removes the core of productive adults in their prime. The legions of orphans then become cannon fodder, willing to commit the most awful of atrocities. Take a look at what really happened in Liberia and Sierra Leone not so long ago. It is "Lord of the Flies" writ large.
I know Hans Rosling, and respect him very much. His Gapminder site is well worth seeing. But I think there is a big difference between the trajectories of nations that pull themselves up and nations where everything comes from outside. And there is an even larger difference between the trajectory of the European nations that pulled themselves up before the population of the globe hit the wall, and these nations that want to come up as the world overshoots carrying capacity.
We are seeing the world hit the wall environmentally. Mass death beyond the comprehension of former generations IS going to happen, period. We WILL see billions of people dying in very short periods of time. That is what anybody who has observed ecologies knows.
So it actually is a real question. Are we doing the right thing by ANY of our global health interventions? Are we really? That question troubles me greatly.
While entangled in the hot climate-change issue, one should also not forget or neglect the poor-cum-sick.
Reply | Report Abuse | Link to thisProviding them with adequate medical care can be important, but educating them would be the more desirable and essential move.
Meantime, they must take the initiative to have less children.
John, I don't think that our conclusions are very different, just the mechanism of human population changes because it is different to other populations. My writing abilities clearly failed here in the first post. Status quo (with regards to human NTDs) will prevent expansion of a population I agree, but neglect to act will not reduce a given population. It will simply continue a poor and limited quality of life. To state that conflict (war) is a result of population increases is only occasionally true; lack of resources leading to poverty was a major factor in Rwanda, but Congo / Zaire has had half a century of bloody conflict although it is rich in resources and many combatants have had to be imported to keep the fighting going.
Reply | Report Abuse | Link to thisThe human population expansions in the non-third world have halted and reversed as the quality of life has improved.. As you and other commentators have pointed out (and I tried), the simple removal of the restrictions on survival by intervention (medical / finance/ etc) do not work. The empowerment of people - I mentioned via environmental health, others education and gender equalities - is essential in improving their quality of life and so arriving at a stable and sustainable world. To say, 'control population first', is never going to be acceptable to people who directly rely upon their own children to feed them.
My personal view is that intervention by provision of aid which itself completes 'a project' does do harm as it removes the self confidence which is an essential part of action to reduce the suffering due to disease and malnutrition. Having worked in African countries and been a trustee of charities I'm now firmly against the ideal of many good people who try to provide a resource such as a village water supply and believe that they have permanently bettered the quality of life of that village. This does not mean that we cannot support the people. I do have some ideas and will send a quick outline of one if anyone wants to email me on ehs284@btopenworld.com
What if we were the "them".
Reply | Report Abuse | Link to thisWhat if the "population" suffering from NTDs was your country, state, county, city, family?
I am not naive to the problems presented and I know every solution brings its own set of problems.
But, I think the future has a better outlook if every human population has the best opportunity to develop - which, in the context of this discussion, means relief from disease.
I understand it is generally accepted that healthier people are more likely to be economically "successful" which leads to fewer children who, then, have a better life and an improved chance for education.
hotblack:
Reply | Report Abuse | Link to thisI agree with everything you say, but would like to add, we also need to shut down our entire medical system. Everybody is subject to the same laws of nature. Population has to be reduced.
Those of you who believe in gods and similar entities should have no problem with this. An omnipotent, omnipresent and omniscient should not have his/her will imposed upon by medical staff. I don't understand how an omniscient individual can be omnipotent.
By the way, why are no nation states volunteering to take up Bangladesh's 20 million surplus people. They asked for this action (listen to the BBC interview) 1126 people per square kilometre does seem like a lot for a nation that is not a city state.
gwernymynydd,
Reply | Report Abuse | Link to thisIf the rest of the world did not provide food aid, what do you think the world population would be?
By the way food aid is generated at the expense of our environment and biodiversity for the most selfish reason in the world - money. Most of the people greedy for more money, have no understanding of what money is or where it comes from.
SE,Your question is a good one and I don't think that we know the answer. Certainly in the immediate effects there is/can be saving of lives, however does this mean in the lnger term a greater problem next time round? I don't know. Food aid has often prolonged conflicts thus causing more suffering. It's complicated and I for one would not refuse food aid. Your second point is well made and fits with your earlier comment on taking refugees from climate affected areas such as Bangladesh. As the area of food producing land decreases, the price of food will rise. It could well be that currently rich countries such as UK will not be able to afford to import foods for their own populations and will not be able to buy foods for food aid on the open market. This is compounded by the growth of economically advantageous crops rather than safe staples and by not seeing the problems of unstable crops, e.g. maize is not native to Africa but is widely grown as the staple food. It has limits on its ability to cope with water stress. This year in Zimbabwe it is only raining on occasion when there would usually be daily predictable rains. What will be the situation in October?
Reply | Report Abuse | Link to thisCombine the large number of people who have to move as (e.g.) coastlines move and the overall shortage of food then ??
Back to the original NTDs question - if we can make life better for people then the chances of them being able to stay in safe places and feed themselves increases and makes for a stability for them and us. JS49's point about being in their shoes is well made, but I think that attitudes to dealing with the diseases and improving quality of life would be exactly similar in Kent and Kenya. Quality of life (including life expectancy and disease control) improved in Europe due to sanitary reforms - see when TB prevalence fell: long before medical intervention was possible - and there is no reason why the rest of the world should not have the same benefits.
Clearly, the answer is education and contraception. Leaving people to die, especially when there are cheap alternatives is reprehensible.
Reply | Report Abuse | Link to thisgwernymynydd,
Reply | Report Abuse | Link to thisThe answer to me is obvious, if we did not dump our surplus food and retained our forests, we would not have the population problem we have today and we would have more forest cover.
When the politicians say global warming is caused by CO2 levels, they are not blaming the culprit, they are blaming the result. CO2 levels are rising because we emit more CO2 but more so because we have destroyed the vegetative cover of our planet.
When you remove vegetative cover, not only are you lowering the CO2 processing capacity of the planet, but you are also diverting the vast amount of solar energy used to process CO2 to sugars into heat.
When it comes to rain, a warmer planet will hold more moisture in the atmosphere, further increasing warming. Bacteria from forests seed clouds and create rain over the forests, this discovery proves the old observations that forests have more rain. Forests also offer a cool habitat for their inhabitants. Cut down the forests we reduce historic rain patterns, and when it does rain, it will be in volumes that cause damage.
Making life better is a dream. Study the problems associated by the wealthiest in our societies, they create problems to escape what you believe is a dream life.
Most importantly, every life must end. It is immaterial if it was for a day or a hundred years. Life has no purpose and no existence beyond death. Life exists in spite of the second law of thermodynamics thanks to gravity.
scientific earthling,
Reply | Report Abuse | Link to thisSeems to me, you've stated your position clearly.
Your "shut down the entire medical system" and "life has no purpose" comments pretty much says it all.
So, I'm guessing there's little else you can contribute to this particular topic.
For Hotblack:
Reply | Report Abuse | Link to thisPopulation control...hmm...weed out the sickly, the poor, the parasitic breeds...You know, if you were around in 1943, give or take a year or so, seems you would get along with a man named Hitler - but I hope for your sake you are not Jewish and sport blue eyes and God forbid if you're sickly. You have it all planned out, only the strong survive and so on...You know the old saying, "there but for the grace of god go I"? Well, I'd advise you to think Your Majesty! ~ Setag ~
Compassion. Without it we are not human. The logic expressed above wherein a stable world is created allowing enough space for resource provision (including food and CO2 balancing) by reducing the life potential by disease or starvation is unacceptable to me and, I hope, to the majority of other people. Indeed we sometimes cull wild animals to prevent them starving. To return to the original article - I do believe that there are better long term answers to the diseases addressed, although drug treatments to kick start the system are not bad. Anyone interested in one idea please e-mail ehs284@btopenworld.com. Would anyone at Sci Am like this as an article?
Reply | Report Abuse | Link to thisAnd how are these people going to be fed? When will we learn that POPULATION CONTROL is the answer to most of the third worlds problems?
Reply | Report Abuse | Link to thismikehattan,
Reply | Report Abuse | Link to thisCertainly population control is an important part of solving human-related problems.
But, what I find very distubing is the callous approach voiced more than once in this discussion to let "them" suffer, starve and die.
Have any of you who take this approach actually been without potable water or food for days, weeks, months?
Have any of you suffered from a painful, disfiguring infectious disease for any significant length of time yet, all the time, knowing there is available relief ?
Have you seen your children or loved ones suffer from the diseases described in the article?
Have you read "Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and Their Impact on Global Health and Development" by Peter Hotez?
Until you can answer 'Yes' to these questions, then your glib answers to these problems are irrelevant.
Sorry, can't save these people. Too busy trying to fight climate change. Besides, no $$$ in it.
Reply | Report Abuse | Link to thisBrought to you by the IPCC and Greedpiece.
JohnS49:
Reply | Report Abuse | Link to thisI have seen people die. The process is not as horrible as you make it out to be.
Starvation causes a state similar to drug induced stupor. The person becomes delusional, has no pain or any other feelings, does not want anything or want to do anything. Seems to hallucinate and simply dies. Its almost like witnessing a person in the final stages of septicemia.
Having witnessed several deaths, I have come to the conclusion that in each case death was the best thing that could have happened.
Not ever being born, is better.
The world had the opportunity to educate the masses before the number of uneducated swelled to the current mind boggling levels, but greed and market economics did not allow this to happen.
An educated population is a responsible population. We would not be in this mess if we had an educated world.
We cull "wild" animals more because we have destroyed ecological balances - such as in extirpating their predators and/or destroying their habitat - than to help them cease starving.
Reply | Report Abuse | Link to thisIn Shakespeare's time, I believe that the average lifespan in London was around 32 years, while the average in rural or wild lands came a great deal closer to our own.
Natives of tropical lands, where a greater proportion of our species has lived for a greater length of time, have a higher burden of parasites, which have evolved with them.
I note that assassin bugs, a carrier of Chagas' Disease, also occur in North America, although in limited areas.
Where I live, Aedes mosquitoes, which in tropical areas can carry yellow fever, now live. The temps here rarely get above 18C.
Mosquitoes have been spread by world marketing, some since the 1700s, and some quite late in the 20th century.
Arctic and cold temperate varieties and species carry more fats genetically, allowing them to live in cool areas. Whether or not significant warming occurs, with a sufficient prey population, this vector will be taken advantage of by some viruses and other parisitic organisms.
Although we can look to global heating as changing habitats, we also must recognize population increase, such as the 1400% increase in human African within a century, as primary in the emergence and spread of our only significant remaining predators.
Fraud in African nations, in the form of adulterating small quantities of effective medicinal treatments for parasitic, bacterial, and viral diseases, is rampant. Just enough, and sometimes less, of a medicine is put into a concoction to give some relief at first, selecting for resistance in remaining organisms. The AIDS virus appears to be mutating resistance there, in the heart of the AIDS epidemic, due to this, as are numerous other diseases.
War, as causing travel and spread of disease, is a factor to be recognized. War is also a factor in famine. Once, such places as Afghanistan were more forested, with arboriculture and wild and domesticated animals prolific enough to prevent want. Over 150 years of war has devastated the earth there.
Historically, Humans never take the initiative to have less children following wars.
Vibrio bacteria (as in vibrio cholerae) appear to increasingly tolerate salt water.
You have a changing world, changing far more quickly than previously experienced
scientific earthling,
Reply | Report Abuse | Link to thisFirst, please read my comments: I did not refer to "dying" but rather suffering.
Second, read Hotez's article - I suspect you haven't done that either.
Third, I ,too, have seen people die. How is your having seen people die germane to the discussion of relieving/preventing NTDs? Which is, by the way, this article's topic!
What you describe is the last physiological stages of death, not the suffering and debilitation described in the article.
If having an NTD is so "painless" (your word, not mine), then I'm guessing you certainly wouldn't mind having a gut full of ascaris; or being tormented by and eventually blinded by onchocerciasis; or having your face disfigured by leishmaniasis?
You see, scientific earthling, you strike me as one who easily discounts the suffering/death of others while pontificating from your own comfort zone. You're full of opinion and nothing else.
Until your can demonstrate your contribution is more than "life has no meaning" and let the poor bastards suffer until they die, I do think your remarks are irrelevant to this topic.
There are those persons who are more experienced and probably more educated than you who clearly see all the problems associated with improving human and non-human life on this earth and do not share your nihilistic/do nothing view.
You've made your defeatist point; further repetition is unwelcomed redundancy.
Are you a Libertarian? You sound like one.
Reply | Report Abuse | Link to thisWhat would the Buddha do? Compassion and a reduction of the suffering of afflicted people is not going to tip the world into any more dire a population catastrophe than already exists.
Reply | Report Abuse | Link to thisSolutions mean hard work, and not casual Libertarian death sentences for suffering people.
Hasn't former President Carter done work on the Guinea worm that causes, among other things, blindness? Drinking water, clean drinking water, ends much suffering.
Reply | Report Abuse | Link to thisYes, the Carter Center does have a Guinea worm (dracunculiasis ) eradication program which was started in 1986.
Reply | Report Abuse | Link to thisThe information on the Carter Center website indicates the number of indigenous Guinea worm continues to decline - eradication being the ultimate goal.