DDT Good! Chloroquine Bad!

On one occasion in 1976 when I left my New Guinea village to make a trip into town, my host family asked me to get medicine to kill the head lice their son had picked up while away at school. I did so, and he rubbed it into his hair and then tried to refrain from scratching his scalp as the lice ran around in their death throes. I think he may have had to “lather, rinse, repeat” to get the remaining nits after they hatched, too. It seemed to be effective, but I was horrified at the time to read on the label that the active ingredient was DDT. Nowadays, though, the reputation of DDT seems to have entered rehab.

On 11 April, the New York Times carried a story by Tina Rosenberg headlined, What the World Needs Now Is DDT:

[The book] ”Silent Spring” changed the relationship many Americans had with their government and introduced the concept of ecology and the interconnectedness of systems into the national debate. Rachel Carson started the environmental movement. Few books have done more to change the world.

But this time around, I was also struck by something that did not occur to me when I first read the book in the early 1980’s. In her 297 pages, Rachel Carson never mentioned the fact that by the time she was writing, DDT was responsible for saving tens of millions of lives, perhaps hundreds of millions.

DDT killed bald eagles because of its persistence in the environment. ”Silent Spring” is now killing African children because of its persistence in the public mind. Public opinion is so firm on DDT that even officials who know it can be employed safely dare not recommend its use. ”The significant issue is whether or not it can be used even in ways that are probably not causing environmental, animal or human damage when there is a general feeling by the public and environmental community that this is a nasty product,” said David Brandling-Bennett, the former deputy director of P.A.H.O. Anne Peterson, the Usaid official, explained that part of the reason her agency doesn’t finance DDT is that doing so would require a battle for public opinion. ”You’d have to explain to everybody why this is really O.K. and safe every time you do it,” she said — so you go with the alternative that everyone is comfortable with.

”Why it can’t be dealt with rationally, as you’d deal with any other insecticide, I don’t know,” said Janet Hemingway, director of the Liverpool School of Tropical Medicine. ”People get upset about DDT and merrily go and recommend an insecticide that is much more toxic.”

So DDT is now making a comeback, but Chloroquine, the antimalarial I took in New Guinea, is now anathema. (And it wasn’t all that effective for me. I got a bad case of Plasmodium vivax while there, and another within a year of returning from fieldwork.)

On 8 April, the Independent carried an alarming story by its health editor, Jeremy Laurance, headlined WHO failures led to hundreds of thousands dying from malaria, say medical experts.

Two of the world’s most powerful medical organisations have been accused of medical malpractice for knowingly promoting useless drugs that have led to the deaths of hundreds of thousands of children.

The World Health Organisation and the UN Global Fund, which was set up to buy drugs for poor countries, have allocated millions of dollars to malaria medicines that are no longer effective against the disease, a group of specialists said. They claim negligence by the two organisations contributed to a rising death rate from malaria, which has doubled in a decade in some parts of Africa because of growing resistance to older drugs.

The WHO launched its Roll Back Malaria programme in 1998 with a target to halve the number of deaths by 2010, but six years into the 12-year programme deaths have risen from between 600,000 and 800,000 to over one million annually, of which 90 per cent are in children under five.

Amir Attaran, of the Royal Institute of International Affairs in London, who made the accusation of malpractice in The Lancet with 12 malaria specialists from Britain, the US, Africa and the Far East, said yesterday: “I am angry because I know hundreds of thousands of kids have died for nothing; possibly millions. It is really negligent for these organisations to have made no progress towards the target in six years. Why should anyone connected with the programme still have their job?”

In 2003 the Global Fund, acting on advice from the WHO, spent $41.4m (£22.5m) on the outdated anti-malarials, chloroquine and sulfadoxine-pyrimethamine, which have been rendered useless by growing drug resistance, but only $18.3m on artemesinin-based therapies, which are effective.

Countries worst affected by malaria in sub-Saharan Africa have proved reluctant to buy the new artemesinin drugs because they are more expensive at $1 to $2 a dose, 10 times more than chloroquine. Although they get help from the Global Fund, they fear they may be left to foot the bill themselves. As a result, patients treated with the outdated drugs in Africa outnumber those given the effective artemesinin drugs by more than 10 to one.

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