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India Blames UNICEF for Vitamin A Overdose Deaths

An Indian court ruled in September that the United Nations International Children’s Fund and the United Nations were jointly responsible for the deaths of more than 30 children in November 2001 and ordered the two agencies to pay compensation to the families of the children.

The children died after being administer shots containing vitamin A. Vitamin A deficiency is a major problem in India.

UNICEF maintains that the medicine it delivered were perfectly safe, but that poorly trained health care workers in the Indian state of Assam gave some children unsafe doses of the medication leading to the deaths.

The judge hearing the case did find that health care workers in Assam were partially responsible, but also cited UNICEF for changing the method of delivering the vitamin A from a traditional two-milliliter spoon dosage to a five milliliter dosage taken by cup.

UNICEF said that it brief the Assam government on the changes and the proper way to administer the vitamin A.

No word on whether or not UNICEF plans to appeal the judgment.

Sources:

India child deaths blamed on UNICEF. Subir Bhaumik, The BBC, September 3, 2003.

India: 14 children dead after UNICEF vitamin programme. Pravda, November 19, 2001.

Do Africans Follow Anti-HIV Drug Regimen Better Than Americans?

One of the long-standing arguments against the use of anti-retrovirals to treat the AIDS crisis in Africa goes like this: African countries like the health infrastructure to ensure that patients will consistently take anti-HIV drugs (which, of course, have a number of side effects). This will create a situation, the theory goes, where few patients take the full set of drugs and likely give rise to more virulent, drug-resistant forms of HIV.

But a survey of African patients in Botswana, Senegal, South Africa and Uganda found that, in fact, HIV patients in those countries were more likely to stick to their regimen of AIDS drugs than were Americans.

On average, the survey reported that AIDS patients in those four countries take about 90 percent of the prescribed drugs. That ranks favorably with American AIDS patients who, in similar surveys, reported taking about 70 percent of their anti-HIV drugs.

Interestingly, there is also evidence that African patients are more truthful in reporting their compliance with the anti-HIV regimen than American patients. According to the New York Times’ report of the survey results,

Moreover, doctors say, most African patients are zealous about their regimens. They are also more truthful when estimating their adherence, said Dr. David Bangsberg, a professor of medicine at the University of California in San Francisco who has studied compliance patterns here and abroad.

On average, he said, American patients tell their doctors that they are doing 20 percentage points better than they really are — that is, a patient who says he takes 90 percent of his pills will, when tested with unannounced home pill counts or electronic pill-bottle caps, turn out to be taking 70 percent.

A study of 29 Ugandan patients found that, on average, they estimated that they were taking 93 percent of pills and proved to be taking 91 percent.

There are a number of possible reason for the difference, including that in African nations a number of people in the AIDS patient’s extended family may be contributing to help pay for the relatively expensive drugs, and that AIDS patients in Africa have a more immediate experience with numerous fatalities from the disease given the relatively high death rate from AIDS in Africa compared to the United States.

Sources:

Africans Outdo Americans in Following AIDS Therapy. Donald G. McNeil Jr., New York Times, September 3, 2003.

Survival Rates in the British NHS vs. U.S. Hospitals

There is some support in the United States for “solving” America’s health care problems with a state-run health system like Canada and European countries have. Fortunately, although there might be a lot of support for a generic health care system like this, such support tends to vanish when people start seeing the details (e.g. HillaryCare).

British paper The Telegraph had a story back in September about a study comparing the performance of the UK’s National Health Service with that of the United State’s mishmash of private, semi-private and public system of hospitals. The difference was quite striking,

Patients who have major operations on the National Health Service are four times more likely to die than Americans undergoing such surgery, according to a new study.

. . .

The results showed that just under 10 per cent of the British patients [in the study] died in hospital after major surgery, compared with 2.5 per cent of the American patients.

What would explain such a high difference in mortality? Are British surgeons and nurses less competent than Americans? Do Americans use technologies that the British don’t have access to?

Part of the difference in mortality rates is explained by a feature of most nationalized health care systems — the increased waiting period from diagnosis to surgery.

The joint study, carried out by University College London and a team from Columbia University in New York, found that patients in Britain who were most at risk of complications after major surgery were not being seen by specialists and were not reaching intensive care units in time too save them.

The other part is due to cost-cutting measures in Great Britain when it comes to post-op care. Quite simply, in the United States someone undergoing such an operation would be treated in post-op by another surgeon and an anesthesiologist, typically in a critical care unit.

Prof [Monty] Mythen . . . said: “In The Manhattan hospital, the care after surgery is delivered largely by a consultant surgeon and an anesthetist. We know from other research that more than one third of those who die after a major operation in Britain are not seen by a similar consultant.

“In America, everyone would go into a critical care bed — they go into a highly monitored environment. That doesn’t happen routinely in the UK.”

Which brings up my other pet peeve about nationalized health plans proposed for the United States. Advocates of such plans frequently blast HMOs for interfering with the doctor-patient relationship by dictating what doctors can and cannot offer their patients. But a nationalized health system would simply substitute a single entity — the federal health agency — for the various HMOs. Call it the mother of all HMOs.

The trend in countries that have nationalized health care is not some utopian health care system where doctors get to treat patients regardless of cost. Rather it is a system where health care is explicitly rationed by state and/or national health care agencies and health care decisions are completely subsumed to the need to control costs.

Source:

US surgery safer than under NHS. Thair Shaikh, Telegraph (UK), September 7, 2003.

Swaziland Government Demonstrates Its Support of Free Speech

About 2,000 protesters turned out to highlight the lack of democracy in Swaziland in August. Swaziland was being visited at the time by heads of state as part of an international conference on sustainable development.

Swaziland made the protesters’ point for them by using what the BBC described as “heavily armed paramilitary police and soldiers [who] fired tear gas canisters and rubber bullets to disperse” the crowd.

Of course the sustainable development conference included such stalwart supporters of democracy as Zimbabwe’s Robert Mugabe — perhaps Mugabe was taking notes on Swaziland’s technique for later application back home.

Source:

Swazi protesters and police clash. The BBC, August 13, 2003.

Congressional Idiots’ Hilarious IT Mishaps

Okay, so the mini-scandal of the week was the revelation that a person apparently part of Republican Orrin Hatch’s staff managed to access a Congressional server that contained drafts of memos by Democrats. The person in question then posted some of those memos on the Internet and/or leaked them to media people.

How could this happen? Because, in part, the Senate has what is bar none the dumbest way of handling its IT needs of any organization I have ever heard of. According to a Washington Times story on the leak investigation (emphasis added),

Republicans blamed the security problem on a glitch dating to May 2001, when Sen. James M. Jeffords of Virginia left the Republican Party to become an independent, giving Democrats control over the Senate and Judiciary Committee. When that happened, control over the Judiciary Committe servers also switched hands and new computer technicians unfamiliar with the system were hired.

How stupid could an organization be that it would arbitrarily recycle its IT staff for mission-critical infrastucture in this manner? Are people in the Senate really this stupid?

Wouldn’t the obvious solution be to place Senate IT duties with some non-partisan group that remains stable regardless of the vagaries of each election or party defection?

Stupid beyond words.

Source:

Senate GOP backs leak investigation. Charles Hurt, Washington Times, November 25, 2003.

Why Not Go All the Way on Reimportation of Drugs?

The debate over allowing Americans to import drugs from Canada — where they are generally cheaper — is fascinating if only to watch free trade Republicans come out in favor of protectionism and protectionist Democrats suddenly find the free trade religion.

I agree with those who believe Americans should be able to buy imported drugs from practically anywhere. If you can get your medication in Mexico or Canada cheaper than in the United States, go for it.

The main argument against this is that drug companies in Canada, for example, are forced to charge lower prices by the government there. Without higher drug prices in the United States, there won’t be enough money for future research and development.

This argument has some appeal, but frankly this is a problem the drug companies themselves are going to solve. Look, the basic problem is that drugs in Canada are far too cheap. Rather than challenge Canada’s ridiculous formulary pricing, drug companies just cave and pass on the costs of doing so to Americans. Screw that. Hopefully, allowing importation of prescription drugs will give the drug companies some backbone in such countries.

The other argument against reimportation of prescription drugs is, in my opinion, a red herring — that such drugs may be unsafe by American standards. Certainly those who favor reimportation dismiss such arguments as simply industry-serving nonsense.

But why not go all the way with this? Why not let American firms adopt manufacturing standards that are acceptable in Canada (or Mexico for that matter)? Why not let Americans import drugs from Canada (or other countries) that have yet to be approved by the FDA?

If it’s good enough for Canadians, it’s good enough for Americans, right?