Like Meirelles I Make Mad Films, Okay I Don't Make Films, but if I Did they'd have the NIH

Did you know that 40% of snakebite victims are legally intoxicated when the paramedics arrive?

I knew that, because I go to Public Health School now. Among other things I've learned over the past three weeks: 1. When individual members of married couples are asked to name their best friends, the woman will typically name a female friend, but the man will typically name his wife. 2. The statistic I've been throwing around for the last ten years about how left-handed people die younger due to accidents with equipment made for right-handers is false, because the study in question confused the probability of dying stupidly given that you were left-handed with the probability of being left-handed given that you died stupidly. Mathematically, these are not equally probably events. 3. Bagel-slicing injuries skyrocket on Sunday mornings, and are strongly associated with high socioeconomic status. The safest way to slice a bagel is to use a serrated knife, and for the first half of the cut, press down on it with the hole parallel to the cutting board, then rotate 90 degrees in the sensible direction to finish out the cut.

So, basically, this is money well spent. Now on to some stuff that I think you all would profit from knowing, the sharing of which information was suggested to me by the movie Michael and I saw tonight, The Constant Gardner. It's a very good movie, they bothered to do meaningful research before slapping a film together, and I recommend it. It was so refreshing to see a movie whose writers knew at least as much about their topic as I did; given that it's a story about pharmaceutical companies running amok in Africa, that was the outcome I was least expecting. Anyway, my principle objection to the movie is that a good chunk of the plot relies on the circulation of a particular letter which is highly damning to its author, and I think it implausible that anyone connected with either pharmaceutical research, the British foreign service, or espianoge, would be willing to incriminate himself thusly in print. But that's a small objection.

In some ways Pharmaceutical Companies are an easy target--I only mean artistically. In practical terms they're almost impossible to target, unless they get caught doing something ethical like admitting a mistake, in which case they court bankruptcy. Now here's the movie I would have made, if I made movies.

The conduct of several clinical trials of antiretroviral drugs in African and other nonindustrial countries in the past several years has generated intense debate within the scientific community over trial designs that would not have met standards of ethical scientific practice in the U.S. Nine of the sixteen of these studies were funded by the U.S. government through the Centers for Disease Control or the National Institutes of Health; the rest were funded by other governments and by the UN AIDS program. All nine U.S.-funed studies and six other studies used a placebo arm in investigating interventions into mother-infant (vertical) HIV transmission even though the antiretroviral drug AZT is known to effectively intervene in vertical transmission. (Craddock S. AIDS and Ethics: Clinical Trials, Pharmaceuticals and Global Scientific Practice. In: HIV and AIDS in Africa: Beyond Epidemiology. Kalipeni E, Craddock S, Oppong JR and Ghosh, J, eds. Blackwell Publishing, 2005. p 240)(emphasis and color scheme mine).

Let me translate a little further: in developed countries like the US the medical ethics governing research prohibit using a placebo in a trial if an effective treatment exists. In other words, you can't compare your new intervention to a placebo unless no known treatment exists, you can only compare it to the standard treatment. Research conducted in developing countries has a history of snaking through with lower ethical standards, and such was the case in these studies. We knew that AZT could prevent the transmission of HIV through breastmilk, but the control groups of these studies were not provided with AZT, on the argument that there is a different standard of care in their native countries. According to that logic, they would have had no care at all had the research not been performed there, so they were no worse off participating in the trial. The standard applied to Africans was lower than the standard of care for Westerners. You can see why people wind up acting on that logic, but God help us if that comes to be recognized as ethical practice. And, as you can see, the NIH and the CDC and the UN were all behind these studies, so unlike in the movie world the problem wasn't that the people involved were all villains, it's that the problem is large and the medical community fell down on the job, or chose to look the other way because the stakes were so high. That's pretty fucked up in a fascinating sort of way if you ask me.

Now, don't you think one of those sixteen stories is worth making into a movie? Joel? Meitav? Anyone?