Malaria: Can science cripple development?

The title is from a provocative article by Bart Knols (of MalariaWorld) on the modern malaria research establishment. I came across the piece through some related commentary at the terrific PloS Speaking of Medicine blog. His central thesis is a somewhat rhetorical question: “Is the bulk of today’s malaria research helping to control malaria?”

As someone within the research confines, Dr Knol’s comments ring true. Even in malaria research institutions in endemic countries, where  presumably there is greater pressure to focus on applied and operational questions, most new young scientists are taken by the latest molecular method.

These topics reminds me of a letter to the editor I came across a few years back:

Maintaining health in the tropics requires more than medical intervention after disease strikes. It requires more than drugs and vaccines to prevent disease. It requires something else, hygiene. Next year will be the 100th anniversary of the commencement of the work of Dr. William Gorgas in Panama. That 10-year effort was not accomplished with medicine or global health, it was hygiene: spraying insecticides, eliminating breeding sites, creating efficient drainage, building homes that keep mosquitoes at bay, and many other measures unrelated to clinical or laboratory medicine. Today many of the tropical infectious agents our Society investigates creep out of the conditions created by ignorance of hygiene.

The neglect of hygiene as a tool of disease prevention is lamentable. A simple hygienic practice that could prevent endemic disease often doesn’t happen because no one thought of it. We fly into areas of endemic disease bearing rapid diagnostics and effective therapies, but we neglect to bring the idea for a simple measure of hygiene that could prevent most of the infections being diagnosed and treated. Hygiene has no cache. No one funds research aimed at improving hygiene, and that’s too bad. Hygiene comes with no microsatellite arrays, ELISA wells, or dramatic recoveries in the clinic. Sound hygiene quietly creates communities of healthy people.


5 Responses to “Malaria: Can science cripple development?”

  1. 1 Akash April 17, 2010 at 5:13 am

    Yeah, when I asked you about your thoughts on single-issue eradication efforts dominating developing country health budgets, it was based on an editorial in India complaining about the lack of attention given to basic public health measures like sanitation. The authors were annoyed that things like polio eradication were getting huge funding, but were doomed to fail without basic sanitation because of feco-oral transmission. And they thought health payoffs for non-disease specific interventions like sanitations were larger.

    But I think there is a valid argument to say that single-issue programs are great as long as they focus enough of their attention and money on basic services (like the letter you quote talking about hygiene), recognizing that they’re important to the single issue itself.

    Anyway, interesting post.

    • 2 naman April 17, 2010 at 7:03 am

      thanks Akash – like we discussed before, focused control programs and basic biomedical research have made great strides. We just shouldn’t forget the basics either. I’m enjoying your blog posts – keep it up!

  2. 3 Will April 18, 2010 at 1:52 pm

    I wonder if promoting hygiene has lost favor in part because it sounds ‘colonial’. The promotion of hygiene has a very 19th century ring to it.

  3. 4 naman April 18, 2010 at 2:21 pm

    hah. It does seem 1920s-ish. Old is gold?

  4. 5 Akash April 20, 2010 at 7:18 am

    I read a pretty sweet book about that, actually:

    Its called Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines. Kind of an anthro/history study of US hygiene and sanitation efforts in the philippines in the early 20th century. Would definitely recommned.

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