Archive for the 'Communication' Category

Everything has its time

The Malaria Blog is retiring. Writing posts was a blast while it lasted but the times change. The blog helped focus what I was already reading into meaningful output, connected me to many kind strangers, and provided a platform to share some of my own views. Five years later, none of these matter anymore. My audience is different, my interests are broader, and I use different platforms for disseminating ideas. The public nature of blogs, generally a boon for many reasons, was always a source of some slight discomfort. The ideal of quiet service, acting (or writing) without fanfare, is appealing and seems incompatible with the medium. Perhaps it is not, but I need to try other means now. I’m grateful to everyone who read and commented.

PS the site will be archived here.

Style of criticism

I’d like to turn to the subject of being critical. I have no desire to pour rain on the good intentions of others. Yet many of my posts take on a critical tone and some are even snarky. But they are always accompanied with a certain guilt. Critical thought has a place. It’s a perspective missing in much public debate. The web especially tends towards an echo chamber.  Why does this happen? Lots of reasons: we live in an era of concerted marketing, an inability to respond critically (especially for heavily technical areas), the lack of confidence to publicly express criticism, social desirability which suppresses it, and so on. The problem may be worse within communities working on humanitarian matters where normative stances tend to be similar. Additionally, the dominance of soft money, a limited set of funders, and frequent career jumps edges us towards caution. I’m reminded of a scene from a TV show (edited some for brevity and mostly for foul language):

If only half of you at the district attorney’s office didn’t want to be judges, didn’t want to be partners in some downtown law firm… If half of you had the balls to follow through, you know what would happen? A guy like that would be indicted, tried and convicted… But no, everybody stays friends. Everybody gets paid. And everybody’s got a future.

– The Wire

But thinking critically and expressing it are different matters. The former is desirable and essential. The second of questionable utility and perhaps taste. I came across this somewhere:

Attacking bad books is not only a waste of time but also bad for the character. If I find a book really bad, the only interest I can derive from writing about it has to come from myself, from such display of intelligence, wit and malice as I can contrive. One cannot review a bad book without showing off.

– W. H. Auden, “Reading,” The Dyer’s Hand, And Other Essays

I’ve heard it another way – it’s easier to clever than it is to be kind. What’s the alternative to critical expression then? I don’t think there is any per se but I’m trying, struggling, to apply two points. First, being generous with one’s criticism. Second, thinking appreciatively. These are not unrelated. The former allows us to retain the benefits of the critical approach and in fact, enhances it by upholding a higher standard. The latter makes sure we don’t get overwhelmed by it. I won’t elaborate more because the links are excellent. Another term ‘steelmanning‘ (hat tip: Andrew).

Paid writing of malaria trial results

The New England Journal of Medicine recently reported phase III trial results for artesunate + pyronaridine and tucked away in the acknowledgments I noticed this:

We thank Naomi Richardson (Magenta Communications) for developing the first draft of the manuscript and for editorial assistance.

I wondered, why? On one hand, for a well-defined type of study such as a phase III randomized controlled trial the writing can be fairly formulaic and easy to outsource. The data analysis was also conducted by another corporation. As an industry-sponsored study, no doubt the funders wanted a quick, and efficient process once the trial was complete. The additional cost of these services (anyone know how much?) which I suspect are expensive may not be much compared to the entire study budget. Still, it is somehow disappointing to me to see a paper which was not analyzed or written by the scientists who conducted the work. Is the process not important and what are we losing to the CRO culture which dominates these days? By all accounts (number of previous publications), Dr Ronnatrai Rueangweerayut who is the first-author, could have benefited from the writing experience. How else will we build scientific capacity?

Wall Street Journal book review: Lifeblood

From the WSJ, Sonia Shah author of The Fever (here and here), reviews Lifeblood which chronicles the efforts of Ray Chambers to deliver lots and lots of treated bed-nets to Africa (previously discussed here). I’m mostly sharing this post because I’m a big fan of strong opening and closing sentences and these blew me away:

Readers may wonder how this new business-driven aid substantially improves on the old—which to date has eradicated smallpox, exterminated malaria from 18 countries and nearly eradicated polio. To achieve its goals, old-style aid may have sometimes exaggerated the depth of the problems it sought to address. But the new aid, as depicted in “Lifeblood,” seems to exaggerate the value of its interventions.

Having closely followed all efforts malaria, I’m inclined to think her observations are right on the mark.

Has WHO eliminated artemisinin resistant parasites?

Possibly, but probably not, and certainly too early to tell. Though some would have you believe it already. The World Health Organization press release makes two claims: 1) artemisinin-resistant malaria (previously discussed here and here) has almost disappeared from areas tested in a pilot project managed by WHO and 2) the overall incidence of malaria has reduced significantly in the zone targeted by the project.

For the first claim no citation, efficacy or parasite clearance time data, or evidence of any sort are mentioned including who these researchers might be. The (presented) basis for the second claim lies in the screening of just 2,782 persons (it is unclear if this was a mass survey or several months of active case detection) in which only 2 P. falciparum cases were found. I realize this is not a scientific paper, but the ‘screening’ of a few thousand people in a border population of millions before the main malaria transmission season over the upcoming months seems little to be excited about. What was the need for this? The project just began in 2009. Why not wait another two years before making any public pronouncements? Alternatively, only provide regular updates through a somber and detailed format such as an annual project summary.

I believe in WHO. First, WHO has an unique mandate for supranational coordination. Second, WHO operates by consensus which, while time-consuming and difficult at times, allows countries large and small to have a voice at the table. And finally (related to the previous point), they maintain the trust of ministries of health in a way no other organization does – at least for now… They are losing their reputation by continuing to release shoddy statements backed by limited or poor quality data.

I’ve already complained about science and public health by press release. I understand it though from NGOs but I do not understand this trend from an organization which prides itself as a leader in developing quality health recommendations and soliciting technical excellence.


Malaria research and control by press release

I’m torn about press releases of scientific and programmatic work.

On one hand issuing press releases rapidly disseminates findings, generates interest, and helps reach new audiences. Every institution, whether a university, NGO, or even a multilateral, has to maintain a supportive constituency and most will seek to ever expand this base. The pressure to leverage every piece of potential news is therefore great.

On the other hand many press releases are about early stage findings which may not matter. Everyday I see new articles about malaria drug targets or bed net distribution which are heralded as ‘breakthroughs’ in the effort to cure or control malaria. They may be right but we won’t know for many years. It seems that  the deluge of press releases, which often in their original form or in their retelling misstate the research, unduly raise expectations. It also raises overall noise level of information vying for our attention – making it harder to find and focus on the news which really matters. In the end, too much public relations spin risks credibility.

Effect Measure, a terrific public health blog, wrote the following three years back:

Science is a slow business, unfortunately and we will need time. So I don’t understand why NIH has to issue a press release about it. It’s not exactly breaking news that will make an immediate difference if it makes a difference at all. I understand why various biotech companies pull this kind of PR stunt. They are trying to raise venture capital and reassure stockholders. But why does NIH need to do this?


Need to stay up to date on malaria research? MalariaWorld is a site which consolidates and summarizes recent papers. They also have a blog and a useful list of malaria related job openings and graduate research positions.