Scientific American-January 2008
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OPINION posed increases may vanish before the ic stem cell research. But some Demo- bills become law, and in the meantime cratic lawmakers have also obstructed THE EDITORS’ BL8G federal agencies have to operate at last progress. Representative John Dingell of For more posts from SciAm Observa- year’s funding levels. Michigan, chairman of the House Ener- tions, see www.SciAm.com/blog Who’s to blame? Our government’s gy and Commerce Committee, fought dismal science record for 2007 is partly the increase in fuel economy standards Won a Nobel? Go Nuts! the result of the political gridlock that proposed in the Senate’s energy bill, say- Posted by Philip Yam, October 19, 2007 occurs whenever one party controls ing it would devastate U.S. automakers. As a long-time science journalist, I have Congress and the other rules the White Internal divisions among Democrats led learned to take what James Watson says House. Last June, for example, President to the current logjam on the energy issue, with a grain of salt. Even so, I was caught Bush vetoed legislation that would have which must be untangled for the sake of off guard by the outrageousness of his expanded federal funding for embryon- our planet. g latest words. Watson gets all the kudos for his genetics work, and his discovery with Francis Crick of the double-helical structure of DNA unquestionably Sustainable Developments deserved the Nobel Prize. But maybe that’s what’s wrong. For most research scientists, winning the Nobel Prize stands as the pinnacle of Primary Health for All success, the ultimate goal that takes intelligence, dedication, luck and Ten resolutions could globally ensure a basic human right ambition (and don’t be fat, Watson would at almost unnoticeable cost say, because fat folks are not ambitious). BY JEFFREY D. SACHS Once the king of Sweden drapes that medal around your neck, life is good— Sixty years ago at the Second, half the increase should be people want to hear you speak, offer you launch of the World channeled through the Global Fund to prestigious positions and are more Health Organization, Fight AIDS, Tuberculosis and Malaria. inclined to give you what you want. the world’s govern- The Global Fund has proved to be a To their credit, some scientists take ments declared health highly effective institution, with mini- the opportunity to tackle very “out there” to be a fundamental mal bureaucracy and maximum impact. research. Soon after he won his 1995 Nobel in Physics, Martin Perl launched a human right “without It has supported the distribution of project to fi nd “free quarks.” distinction of race, religion, political approximately 30 million antimalaria Conventional thinking says there can be belief, economic or social condition.” bed nets, helped to get nearly one million no such things—quarks must remain Thirty years ago in Alma Ata, the world’s Africans on antiretroviral treatment and bound in the particles in which they governments called for health for all helped to cure more than two million build—but some scientists speculate that by the year 2000, mainly through the people of TB. some quarks might have been left over expansion of access to primary health Third, low-income countries should during the big bang. Perl recognized the facilities and services. While the world devote 15 percent of their own national long-shot odds of fi nding these quarks, missed that target by a budgets to health. but it was a project he could do because long shot, we can still Consider a poor coun- of his Nobel. A graduate student would be achieve it, at remark- These simple steps try where the average committing career suicide. ably low cost. Ten key income is $300 a year. Other researchers run from the glory. could save the lives steps can bring us to The total national Brian Josephson, who discovered the of nearly 10 million quantum effect in which superconducting health for all in the budget might be electrons could jump across a narrow next few years. adults and children. around 15 percent of barrier, went off to study mysticism and First, affl uent coun- GDP, or roughly $45 psychic phenomena. (His problems, tries should devote 0.1 percent of their per capita. Fifteen percent of that fi gure though, may run deeper; not many people gross domestic product to health care for devoted to health would come to just would choose Taco Bell for a [free] lunch low-income countries. With a rich world $6.75 per person per year: not enough to meeting.) GDP of $35 trillion, that would create a provide adequate basic health care on its After the wacky things James Watson fund of roughly $35 billion a year— own, but combined with $35 per capita has uttered over the past decades—on enough for $35 per capita in added health from donor aid, it would do the job. continued on page 37 services for the roughly one billion peo- Fourth, the world should adopt a plan ple who need them. for comprehensive malaria control, aim- INSTITUTE GILBERT/EARTH BRUCE 34 SCIENTIFIC AMERICAN January 2008 © 2007 SCIENTIFIC AMERICAN, INC. OPINION ing to bring malaria mortality nearly to zero by 2012 through nurses and community health comprehensive access to antimalaria bed workers. nets, indoor spraying where appro- Tenth, using recent break- priate, and effective medicines throughs in medicine and when malarial illness arises. public health, the expanded Fifth, the rich countries health systems in the poorest should follow through on their countries should be equipped long-standing and achievable to handle noncommunicable commitment to ensure access diseases that have long been to antiretrovirals for all HIV- neglected but are treatable at low cost: infected individuals by 2010. hypertension, cataracts and depression. Sixth, the world should fi ll the These simple steps could save the lives of nearly 10 million fi nancing gap of roughly $3 billion adults and children a year, at a cost that would be nearly unno- a year for comprehensive TB control— ticeable to the world’s wealthiest nations. These measures would another area where known and long-proved interventions are also slow, rather than accelerate, population growth in impover- highly effective but chronically underfunded. ished regions, thereby easing the economic and environmental Seventh, the world should honor, for just a few billion dollars strains that bulging populations are imposing on them. Health a year, the access of the poorest of the poor to sexual and repro- for all is not only the moral imperative it was at the launch of the ductive health services, including family planning, contraception World Health Organization 60 years ago, it is also the best prac- and emergency obstetrical care. tical bargain on the planet. g Eighth, the Global Fund should offer roughly $400 million a year for comprehensive control of several tropical diseases (main- Jeffrey D. Sachs is director of the Earth Institute ly worm infections), which occur in virtually the same regions at Columbia University (www.earth.columbia.edu). where malaria is rampant. Ninth, the Global Fund should open a new fi nancing mecha- An expanded version of this essay is available at nism to bolster primary health care, including—most impor- www.SciAm.com/ontheweb tant—the construction of clinics and the hiring and training of Forum A Better Mosquito Net Fighting malaria will require more innovative defenses BY EVA KAPLAN Malaria remains one of To combat the disease, many develop- there is anecdotal evidence that some the world’s great scourges, ment agencies have focused on distribut- people have employed the nets as wedding striking more than 500 ing mosquito nets that would protect Afri- veils or fishing aids. Some economists million people every year. cans from being bitten while they sleep. argue that charging a small fee for the The groups most at risk This strategy has resulted in a huge upsurge nets would increase the likelihood that are pregnant women and in the number of bed nets supplied to the they would be used appropriately. Others children younger than population as a whole and particularly to claim such a fee would prevent a large fi ve years old. In sub-Saharan Africa, 20 pregnant women and young children. The part of the population from receiving percent of all childhood deaths are from widespread distribution, however, has nets. These are valuable debates. Before malaria. Pregnant women who contract not resulted in a signifi cant decrease in delving into behavioral economics, the mosquito-borne disease can develop malaria. Many doctors in sub-Saharan though, it might be useful to consider a severe anemia and give birth to under- Africa attribute the failure to an overreli- more basic problem: the mosquito nets weight babies. The World Health Organi- ance on nets in lieu of other interventions, are poorly designed. zation estimates that 10,000 pregnant such as the indoor spraying of dwellings The bed nets distributed by govern- woman and 200,000 infants in Africa die with insecticide. Other experts say the ments and international organizations from malarial infections every year. problem is the misuse of mosquito nets; have one of two basic designs: circular or COLLINS MATT BY ILLUSTRATION BORLAND; JAMES BY PHOTOGRAPH 36 SCIENTIFIC AMERICAN January 2008 © 2007 SCIENTIFIC AMERICAN, INC. OPINION THE EDITORS’ BL8G For more posts from SciAm Observa- tions, see www.SciAm.com/blog continued from page 34 women, homosexuals and the obese, to name a few—now comes his decision to join hands with the transistor-developing, eugenics-advocating, sperm-donating William Shockley, who, I recall, blamed his wife’s genes for his kids being less than genius.