TIM LAMBERT, DISSEMINATOR OF MISINFORMATION (PART 3)
Lambert's latest DDT related post is an attack on an Alicia Colon article in the New York Sun. For the sake of clarity here's the whole thing:
The DDT ban is similar to the ban on visiting certain websites on the computer network at my workplace. The system employs some sort of filtering that blocks access to sites deemed to have "inappropriate" content. Each blockage is accompanied by a notice that the user should see the system administrator if the blockage is felt to be unnecessary. Realistically, no one is willing to rock the boat, attract undue attention to himself or jump through the bureaucratic hoops necessary to have inappropriate blockages removed so even though access to certain sites isn't banned, it is. Of course, as with all bans, this ban on inappropriate sites isn't airtight; lots of inappropriate sites can still be accessed via the network.
Developing countries are naturally reluctant to use DDT when the US and EU ban it. This is complicated by the anti-DDT attitude of the World Health Organization, USAID, Roll Back Malaria and other international organizations. Even if a country does decide to use DDT as part of an anti-malaria campaign, there is a fearsome bureaucratic maze of notifications, registries and reporting to be navigated. These obstacles effectively prevent the use of DDT except in in a few cases: India and China, with their own DDT production facilities, being notable examples.
Right, back to Lambert and Colon. Colon does make a number of factual errors in her article. Referring to "The Silent Spring" instead of "Silent Spring" makes her look a bit silly but none of her errors negate the overall thrust of the article, that is, preventing African nations using DDT amounts to racism. Lambert somehow misses this, focussing instead on Colon's incorrect claim that Mozambique uses DDT.
Mozambique actually uses bendiocarb in its indoor residual spraying (IRS) program. Lambert fails to note, however, that bendiocarb is a poor substitute for DDT: it costs over 2 1/2 times as much as DDT; it must be applied much more often; and it's so toxic to animals and humans it was withdrawn from sale in the US – when used on interior walls it poses a particular hazard to children.
Lambert also fails to note that bendiocarb isn't the preferred IRS insecticide, DDT is. Why isn't DDT used? Simple, it's banned by the Mozambique Ministry of Health:
Lambert's mission is scoring political points, not disseminating accurate information. Odd for a science blog, no?
Update: In a post at his old site – copy and paste http://timlambert.org/2005/11/kmmn/ – Lambert notes the following in regard to Africa Fighting Malaria's petition for more effective expenditure of US anti-malaria funds:
Update II: A Google blog search shows this as the latest and most relevant DDT-malaria blog post. The post, titled "DDT Myths", sounded familiar because it is:
Update III: As pointed out in comments, I didn't "read the fine print" and incorrectly attributed the link in Update II to a Science Blog blogger. Apparently this mistake means my credibility is questionable. (I'll leave the error in Update II intact so readers can decide if my point about spreading misinformation is valid or not.)
Update IV: The Wall Street Journal reports on a new anti-malaria initiative:
Note: The second of the three posts in this series is at the "bullshit bingo" link above. The first is here.
Editing note: "maze of permissions" changed to "maze of notifications".
Alicia Colon has written the usual rubbish about how Rachel Carson killed millions of people (see DDT ban myth bingo for corrections to the stuff she gets wrong). After claiming that DDT is banned she writes:Rather than tell us what's wrong with the article Lambert engages in a bit of self-promotion in directing readers to his bullshit bingo – he obviously thinks his little game is really neato because just about every DDT post links to it. Lambert then accuses Colon of wrongly claiming that DDT is banned: Colon clearly has this right because she specifically refers to the United States, where the non-emergency use of DDT is in fact banned. Even if Colon isn't talking about the U.S. she's right because there is an effective, general DDT ban.Within two years of starting DDT programs, South Africa, Mozambique, Zambia, Madagascar, and Swaziland slashed their malaria rates by 75% or more.Apart from contradicting her claim that DDT is banned, this passage contains an interesting mistake. Mozambique has indeed slashed its malaria rate, but it hasn't used DDT. It seems that what is killing people in Africa is not restrictions on DDT, but lack of money for spraying and bed nets.
The DDT ban is similar to the ban on visiting certain websites on the computer network at my workplace. The system employs some sort of filtering that blocks access to sites deemed to have "inappropriate" content. Each blockage is accompanied by a notice that the user should see the system administrator if the blockage is felt to be unnecessary. Realistically, no one is willing to rock the boat, attract undue attention to himself or jump through the bureaucratic hoops necessary to have inappropriate blockages removed so even though access to certain sites isn't banned, it is. Of course, as with all bans, this ban on inappropriate sites isn't airtight; lots of inappropriate sites can still be accessed via the network.
Developing countries are naturally reluctant to use DDT when the US and EU ban it. This is complicated by the anti-DDT attitude of the World Health Organization, USAID, Roll Back Malaria and other international organizations. Even if a country does decide to use DDT as part of an anti-malaria campaign, there is a fearsome bureaucratic maze of notifications, registries and reporting to be navigated. These obstacles effectively prevent the use of DDT except in in a few cases: India and China, with their own DDT production facilities, being notable examples.
Right, back to Lambert and Colon. Colon does make a number of factual errors in her article. Referring to "The Silent Spring" instead of "Silent Spring" makes her look a bit silly but none of her errors negate the overall thrust of the article, that is, preventing African nations using DDT amounts to racism. Lambert somehow misses this, focussing instead on Colon's incorrect claim that Mozambique uses DDT.
Mozambique actually uses bendiocarb in its indoor residual spraying (IRS) program. Lambert fails to note, however, that bendiocarb is a poor substitute for DDT: it costs over 2 1/2 times as much as DDT; it must be applied much more often; and it's so toxic to animals and humans it was withdrawn from sale in the US – when used on interior walls it poses a particular hazard to children.
Lambert also fails to note that bendiocarb isn't the preferred IRS insecticide, DDT is. Why isn't DDT used? Simple, it's banned by the Mozambique Ministry of Health:
From the outset, pyrethroids were identified as the insecticide to be used in the spraying component of the LSDI. However, with the discovery of high levels of pyrethroid resistance in An. funestus, meetings were held with the RMCC, national and international experts to recommend an alternative to the use of this family of insecticides. Based on scientific data, it was unanimously agreed the best course of action would be to use DDT. In the light of Mozambique not agreeing to the use of DDT, an alternative recommendation was that a carbamate such as Bendiocarb be used. Ongoing research indicates levels of carbamate resistance outside the Zone 1 area and collections within the study area have been completed towards evaluating selection in this regard following spraying with a carbamate.Gee, maybe there's a shortage of anti-malaria money because the pressure's on to use expensive alternatives to cheap, reliable and nearly non-toxic to humans DDT.Increasing levels of insecticide resistance and the limited number of available insecticides, restricts what can be used in the residual house spraying programme in southern Mozambique. Given the discovery of pyrethroid and possibly carbamate resistance in the LSDI area the only remaining group of insecticides are the organophosphates which have a high mammalian toxicity. Since the use of DDT alone has not been approved by Ministry of Health in Mozambique, a rotational method of spraying is proposed, using different insecticides, as the way forward. DDT would need to be one of the insecticides used during such a rotational insecticide spraying programme.
Lambert's mission is scoring political points, not disseminating accurate information. Odd for a science blog, no?
Update: In a post at his old site – copy and paste http://timlambert.org/2005/11/kmmn/ – Lambert notes the following in regard to Africa Fighting Malaria's petition for more effective expenditure of US anti-malaria funds:
This is an absolutely dreadful way to run an anti-malaria program. The goal should be to reduce malaria and you should let the experts figure out the best way to do this. It should not be to spray DDT.Well, experts decided that DDT is the best possible insecticide for Mozambique but can't use it because it's banned. DDT is banned because people like Lambert continually spread misinformation about its use. This is bound to have a negative impact on Africans.
Update II: A Google blog search shows this as the latest and most relevant DDT-malaria blog post. The post, titled "DDT Myths", sounded familiar because it is:
Tim Lambert has been covering this beat for a while, and most of my info on the subject comes by way of him. Anyone curious should read his full archives on the subject here.The incestuous nature of this post can be accounted for at least in part by the fact that it was written by one of Lambert's fellow Science Blog bloggers. Thus is misinformation spread.
Update III: As pointed out in comments, I didn't "read the fine print" and incorrectly attributed the link in Update II to a Science Blog blogger. Apparently this mistake means my credibility is questionable. (I'll leave the error in Update II intact so readers can decide if my point about spreading misinformation is valid or not.)
Update IV: The Wall Street Journal reports on a new anti-malaria initiative:
George Ayittey of the Free Africa Foundation recently joined with hedge fund manager Lance Laifer and other investors to create "malaria-free zones" in Ghana, Nigeria, Kenya and Tanzania. "We held a fund raiser last September and by December -- two and a half months -- we had one village [Yawkoko, Ghana] up and running" with insecticide-treated bed nets and antimalarial drugs, says Mr. Ayittey. "We've been able to avoid the bureaucracy and move very, very quickly." By December, a second malaria-free zone was established in Nigeria, and a third village in Kenya followed last month. "We now have other private citizens in America interested in adopting villages," says Mr. Ayittey.Anyone wanting to contribute to the Laifer organized anti-malaria bed-net drive can do so here.
Note: The second of the three posts in this series is at the "bullshit bingo" link above. The first is here.
Editing note: "maze of permissions" changed to "maze of notifications".
posted by J F Beck at 11:39 PM
4 Comments:
Keep Up the good work RWDB
Here my stuff on Tim Lambert's state of denial a third, cleaner time
detribe--AT---gmail.com
There are two major issues Lambert has avoided in discussions with me.
The first is the outbreaks in South America caused by banning DDT. The details are given in the Nature Medicine paper quoted just below.
The second substantive issue that Lambert avoided in discussions with me is the epidemic of malaria that occured after DDT was banned in South Africa in the leadup to the Joberg 200 conference (details below).
When DDT was eventually reintroduced the epidemic was bought under control. This epidemic only got out of control because of political activism in RSA (mentioned politely in the papers I paste in below)to ban DDT.
There were tens of thousands of cases for several years, so there were about one hundred deaths in Zwa Zulu.
Lambert is right about one thing. Deaths from anti DDT activism were probably not millions, but 100 thousands of cases is a lot of misery, and say, at a death rate of about 0.3% per case, many deaths.
Nature Medicine 6, 729 - 731 (2000)
Balancing risks on the backs of the poor
Amir Attaran2, Donald R. Roberts1, Chris F. Curtis3 & Wenceslaus L. Kilama4
Department of Preventive Medicine and Biometrics Uniformed Services University of the Health Sciences Bethesda, Maryland 20814, USA
droberts@usuhs.mil
Center for International Development Kennedy School of Government Harvard University Cambridge Massachussetts 02138, USA
amir_attaran@harvard.edu
London School of Hygiene & Tropical Medicine London WC1E 7HT, UK
Chairman, Malaria Foundation International; also Chairman-Coordinator, African Malaria Vaccine Testing Network C26/27 Tanzania Commission for Science and Technology Building, Ali Hassan Mwinyi Road, P.O. Box 33207 Dar Es Salaam, Tanzania
Malaria kills over one million people, mainly children, in the tropics each year, and DDT remains one of the few affordable, effective tools against the mosquitoes that transmit the disease. Attaran et al. explain that the scientific literature on the need to withdraw DDT is unpersuasive, and the benefits of DDT in saving lives from malaria are well worth the risks.
KEY QUOTES
Until now, developed countries have grudgingly tolerated the use of DDT against malaria in poor tropical countries; at least 23 countries do so1. However, this may now be ending. Led by the United Nations Environment Programme, more than 110 countries are negotiating a treaty to "reduce and/or eliminate...the emissions and discharges" of 12 persistent organic pollutants, citing their "unreasonable and otherwise unmanageable risks to human health and the environment."2 If it becomes law, the treaty will likely end DDT manufacture, or at least make the supply scarce and unaffordable to tropical countries.
This, in our view and that of nearly 400 colleagues who have signed an open letter to the diplomats negotiating the treaty, is simply dangerous3. The scientific literature is unpersuasive of the need to withdraw DDT; on the contrary, it is clear that doing so risks making malaria control ineffective, unaffordable, or both.
...
In contrast, DDT spraying for malaria control is less intensive, less frequent and far more contained. The current practice is to spray the interior surfaces only of houses at risk, leaving a residue of DDT at a concentration of 2 g/m 2 on the walls, ceiling and eaves, once or twice a year. Half a kilogram can treat a large house and protect all its inhabitants. Doubtless some fraction of this escapes to the outdoors, but even assuming it all did, the environmental effect is just 0.04% of the effect of spraying the cotton field. Guyana's entire high-risk population for malaria can be protected with the DDT that might otherwise be sprayed on 0.4 km2 of cotton in a season5. Compared with its agriculture uses, public health uses of DDT are too trivial to merit banning with any urgency.
Tonic...or toxin?
Environment aside, health considerations arise, and with them the dilemma that one man's benefit is another man's risk. Environmentalists in rich, developed countries gain nothing from DDT, and thus small risks felt at home loom larger than health benefits for the poor tropics. More than 200 environmental groups, including Greenpeace, Physicians for Social Responsibility and the World Wildlife Fund, actively condemn DDT for being "a current source of significant injury to...humans."6 But five decades of experience with DDT shows that it is highly effective and safe when deployed in house spraying7.
...
But despite 'resistance' in itself, DDT still works to alleviate mortality and morbidity. Resistance tests work by measuring whether mosquitoes survive a normally toxic dose of DDT. The tests wholly overlook two non-toxic actions of DDT: contact-mediated irritancy9, which drives mosquitoes off sprayed walls and out of doors before they bite, and volatile repellency10, 11, which deters their entry in the first place. Both actions disrupt human−mosquito contact and disease transmission.
Data from the Pan-American Health Organization show a strong inverse correlation between malaria cases and rates of spraying houses (1959−1992) in South America, even after DDT resistance became widespread in the 1960s ( Fig. 1). Here, 'cumulative cases' represent the population-adjusted, 'running' total of cases that exceed or fall short of the average annual number of cases from 1959 to 1979 (years in which World Health Organization strategy emphasized house spraying12). Cumulative cases increase considerably in later years, coincident with a sharp decrease in rates of spraying houses.
This body of evidence is so indisputable that even environmental groups such as Physicians for Social Responsibility concede that DDT is "highly effective" in malaria control15. Campaigning for a DDT ban given this benefit would seem politically difficult unless one alleged even greater health risks associated with its use, which is precisely what environmentalists do. Recent bulletins from Physicians for Social Responsibility and the World Wildlife Fund cite animal studies indicating involvement of DDT in neurological and immune deficits, and epidemiological studies linking DDT to human cancers and endocrine-disrupting effects, such as reduced lactation15, 16.
In this kind of 'balance of risks' paradigm, the evidence must be scrupulously weighed. Although the International Agency for Research on Cancer rates DDT as a possible human carcinogen (along with, notably, several pharmaceutical drugs), not one case-control study of DDT's human carcinogenicity has been affirmatively replicated. Breast cancer furnishes the clearest example: the first study to correlate DDT exposure with statistically elevated risk17 has now failed to be replicated at least 8 times18, 19, 20, 21, 22, 23, 24, 25, and of these later studies, some found exposure to significantly reduce risk24, 25. Much the same can be said of studies indicating involvement of DDT in multiple myeloma, hepatic cancer and non-Hodgkin lymphoma26, 27.
That DDT interferes with maternal lactation is also questionable. The leading study to correlate DDT metabolites in breast milk with unexplained, premature weaning28 does not reach statistical significance unless the data are first 'adjusted' for potential confounders, but the authors did not disclose how their adjustment was done, and other labs have yet to confirm the result28. Lactation's many social, nutritional and cultural influences make inferences difficult, but even if DDT really abridges lactation, the authors found a "lack of any detectable effect on children's health."28
With such weak evidence of harm to human health, one must decide whether to set policy as a precaution and ban DDT based on animal studies. Ordinarily, this makes sense (given the alternative of experimenting on humans with toxins), but not for the spraying of houses with DDT. Acting with precaution because there are risks in animals, and thus denying people the known health benefits of malaria control, is very unethical: house spraying exposes millions of people to DDT, any of whose health can be studied, making extrapolations from animal studies unnecessary. Proper case-control studies should be done before policy is cast in treaty law.
Indeed, if precaution is relevant, it favors spraying houses with DDT, because it is affordable or effective where other interventions may not be. Cost data from India show that, even using DDT alone, the entire national malaria-control budget is sufficient to protect only 65% of high-risk persons. Switching to malathion, the next-cheapest alternative, reduces that coverage to 21%, which leaves 71 million more persons unprotected29. House spraying also has the advantage that it protects whole families, which is sometimes overlooked in comparing it with insecticide-treated bed-nets, which protect only one or two people at a time30. Simply put, there are too few economic studies to determine with certainty whether bed-nets are more or less cost-effective than DDT house spraying31. However, the fact that spraying houses with DDT can lower the prevalence of malaria parasitemia in highly endemic African communities to levels below that achieved by bed-nets (less than 5%) indicates that it is careless to treat them interchangeably8.
Patience in all things
How then to reconcile DDT's 'Janus-faced' character? Its benefit in alleviating the suffering of malaria, at a reasonable cost, outweighs any reasonable speculation of its health risks. Living with this may not be easy; changing it is harder still.
Above all, rich countries must allow, and even facilitate, poor tropical countries to make choices about DDT freely, and with informed consent. African countries in particular lack the resources to dispatch health experts to the treaty negotiations, and although it provides financial assistance, the United Nations Environment Programme has declined to assist with this, or even to provide a translator when French- and English-speaking diplomats meet to discuss DDT. The resulting lack of knowledge suffocates debate. At worst, threats are used, as Belize learned when the US Agency for International Development demanded that it stop using DDT.
Such arm-twisting is as lamentable as it is effective. Highly indebted poor countries must of necessity rank poverty reduction over environmental orthodoxy, and stimulating growth and foreign investment will require nearly eliminating malaria from economically productive zones. This is essential for development in sub-Saharan Africa, where malaria subtracts more than one percentage point off the gross domestic product growth rate, for a compounded loss (since 1965) now reaching up to $100 billion a year in foregone income32.
Seen in this way, the insistence to do without DDT is 'eco-colonialism' that can impoverish no less than the imperial colonialism of the past did. Sub-Saharan Africa, which never experienced much spraying of houses with DDT, should consider starting this. South Africa, Swaziland and Madagascar, among others, run successful DDT-spraying programs and prove it can be done1, 33.
At present, the United Nations Environment Programme mandate to "reduce and/or eliminate" DDT probably cannot be accomplished safely, without causing extra disease. As 'preachers of precaution', environmental groups and rich country governments should start by committing at least $1 billion annually to roll back malaria in Africa.
THE British Medical Journal has an open access article discussing effort to ban DDT- a ban Lambert repeatedly claimed was never attempted or implemented.
Doctoring malaria, badly: the global campaign to ban DDT
http://bmj.bmjjournals.com/cgi/content/full/321/7273/1403
DDT for malaria control should not be banned
BMJ 2000;321:1403-1405 ( 2 December )
Amir Attaran, director, international health research, a Rajendra Maharaj, deputy director, vector-borne diseases. b
a Center for International Development, Harvard University, Cambridge, MA 02138, USA, b South Africa Department of Health, Communicable Disease Control, Private Bag X828, Pretoria 0001, South Africa
The treaty on persistent organic pollutants---POPs---will be finalised at the United Nations Environment Programme meeting in Johannesburg, 4-9 December. One proposal is to ban DDT, still used by many countries for controlling the mosquitoes that spread malaria. It should not be banned, argue Amir Attaran and Rajendra Maharaj, specialists in malariology and also international development and law---there's no evidence that spraying with DDT harms anyone. The issue is not straightforward, says Richard Liroff, director of the World Wildlife Fund's alternatives to DDT project; the treaty raises a series of equity challenges.
KEY QUOTE FROM THIS PAPER
South Africa illustrates these limitations in practice. Facing pressure from environmentalists, the national malaria control programme abandoned DDT in favour of more expensive pyrethroid insecticides in 1996. Within three years, pyrethroid resistant A funestus mosquitoes invaded KwaZulu-Natal province, where they had not been seen since DDT spraying began in the 1940s. Malaria cases then promptly soared, from just 4117 cases in 1995 to 27 238 cases in 1999 (or possibly 120 000 cases, judging by pharmacy records). Other provinces experienced similar catastrophes, and South Africa was forced to return to DDT spraying this year. It had little alternative: no other insecticide, at any price, was known to be equally effective.
This experience raises a challenging question: if the wealthiest, most scientifically advanced, and least malarious major country of sub-Saharan Africa cannot make do without DDT, how can superendemic and impoverished countries like Tanzania, Congo, or Mozambique do so? Should they be asked to?
We conclude that the public health benefits of DDT amply outweigh its health risks---if, indeed, such risks exist at all. For doctors or their banner groups such as Physicians for Social Responsibility to campaign otherwise is not only wrong but outrageously unethical. Risk-benefit trade-offs are part of public health and medicine, and we would be swift to condemn the malpractice of doctors who would from ideology deny their patients cyclosporin, tamoxifen, chlorambucil, azathioprine, or any other lifesaving drug known to be a human carcinogen.12 The situation with DDT and malaria is hardly different. The public health malpractice of its avoidance must stop.
The second substantive issue that Lambert avoided in discussions with me is the epidemic of malaria that occured after DDT was banned in South Africa in the leadup to the Joberg 200 conference (mentioned abouve) . When DDT was eventually reintroduced the epidemic was bought under control. THis epidemic only got out of control because of policical activism to ban DDT. There were tens of thousands of cases for sevel years, so there were about one hundred deaths.
S Afr Med J. 2005 Nov;95(11):871-4
Impact of DDT re-introduction on malaria transmission in KwaZulu-Natal.
Maharaj R, Mthembu DJ, Sharp BL.
Malaria Research Programme, Medical Research Council, Durban, South Africa. rajendra.maharaj@mrc.ac.za
OBJECTIVES: To determine whether the re-introduction of DDT in KwaZulu-Natal had any effects on malaria transmission in the province. DESIGN, SETTING AND SUBJECTS: The 2000 malaria epidemic in KwaZulu-Natal has been attributed to pyrethroid-resistant anopheles mosquitoes in the area. Previous studies have shown that these mosquitoes are still susceptible to DDT. To determine whether DDT re-introduction had any impact on malaria transmission in KwaZulu-Natal, the following variables (pre- and post-epidemic) were investigated: (i) the number of reported cases; and (ii) the distribution of Anopheles funestus in relation to the insecticides sprayed. OUTCOME MEASURES: The notified malaria cases and the distribution of A. funestus were measured to determine the effects of DDT re-introduction on malaria transmission. RESULTS AND CONCLUSION: After DDT re-introduction, the number of malaria cases decreased to levels lower than those recorded before the epidemic. A. funestus appears to have been eradicated from the province. The combination of an effective insecticide and effective antimalarial drugs in KwaZulu-Natal has resulted in a 91% decline in the malaria incidence rate. Unfortunately the continued exclusive use of DDT within the malarious areas of the province is threatened by the emergence of insecticide resistance.
speaking of misinformation...the post you link to wasn't written by me, but another co-blogger who isn't affiliated with science blogs. your credibility would be increased if you actually read the fine print to see who posts what on group blogs, as i assume you can agree that the notice "posted by Matt McIntosh" differs from "posted by Razib."
More to the point, razib, which side do you agree with?
More to the point, razib, which side do you agree with?
busy. i have no opinion at this point.
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