Monday, October 01, 2007


Computing teacher Tim Lambert introduces a post consisting almost entirely of excerpts -- 568 out of 696 words -- from a Lancet "paper":
Last year I wrote about the inaccurate claims that the World Health Organization had reversed its policy on DDT when it had in fact supported its use all along.

A recent paper in Lancet Infectious Diseases 2007; 7:632-633 also concludes that there has been little real change.
Lambert's earlier post has already been shown to be the usual misleading crapola. For example, he says that as recently as 1994 the World Health Organisation nominated DDT as its insecticide of choice but the link he provides doesn't support his claim, instead citing 1984. This is but one of his many misrepresentations. Thus his praise for the Lancet "paper" is really a damning endorsement -- akin to OJ touting a particular brand of knife.

The Lancet "paper" is not a research paper as such; it's really nothing more than an opinion piece that parrots the same anti-DDT line pitched by Lambert. Let's take a look.

The opinion piece starts off (my bold):
In September, 2006, WHO alarmed many of us working toward a reduction in the use of toxic chemicals such as dichlorodiphenyltrichloroethane (DDT). In a press release, the organisation announced the promotion of DDT for indoor spraying against malaria mosquitoes.[1] After 30 years of gradually reduced focus on DDT, this appeared to be a sudden turnaround.
So the authors are alarmed at the WHO's plan to promote greater use of DDT, the only thing is, they claim the WHO never actually reduced DDT use:
We, however, cannot see a real change in WHO policy. DDT was the main component of the WHO Global Malaria Eradication Program during the 1950-60s. The programme ended in 1969 following evidence of DDT resistance in mosquitoes and increased public concern about adverse health and environmental effects. From 1970 onwards, many countries banned the agricultural use of DDT. However, in 1971, an executive WHO board maintained that indoor spraying of DDT was still WHO policy.[2] During the following decades, the WHO Expert Committee on Malaria continued to order indoor spraying of DDT for malaria vector control, provided that the targeted mosquito species were vulnerable to the insecticide. In the 1990s, several reports linked DDT to human cancers[3] and [4] and the insecticide was found in breast milk;[5] however, WHO continued to promote DDT use.
The authors are obviously confused -- perhaps because they're so alarmed -- about exactly what the WHO has been doing and what it plans for the future. This confusion is made obvious by their claim that the WHO Expert Committee on Malaria "ordered" DDT use. The WHO Expert Committee on Malaria is an advisory body that doesn't issue orders. And the Committee certainly wasn't pro-DDT back in 1998 when, in contemplation of DDT being formally banned, it recommended:
It is anticipated that for some time to come there will continue to be a role for DDT in combating malaria, particularly in the poorest endemic countries. Restrictions on DDT for public health use contained in a future Persistent Organic Pollutants Convention should therefore be accompanied by technical and financial mechanisms to ensure that effective malaria control is maintained, to at least the same level, through vector control methods that depend less on pesticides generally, and on DDT in particular.
The committe also stating:
... in view of the availability of alternative insecticides for indoor residual spraying, some of which may compete with DDT in terms of epidemiological impact, public acceptability, logistic suitability and compliance with specifications issued by WHO, DDT no longer merits being considered the only insecticide of choice.
The cancer references are also iffy: the cited 1992 study [3] suggests increased pancreatic cancer risk in the case of high level, long term exposure as might be found in those employed in DDT manufacturing; and the referenced breast cancer study [4] is also old, dating from 1993. In any event, the WHO's Expert Committee on Malaria found the studies unconvincing, stating for the record:
The information presented does not provide convincing evidence of adverse effects of DDT exposure as a result of indoor residual spraying as carried out in malaria control activities.
The already iffy stuff gets even iffier with the introduction of environmentalist spin -- hey, maybe the authors did their research at Deltoid; if so, it's no wonder their bias is showing:
The pro-DDT community, which includes the organisation Africa Fighting Malaria, a US senator, Fox News, and, argues strongly in favour of DDT as a panacea for the world's malaria problems. This community's arguments often refer to South Africa, which replaced DDT with deltamethrin in 1996. After 5 years of deltamethrin use, annual malaria cases increased substantially--a consequence of insecticide resistance in mosquito species entering from neighbouring Mozambique.[6] These mosquitoes were still susceptible to DDT; thus, the government resumed indoor spraying with DDT and promoted more effective antimalarial drugs. As a result, the number of malaria cases decreased.

As shown by WHO's Global Malaria Eradication Program, malaria control requires an integrated approach. An arsenal of interventions are needed ranging from timely and effective habitat and vector control, prompt and rapid diagnosis and treatment, reliable distribution of bednets, drugs, and prophylactics, public awareness campaigns, insect-parasite research, and interministerial cooperation to improve people's sanitation and living conditions.
Apparently only anti-science right-wingers, with an unrealistic view of DDT as a magic bullet, support the use of DDT in the fight against malaria. This ignores the fact that a worldwide de facto DDT ban was averted through a campaign supported by a significant number of those actually involved in battling malaria. Hell, even Environmental Defense (formerly the Environmental Defense Fund) is pro-DDT.

And no matter how you look at it, DDT did help bring malaria back under control in South Africa. It is pointless to dredge up the failed malaria eradication effort of the 1950s and 60s when 40 years on even malaria control is beyond the means of many African nations.

The authors then put in a plug for their parent organisation Bioforsk, which is working with the UN, developing integrated pest management (IPM), integrated vector management (IVM) and combined integrated pest/vector management (IPVM) strategies aimed at implementing a "sustainable alternative to DDT and other toxic chemicals" in the relatively well developed countries of "southeast Asia and the Pacific".

While admirable, such programs simply ignore the real malaria problem, Africa, whose people suffer something like 90% of all malaria related deaths. Africa is ignored because the "arsenal of interventions" required for effective integrated management strategies are well beyond the capabilities of the poorest nations. Thus the continuing African need for cheap, and reliable, DDT.

This need is recognized by the authors:
In conclusion, we emphasise the importance of an integrated approach to vector management. Silver-bullet solutions such as DDT alone are not the answer. DDT is still an important temporary tool to control malaria under difficult conditions, but its use should strictly follow WHO guidelines. There are science-based reasons for DDT being on the "dirty dozen" list of the Stockholm Convention on Persistent Organic Pollutants and alternatives are needed. Our responsibility to future generations demands choosing safe and sustainable alternatives in our present activities.
It would be helpful if the authors told us who with any influence on anti-malaria policy advocates sole reliance on DDT against malaria. DDT is, after all, only one of the many insecticides recommended by the WHO for indoor use against mosquitoes, which gradually develop resistance to all chemical control measures. Also, insecticide treated bednets are in some circumstances a viable alternative to insecticides. Thus, it is silly to regard DDT as the malaria solution.

In cautioning that DDT use "should strictly follow WHO guidelines" the authors hint at the danger that DDT will eventually be used indiscriminately -- you know, when right-wing pro-DDT nutters eventually convince the UN to resume DDT carpet-bombing. Such scare-mongering is silly since DDT is sprayed in small quantities inside homes rather than into the environment. Even should DDT be unscrupulously diverted for agricultural use the amounts released would be small; environmental damage would be minimal.

For an academic Tim Lambert produces very little scholarly writing. But he is very active online: duplicating the work of others; misrepresenting ideological opponents; bending facts; smearing ideological opponents; and manipulating discussion at his site. The excerpted Lancet "paper" fits right in. Interestingly, Lambert deemed it necessary to omit the following:
In 2004, WHO published the Global Strategic Framework for Integrated Vector Management (IVM). This approach seeks to improve the efficacy, cost-effectiveness, ecological soundness, and sustainability of disease vector control. IVM is a decision-making process to manage vector populations, aiming to reduce or interrupt vector-borne disease transmission. It is based on the successful experience with integrated pest management (IPM) used in agriculture.

The IPM initiative began as a response to the high-input, chemical-based Green Revolution in agriculture. When it came to effective pest control, the revolution proved unsustainable. Pest resistance and resurgence led to the development of biological control methods using natural predators and environment-friendly alternatives. As a vehicle for IPM implementation, Farmer Field Schools were developed and have now been implemented in 78 countries with about 4 million farmer participants.
In perhaps the understatement of the century the Global Strategic Framework for Integrated Vector Management notes:
Integration at the level required for IVM is not a simple task — national leadership and adequate local capacity are essential.
Indoor spraying with DDT is currently beyond the capability of many African nations, so there's no way they'd be able to implement a much more complicated IVM program.

Deeming the Green Revolution to be "chemical based" proves that the authors live in an alternate reality: the Green Revolution was actually based on new plant varieties.

The Lancet "paper" is misleading crap start to finish. That's why Lambert features it.


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