Episode 06: Of Microbes and Meat

A new episode of A Shot In The Arm podcast is out!

David Evans and I chew the cud about the state of antibiotic resistance, why we are at the end of the golden age of antibiotics, and what is going to happen if we do not get our act together now.

Sounds familiar? It should. There is growing awareness that climate change, global infectious disease, education, economic development and human rights are essentially a “singularity” (to borrow Ray Kurtzweil). That is to say, we face one issue, albeit with many confusing and contradictory aspects.

What is that singularity? I don’t think artificial intelligence covers it fully. Rather, it is about how our survival depends on how we empower individual innovation, while ensuring collective responsibility (to ourselves and our neighbors, animal, mineral and vegetable). Climate change and global infectious disease are the end result of over-population and the destruction of habitats to make room for agriculture to feed that population. We come into contact with old and new enemies, bacteria, viruses and heavens knows what. Only to find we are less prepared than ever to accommodate them.

There is a recently published new biography of the French Philosopher Denis Diderot by Andrew Curran. I strongly recommend it, especially for summer beach reading. Seriously. Admittedly, Diderot is not for the faint-hearted, and he had some obscure and hard-to-understand views on pretty much everything. But Andrew Curran engages you in a most satisfying way. And as it relates to a fundamental singularity, Diderot appears to have thought, at times, that far from being the pinnacle of evolution, humanity’s self-awareness may be a dead-end. it offers no promise, and is self-destructive. The planet will move on without us. There have been plenty of extinctions on this planet. What is one more, really? So, it really does not matter what we do or think. I did my very best to ignore Diderot at university, but at times like these, some of his thinking has a strong, if gloomy appeal.

Humanity’s abuse of anti-bacterials is a prime example of our species’ hubris. We, in the North, now blame the global South for the very problems we created - out of control use of antibiotics to treat diseases and grow food. Read this recent New York Times article, which captures exactly the sensationalist, if tone-deaf sentiment.

In the Post Second World War era, as sure as sliced bread, we have assumed that the science boffins are beavering away at solutions that are just around the corner. However, as David Evans points out, a recent review of current anti-bacterial research by the Pew Charitable Trusts shows that research, such as it is, is really not encouraging.

The perilous state of antibiotic research still surprises many people. We hold a simplistic and dismissive view of science and the sheer bloody perseverance that is demanded of our scientists. What do I mean by this? As an example, at the start of this episode, you can hear one of my occasional rants, this time about the otherwise gripping HBO miniseries Chernobyl. I was outraged that a generation of brave Soviet nuclear scientists (who, at great risk to themselves, spoke out about the disaster and how it might be addressed) was “represented” by one fictional character played by the English actor, Emily Watson. This may have made the facts bend more easily into a sloppy and predictable narrative. But it simply is not true. The producers put a lot of effort into the sets, though. And thus learn yet again, that it is easier to spend more attention on scenery than story.

Yet. Diderot, Chernobyl and antibiotic resistance notwithstanding, I cannot but be optimistic about our future. There is a blinking of a new collective realization that can change the way we will live, and it is possible to transform ourselves. We miss the point if we describe this moment through a stale 20th century lens of capitalism versus socialism. If HBO’s Chernobyl tells us anything, it is that stupidity is not a monopoly of today’s nationalist right. Damning the private sector just because it is private strikes me as clueless as complaining about the incompetence of the public sector.

Rather, the key is for a vibrant civil society to force the private and public sectors to work together. Occasionally, there will be flashes of brilliance, but more often it will be a long, hard slog. The framework that has really outlived its usefulness is the nation state. Viruses, bacteria and radiation know no national boundaries. The real lesson from the golden age of antibiotics is that it is pointless to regulate their use in our country, if they are not regulated next door. We have to find better ways of organizing ourselves. A more positive expression of this sentiment is that being a citizen of everywhere, is greater than being being a citizen of somewhere (yes, that’s a reference to that most unfortunate of politicians, Theresa May).

What do we do? I have always giggled at the late Aldous Huxley saying “It's a little embarrassing that after 45 years of research & study, the best advice I can give people is to be a little kinder to each other”. As always (that is, after he moved to California) Huxley is absolutely right.

Our story-tellers are as important to society as our scientists. It is not just a question of having the facts, but how they are woven into how we understand the world. Many of our story tellers are still employing narratives that do not fit the facts, whether be they be politicians, commentators, journalists, authors or show-runners for streamed mini-series spectacles. As many people would expect me to say, Margaret Atwood represents the kind of story-teller we need for the 21st century. She has an inquisitive and mischevious mind, that strikes me as entirely appropriate for our age (by the way, here is a total shameless plug for her sequel to The Handsmaid’s Tale is which is being released this summer. The novel has also been adapted by the streaming service Hulu and enters its third season in June). I would also like to give a shout out to my Oakland neighbor Oakland Buzz On The Street, which interviews A Shot In The Arm Regular, Gloria Lockett.

Scientists and story-tellers apart, what this means for the rest of us, at the end of the second decade of the 21st century, is the need for a democracy of responsibility: We all have to act, and cannot sit back and expect our authorities (public or private) to take care of things. I do not make that assertion lightly - it will require sacrifice in some way or another from all of us.

I promised in the first episode of A Shot In The Arm that we would stay abreast of developments in Venezuela, a topic that is sadly very relevant to this week’s show. Mary Ann Torres who heads ICASO (and for total transparency, I am its Board chair) has provided this harrowing update on impact the country’s collapse is having on people living with HIV.

Also sobering is the coordinated culmination in many southern states of the USA of hard-right and vicious anti-abortion laws. These are attacks on reproductive health justice. They are rooted in the false narrative of “protecting life” from the emergence of a so-called “fetal heart beat” at around six weeks of pregnancy - a claim that is simply not true.

All of us must “do our bit,” as seems fit and proper for each of us, to support of girls and women. There are a range of ways we can do so, and I list three of them below.

Stay strong everyone!

You may find these links useful:

www.who.int

www.cdc.gov

https://www.google.com/amp/www.pewtrusts.org/en/research-and-analysis/issue-briefs/2019/03/tracking-the-global-pipeline-of-antibiotics-in-development%3Famp%3D1

https://www.plannedparenthood.org/

https://yellowhammerfund.org/
https://www.arc-southeast.org/

You can find us at:
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and on Facebook and Twitter @shotarmpodcast. Subscribe, and if you like us, remember to give us five stars!

Episode 05: The Greatest Experiment In Social Services

This week David Evans, internationally respected treatment and science literacy expert, joins us from Pasadena, CA as we explore how healthcare might be delivered in the USA. We look at some proposals for Medicare for All that are on the table, and how different strategies led by the public sector and - or the private sector might be implemented. David explains why it's really important for community organizations providing infectious disease services - particularly HIV - to take notice now. Many of the drugs we use are coming off patent, and this will have major consequences for funding, if we are not prepared.

Links you might find useful:

https://pnhp.org/what-is-single-payer/

https://www.npr.org/2019/04/13/712997046/examining-sanders-medicare-for-all-proposal

https://www.vox.com/policy-and-politics/2019/2/22/18234606/warren-child-care-universal-2020

https://www.nhs.uk/

https://www.cdc.gov/workplacehealthpromotion/pdf/Workplace-Health-Program-Definition-and-Description.pdf

http://www.gbchealth.org/

and of course…
Pet Shop Boys


You can find us at
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Google Play Music

and on Facebook and Twitter @shotarmpodcast. Subscribe, and if you like us, remember to give us five stars!

Episode 04: Ebola, Measles, HIV: Lessons for Future Epidemics

The latest episode of A Shot In The Arm is out!

The episode was recorded live on April 25th 2019, at The Commonwealth Club in San Francisco. The Commonwealth Club is an amazing venue, with an amazing program, and breathtaking views of the Bay.

This was a special live event, hosted by A Shot In The Arm, and marks the first of a series of live discussions over the next few months to explore in the intersection of global health and human rights.

In this episode, microbiologist Peter Piot and anthropologist Heidi Larson, from the London School of Hygiene and Tropical Medicine share their thoughts on the lessons learned from ebola, measles and HIV for future epidemics. They are the real-life Indiana Jones stars of global infectious disease. I strongly recommend Peter’s memoirs “No Time To Lose.” His life in the former Zaire, now the Democratic Republic of Congo, chasing down ebola is breathtaking. In the second part of the the book, his perseverance in first breaking down the barriers of UN stagnation, creating UNAIDS and then moving the world’s investment in AIDS from millions to billions reminds one of Elizabeth Warren. Heidi is not outshone by Peter. She is founder of the Vaccines Confidence Project, which fights disinformation in the age of vaccines. Her insights into how to engage the “anti vaxxer” movement are telling and inspirational.

This week also sees the United Nations General Assembly meeting in New York to prepare for its Special Session on Universal Health Care (UHC) in September. Thanks to ICASO’s MaryAnn Torres for pointing me in the right direction, I can now doze through sessions in the comfort of my own home, courtesy of the internet.

What is UHC? To be perfectly honest, I am not sure. We can say that it will likely become the pre-eminent global health policy issue of our era. It is deeply intertwined with climate change , as temperatures bring about massive disruptions in populations, clean water access, and the emergence of old and new infectious diseases. As Heidi and Peter remind us, AIDS and measles denialists have chosen deliberately to ignore the facts, placing not only their loved ones, but entire societies at risk. So too with climate denialsts. Their grip on power for the last thirty years will have lasting consequences for humanity.

For right now, we need to recognize that UHC will drive – and unless we deliberately raise additional billions of dollars  - absorb existing and new health access, equity and financing initiatives. We must seize the opportunity.

UHC relates to Sustainable Development Goal target 3.8, “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”   That there is not a specific HIV goal is a conversation for another time. Since 2017, the World Bank and WHO have sought to raise awareness and action on UHC, as now UCH2030 use the following framework definition “all people having access to quality essential health services, without having to suffer financial hardship to pay for health care.

It is a helpful, but incomplete definition, and its continued vagueness, while perhaps smart for shorter-term international negotiations, means that the prediction of the funding needed to achieve it remains obscure. Calls for securing further efficiencies in health care delivery do not suffice, and countries have to face head-on whether to expand public expenditure.

The most effective and efficient way of delivering healthcare is through public funding and service delivery, and a proven model was established in the UK in 1949. The National Health Service is (or would be if not for Tory tinkering) publicly-funded health and wellness for everyone from cradle to grave, regardless of ability to pay. My hero, the Health Secretary of the time, Labour’s Aneurin Bevan said “the NHS is the single greatest experiment in social service that the world has ever seen undertaken.” His words resonate to this day.

Disappointingly, there is currently no global consensus that this the way forward.

As we wrestle with the disruptions of climate change to our way of life, I am optimistic that a new consensus could emerge within my lifetime. As Peter notes, a new influenza pandemic could be a game-changer for humanity. As “Spanish Flu” from 100 years ago shows us, pandemics have no respect for national borders, class, creed or income level. Our survival will require us from the same.

In the meantime, the vast majority of healthcare spending in resource-limited settings will continue to come from Out of Pocket Expenditure (OPE), which is a polite way of saying poor people have to pay exorbitant fees for emergency medical services. Over the next few decades, we should expect that “funding source” to grow, largely unaided and unplanned.

What, then, do we do?

At a bare minimum, donors right now (both in the North and South, public and private) need to meet the 6th replenishment goals of the Global Fund to fight AIDS, TB and Malaria. But they will also need to commit to a 7th replenishment, 8th, 9th and so forth…

It would be a significant, if underwhelming achievement, if we agreed to make OPE work better – supporting our poor to move from paying for emergency health costs, to planning for their future health.  Governments have to lead the way, with the engagement and oversight of their peoples.  Under such a rubric, there are increasingly creative ways for communities and the private sector to make meaningful contributions. These include workplace-based wellness and health programs (in both formal and informal labor markets), low-cost saving schemes for health, co-operatives, and expanded privately and publicly managed health insurance schemes.  

At exactly the same time the UK was creating the National Health Service (its real 20th Century jewel in the crown), India and Pakistan were finally free from the British Empire to experience the joys, challenges and sorrows of self-determination. It is not catchy, but it is direct. Amrit Kaur, women’s rights activist, and independent India’s first Minister of Health could have been offering a definition of UHC when she said, “the welfare state is the economic betterment and provision of minimum standards of living essential for a healthy life for all people.”

There is a question and answer session at the end of the podcast. But do not fear, Peter and Heidi will be back in future episodes. So if you have a burning question, let me know, and Ill be sure to ask them.

You might find these links helpful:

www.lsthm.ac.uk

www.calpep.org

http://sph.berkeley.edu/

https://globalhealthsciences.ucsf.edu/

http://www.csueastbay.edu/

http://med.stanford.edu/

https://www.commonwealthclub.org/

www.sfchc.org

www.sfaf.org

https://www.cdc.gov/vaccines/programs/vfc/index.html

And if you want to know more about HIV:

https://www.hiv.gov/hiv-basics

As always, you can find us at Apple PodcastsSpotify StitcherGoogle Play Music, and on Facebook and Twitter @shotarmpodcast. Subscribe, and if you like us, remember to give us five stars!

Episode 03: Women Are The Cure

We meet Yvette Raphael, the internationally acclaimed South African HIV, Women’s Rights and science activist. She tells her own story of HIV, and how she and a group of women have radically changed the response to HIV prevention and treatment in the country with the highest rates of HIV in the world. She also talks about her fight for women’s empowerment and survival. We also cast our eye across the research in biotechnology and research that is making the news this week.


References You May Find Useful:

AVAC

IPPF

International Partnerships for Microbcides

https://www.tballiance.org/

https://www.preventionaccess.org/

https://tac.org.za

http://thetotalshutdown.org.za/

The People Vs Patriarchy
https://www.youtube.com/watch?v=TAoPFeObqe4

If you are concerned, or want to learn more about HIV testing, prevention and treatment:

http://www.thebody.com

https://www.calpep.org/

https://sfcommunityhealth.org/

https://prepfacts.org/prep/the-basics/

and of course…

Pet Shop Boys

Episode 02: All About the Money

In the latest episode of A Shot In The Arm Podcast, we explore how much money is needed to end global infectious disease, and talk with the Head of Friends of the Global Fight, Chris Collins about how to protect and nurture US investment in  the Global Fight against AIDS, TB and Malaria.

This episode gets down and dirty about the money - how much funding is needed to end infectious disease, who much is currently being spent, and how to get the US Congress to sustain its investment in global health. The US is by far, the largest donor in infectious disease in the world. We explore with Chris Collins, Head of the Friends of the Global Fight how to build support in Congress, the private sector and the general public. 

I hope you enjoy the podcast. You can find us on iTunesGoogle Play MusicSpotify and Stitcher. Follow us on TwitterFacebook@shotarmpodcast. Be sure to subscribe, and if you like us, give us five stars!

A Shot In the Arm is brought to you by NewsDoc Media and Hunuvat Global

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Links you may find interesting:

www.TheGlobalFight.org

www.theglobalfund.org

 https://lee.house.gov/

https://pelosi.house.gov/

 https://www.lgraham.senate.gov/public/

https://cox.house.gov/

https://www.harris.senate.gov/

https://www.feinstein.senate.gov/public/

https://www.kff.org/

http://www.gbchealth.org/

If you are concerned, or want to learn more about HIV testing, prevention and treatment:

http://www.thebody.com

https://www.calpep.org/

https://sfcommunityhealth.org/

https://prepfacts.org/prep/the-basics/

Episode 01: 21st Century Prevention

In the first episode, “21st Century Prevention,” host Ben Plumley explores the future of HIV prevention with guest, Gloria Lockett, co-founder of California’s Prostitute Education Project (CALPEP). The future isn’t just biomedical, its about incorporating new medicines and diagnostic tests into education and prevention outreach with communities most affected by HIV.

We also meet Venezuelan human rights lawyer, MaryAnn Torres, the head of ICASO, to learn more about how the political and economic crisis is having a devastating impact on the health of everyday citizens. Its a story of medicines stolen by the government, and lives put at risk.

For more information, see the following links:

California Prostitute's Education Project
https://www.calpep.org

ICASO
http://icaso.org

HIV
https://www.hiv.gov/hiv-basics
https://www.avert.org/about-hiv-aids/worried-about-hiv
https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids/what-are-symptoms-hivaids
https://aidforaids.org/

HIV Treatment
https://www.preventionaccess.org/

HIV Pre-Exposure Prophylaxis (PrEP)
https://prepfacts.org/
https://www.lovefoundation.or.th/
https://preptaiwan.org/
https://www.gileadadvancingaccess.com/

Venezuela
https://www.icrc.org/en/where-we-work/americas/venezuela

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A Shot in the Arm Podcast is produced by:
www.newsdocmedia.com
www.hunuvatglobal.com

If you enjoyed this episode, please subscribe and follow us at:
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