NEWSBYCAITLIN COHEN

Is it better to set achievable goals or ambitious ones?  The frequent critique of the Millennium Development Goals (MDGs) is that they provide an ambitious destination with very little by way of roadmap or funding. This is the equivalent of sending someone on a mission to Timbuktu via camel, with the instruction “turn left at the sand-dune." The UN will convene at the end of the month to take stock of where member states' wandering camels are on the path toward reaching these eight goals, and how to best to guide them to their destination by the 2015 deadline.

The countries that have made the most progress across the board are those that have had major economic growth, namely China and India.  Unsurprisingly, the countries that are least likely to achieve the goals are those with fewer financial resources, especially sub-Saharan Africa.

The UN and the World Health Organization are notorious for setting unachievable goals, and sadly "failing" to achieve a goal can belie the extraordinary progress that has been made.  MDGs 4 and 5 on maternal and child health are no exception. While astounding progress has been made, few countries will make it to the destination by 2015.

The child health goal is to reduce by two-thirds the under-age-5 mortality rate between 1990 and 2015.  Almost every part of the developing world has shown progress in achieving this goal, but only Latin America and Northern Africa will likely accomplish it. Overall, the developing world has shown a 28% decrease in child mortality in the past 20 years, which is commendable.  Unlike many of the other MDGs, the biggest gains have often been in the poorest countries, where a small difference in healthcare provision makes an enormous difference in survival.

In July, The New York Times reported a new practice called “flashblood” where some intravenous drug addicts in several east African countries inject other users’ drug-filled blood in order to stave off withdrawal.

The public health community is appalled by this news, naturally, as injecting blood is the most efficient way to transmit HIV and hepatitis. And because many of the addicts in question are also sex workers, the increased risk of these diseases is then shared with the wider population. Injecting a blood type different than your own can also cause temporary, though not lethal, reactions against the foreign blood.

The researchers do not know how widespread this practice is. The study reports that the majority of people doing this are women, often as a gesture of solidarity with their compatriots who cannot afford the drug. People who do flashblood claim they receive a rush as though they were doing the drug directly. Doctors are skeptical, though, because of how diluted the drug would be in the blood of the donor. Explanations include the placebo affect or remnant drug clinging to the inside of the syringe.

How to explain the world's current distribution of poverty? A history of colonialism, the industrial revolution, the uneven spread of religion, capitalism or disease burden — the list goes on. However, a new study suggests that the root explanation might be more ancient than all of these causes put together.

The study compared technology development in 1000 BC and 1500 AD with today’s levels of poverty. They found that 78% of the differences we see in poverty levels today can be strongly attributed to technology differences from 500 years ago. In fact, if you peer even further back in history — back 3,000 years or so — ancient technology is still a strong predictor of modern prosperity.

This study was conducted in part by William Easterly, an economics professor at New York University who's also notoriously cynical about the impact of foreign aid. It's a study with results that can be easily seen as grim, because of course there's little that the Gates Foundations or IMFs of the world can do to turn back the clock.

But I don't think that's the full story.

Does treating HIV curb the spread of the disease or increase it? For years, that's the debate that has raged among scientists. Those that believe treatment decreases transmission usually cite the fact that treated individuals have fewer HIV viruses in their blood and bodily secretions, which slows overall transmission. Those who believe that treatment increases transmission argue that because people live longer and healthier lives, they'll spread more of the disease — via more sexual encounters — than if they hadn't received treatment.

This week, a group of researchers in Canada have thrown more fuel into the fire. Specifically, they found the first conclusive proof that increasing HIV treatment does decrease the number of new diagnoses. And that's cause for serious celebration. (Numerous activists greeted this news with cries of  “That’s what we’ve been saying all along.”)

Their study found that putting an additional 100 people on Highly Active Antiretroviral Therapy (HAART) reduces new diagnoses by 3%. It's a finding that might very well change how we approach foreign aid for HIV/AIDS.

Policy experts and donors often see treating HIV and preventing HIV as two mutually exclusive activities that compete for resources. This data will hopefully support the roll-out of treatment as an effective form of prevention — not just as a kind of humanitarian obligation.

Right now, events are underway in African research that could revolutionize our understanding of how heredity affects certain diseases, such as high blood pressure.

Recently, the National Institutes of Health and the Wellcome Trust launched a program to provide African researchers with genetic sequencing and laboratory equipment. Called the Human Heredity and Health in Africa (H3Africa), this program attempts to supply African geneticists with the tools they would need to research not only the genetics of the “big three” diseases (HIV, malaria and tuberculosis), but also more chronic diseases like high blood pressure, cardiovascular disease and cancer.

In the U.S., it's been noted that high blood pressure and several other diseases occur at unusually high  rates in the African-American community. Scientists disagree about why — some believe that environmental and psychosocial stressors are to blame, and others think that genetics play a large role in increased susceptibility. H3Africa may shed light on this debate, indicating which, if any, of these diseases have an ancestral genetic component. (The difference between this and prior research is that the laboratory component can be done in-situ in Africa — as opposed to sending samples back to developed world research facilities.)

I think it's hugely valuable to give African researchers access to this kind of equipment, which is now the norm within U.S. laboratories. Such an act might also help with the pattern of brain drain that Africa experiences. And information on the human genome and its variations is important for good clinical care.

But I'm concerned by the way the project recommends “biobanking” thousands of peoples’ genetic information. How, exactly, will this sensitive genetic information be used?

A parent with a child with HIV faces a terrible conundrum. On the one hand, it’s important to let a kid be a kid — no parent wants their child to constantly worry about his or her own mortality. On the other hand, if parents don't tell their child about their disease, how can they explain repeated doctor’s visits and ensure that their child takes care of their health?

Previously in Uganda, no health professional could tell a child his or her HIV status without the parent’s permission — that is, until the child was at least 12 years old. Earlier last month, legislators proposed a bill that recommended a healthcare worker disclose a child's HIV status to them by age 10 at the latest. The reason for this switch? It turns out that informed children adhere better to Anti-Retroviral Therapy (ART) treatment for their HIV.

Many parents of HIV+ children are opposing this legislation. For one thing, telling your child that he or she has HIV would, in turn, reveal your own status. Parents also fear that their child might be less cautious or aware of when and how to share this information — thereby jeopardizing the family’s reputation, and possibly their employment.

Furthermore, young children are ill-equipped to deal with the reality of mortality. They might not understand that with treatment, HIV can be a chronic disease — not a death sentence. The psychic damage can be considerable.

Imagine that you're a mother in Mali, named Mme Magassa. When you go to visit a health clinic, you need to arrive with a big, pulpy pile of paperwork. These are your child’s clinical records, which you've shepherded through five different homes over the course of as many years. In Mali, patients are responsible for their own medical records, a fact that sometimes has dire consequences: clinicians have no idea what medicines a child has been given, what his or her allergies are and whether or not she has pre-existing conditions. Most homes are made out of mudbrick — and accordingly, with one roof leak, a whole medical history can be lost. Furthermore, many women like Mme Magassa are illiterate: mixed in with the childs records are old electric bills and other irrelevant bureaucracy.

How do we fix this mess of paperwork?

Frontline SMS: Medic offers a solution. Thanks to Frontline SMS: Medic, community health workers can carry simple phones devised to assist at all times. Programmed into these phones are a series of forms with checkboxes and fill-in-the-blank questions. When such a health worker does an exam, or responds to an emergency call, he or she fills in these forms, which are in turn sent automatically to a central database.

If it's beautiful to be white, as so many marketers will tell you, it can also be extremely dangerous, too.

Throughout much of the developing world and the U.S., beauty salons and corner markets offer products like Skinlite and Vite-Fée ("fast fairy") — creams designed to make a person’s skin lighter. As Anna Hirsch writes over on Change.org's Race in America blog, there are a plethora of psychological risks involved in how these products’ perpetuate destructive and westernized standards of beauty.

But the medical risks are significant as well, because over-the-counter products are poorly regulated in the U.S. — and totally unregulated in most other countries.

A study reported by the Chicago Tribune, for example, found that five out of 50 types of skin lightening creams in the U.S. alone contained enough mercury to cause kidney damage over time, despite an FDA ban on mercury in such products. Additionally, a U.K. study found that many of these creams contain fairly high doses of steroids, which can lead to thinning and irritation of the skin. Especially in the developing world, this kind of irritation can make people susceptible to infection. Lastly, many contain hydroquinone, another agent that's banned in over-the-counter products in the U.S. for posing a risk of cancer. 

In 2000, the picture of polio around the world looked pretty good: just 1,000 cases were reported that year. Bill Gates saw this as an opportunity: a chance to invest a little bit of his money and not just control a disease, but eradicate it.

Last year, though, that rosy picture looked both bleak and expensive. As Bruce Aylward of the World Health Organization said, “There’s no way to sugar-coat the past 12 months.” During 2009, we saw a resurgence of polio in 20 countries — many of which had previously eradicated the disease.

The Gates/WHO strategy to fight polio was based on the success of the 1979 smallpox vaccine campaign. In this campaign, though Bangladesh was seen as a last stronghold of the disease, the virus was finally eliminated when a policy of forced vaccination was implemented (which many consider a human-rights abuse). The polio campaign used a similarly simple playbook: vaccinate, vaccinate, vaccinate. And for awhile, it seemed that strategy might work. Now, though, it’s failing. Like the case of smallpox, polio is still deeply entrenched in one place: Nigeria. The country made up half of the world’s polio cases last year, in part due to rumors that have circulated about how the vaccine induces sterility, and in part because of the risk of Vaccine-Associated Paralytic Poliomyelitis, which causes paralysis in about one in a million people who receive the oral polio vaccine.

That's where the Sultan of Sokoto, ruler of 70 million Muslims living in northern Nigeria, comes in.

It sounds like a 28 Days Later-type sci-fi film: Fully two-thirds of the world’s population has been infected with a harmful pathogen that eats people alive from the inside out. Except this time the story is true. Worm infections, considered a Neglected Tropical Disease (NTD), are incredibly prevalent. Yet they've been woefully forgotten by most health initiatives.

Who are these critters? There are the flat worms, round worms and tiny ones called filaria. Most live in your intestines and don’t cause too much trouble, but some prefer your blood, or even your organs (the brain, liver and kidneys). They cause all kinds of symptoms, from anemia and cognitive deficits to skin rashes and massive swelling called elephantiasis.

With such a high number of infected people and such a high disease burden, should we just throw up our hands and let the worms have their way? Hardly. In this sci-fi style fight, we have powerful drugs on our side. A single dose of a drug called albendazole can kill almost all of the intestinal worms in a person, with very few side effects (the worst often being the psychic trauma of passing the worm itself… which is not to be underestimated). The World Health Organization recommends giving all children in the developing world a dose of this drug to promote weight gain and better school performance. (Though this viewpoint has been challenged by some recent research, it's still widely accepted.)