Without Borders

The White Man’s burden, a bit of racism from the 19th century:

The term “the white man’s burden” has been interpreted as racist, or taken as a metaphor for a condescending view of non-Western national culture and economic traditions, identified as a sense of European ascendancy which has been called “cultural imperialism.” An alternative interpretation is the philanthropic view, common in Kipling’s formative years, that the rich have a moral duty and obligation to help “the poor” “better” themselves whether the poor want the help or not. The term “the white man’s burden” has been interpreted as racist, or taken as a metaphor for a condescending view of non-Western national culture and economic traditions, identified as a sense of European ascendancy which has been called “cultural imperialism.” An alternative interpretation is the philanthropic view, common in Kipling’s formative years, that the rich have a moral duty and obligation to help “the poor” “better” themselves whether the poor want the help or not.

I will let the commentators debate the meaning of the poem. There are places in the world so devastated by poverty, disease and political corruption that it may be beyond the capacity of the local populations to overcome. They need outside help. Certainly, the impulse to help those less fortunate than yourselves is a noble tradition. Haiti, Central America and Uganda are parts of the world that need assistance in overcoming an incredible number of problems to reach even a basic level of material support for its population.

What better way to help people in dire need of the basic requirements for health and material well being than to provide them with Western SCAMs?  At least in the industrialized West, we have options. If acupuncture or homeopathy or reiki does not take care of our problem or our diseases worsen, we are a quick trip away from the ER.  We may not be able to afford the care, health care being the number one cause of bankruptcy in the US, but at least effective health care is available. Other societies do not have that option. Often their one point of contact with health care  providers and/or shamans is their only contact and there is no infrastructure to take care of the ill.  Uganda spends $135 per capita on health care,  and has 0.047  physicians per 1,000 people. 1,500 doctors for a population of 35 million. Haiti spends  $82 per capita. I spend more each year on my daily peanut butter and jelly sandwich for lunch ($1.10)  By comparison, the US spends $6,000 a year per capita on health care.

These are societies where small amounts of money spent carefully can have enormous impact. Relatively small amounts of money can do enormous good in impoverished parts of the world. Ten dollars can buy a mosquito net and prevent malaria.  The measles vaccine costs less than a dollar a dose and can prevent devastating outbreaks of disease.  One hundred dollars  can provide the hungry with 2 chickens and a goat. So why spend the money on nonsense?  I know it is a false choice.  Just because money is being spent on something useless like homeopathy or acupuncture does not mean that the same money would go to a more rational choice if it were otherwise available.

In medicine we are aware of the ethical issues in treating vulnerable populations.  The poor and uneducated do not have the resources to separate fact from fiction and may lack the background to make truly informed decisions.

Yet none of this stops the sCAM believers from exporting their nonsense to the poor, the hungry, the under educated and the desperate.

Research

The only thing necessary for the triumph of disease is for good men to do homeopathy.

Diarrhea is a major source of morbidity and mortality in large parts of the world, the second (I originally wrote number 2)  cause of infant death in the world.  Treatment and prevention of diarrheal illness is key to decreasing infant mortality world wide.  How might I make a major impact?  Provide clean water?  Rotavirus vaccination? Wait, I have it! Let’s give random homeopathic medications to the children in the slums of Nicaragua and compare it to placebo and see if it helps their diarrhea.  Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua did just that.

So what did they use for treatments of diarrhea and why (besides normal hydration)?

Who had oversight on this study? From the paper:

Informed consent was obtained from the parent or guardian using a disclosure statement that had been approved by the human subjects review committee of the University of Washington.”

One third of Nicaraguans are illiterate and only half get a fifth grade education. I would think, obviously erroneously, University of Washington would recognize that the parents of children in Nicaraguan slums may not have the background to understand informed consent or the essential irrationality, er, science,  of homeopathic nostrums, and one would hope that the University  of Washington would be interested in protecting those who cannot protect themselves.   Evidently not, since their faculty continues to export magic to vulnerable  children and adults in third world countries. Not yet ethically Tuskegee level research, but they are working on it.

I understand that one persons lapse in medical and scientific understanding is another’s opportunity for a nationally syndicated television show, but they might have well piled the money spent on the study and burned it for all the good it did the subjects and the medical literature.  At least they could have used the heat to pasteurize some milk.

Homeopaths Without Borders. Or sense.

Men never do bad medicine so completely and cheerfully as when they do it from a homeopathic conviction.

Doctors Without Borders,  also known as Médecins Sans Frontières, is an organization that sends physicians to some of the most needy parts of the world.   Using the style, but not the substance of Doctors without Borders, is Homeopaths without Borders, or, as the RationalWiki called it, Médecins Sans Médicaments.  Their goal is to send homeopathic care to those in need.  Based in Florida, it appears to be the work of one homeopath and almost all its work is in Haiti.

“the poor health of the people here is striking. So many girls and women have vaginal infections. So many children have infected cuts. So many men have reddened eyes, rotten teeth, and injuries that are healing badly. The nurses and docs here are as dedicated as anywhere else, but they lack supplies, and they don’t have medicines.”

They need help.  Shall we provide money for antibiotics? Dental Care? Good nutrition?  Clean water?

So lets supply them with water, and not even enough to wash those infected cuts.  I have to admit this brings conflicting emotions.  I have to admire anyone who will take the time to go to a disaster like Haiti and work to help those in need.  On the other hand, they offer nothing but false hope and magic, so cannot make the lives of Haitians any better. Time, money and resources, which could be used so much more productively, wasted.  I see many patients who have pissed away their lives and opportunity with heroin or alcohol or other bad choices.

“Look, if you had one shot, or one opportunity
To seize everything you ever wanted-One moment
Would you capture it or just let it slip?
Give effective therapy or a homeopathy? “

Wasted opportunities always inspires angst. So does Médecins Sans Médicaments.

It does show how powerful delusional states can be for believers of nonsense, since as RationalWiki states “Essentially, they go to nations with sub-standard healthcare, and dilute it even more to make it 10^-430 times as good as the healthcare in wealthier nations.”

PanAfrican Acupuncture Project

The evil that is in the world almost always comes of ignorance, and good intentions may do as much harm as malevolence if they lack understanding.

How best to spend very limited resources and maximize the health in Uganda, where AIDS, malaria, and Tb are endemic and have devastated the country?  Mosquito nets and condoms would be a good start to prevent these blood and mosquito borne illnesses.  Naw.  That might actually improve peoples lives.  Or we could use acupuncture instead:

“The PanAfrican Acupuncture Project trains healthcare workers in Africa to use simple and effective acupuncture techniques that enable them to treat the devastating and debilitating symptoms associated with HIV/AIDS, malaria, and TB.”

Again, I do admire the urge to go to Africa and help others.  They ask for donations and trainers on the website, expecting the trainers to provide their own airfare and $3,000 (aka 300 mosquito nets) to cover their own costs.  No small commitment. Of course, they provide a vulnerable population worthless magic, and I can only imagine what four grand could provide for clean water or malaria nets, interventions  that would actually benefit the Ugandans.

But what is scary is the web page.  Uganda is rife with HIV, which is spread, by, hmmmm, lets see, sex, blood and needles. Unsterilized needles.  In Africa, reuse of needles has been common, often due to lack of resources for sterilization, and has helped to spread HIV and perhaps other infectious diseases. So they have photos of people sticking needles into patients who could and do have HIV. Not a glove to be seen. Remember that blood borne illnesses are spread with acupuncture needles: Hepatitis B, hepatitis C and, rarely in the West, HIV.  It is rare to spread these diseases where good technique is followed scrupulously.  Poor societies are not known for the resources that allow them to fastidiously take care of proper cleaning.  Would anyone besides me worry that some acupuncture needles have a chance of being reused after poking an HIV positive patient?

As best as I can tell from the website, they are training people to potentially spread HIV between patients when and if sterilization breaks down and placing the acupuncturist at small, but real, risk should a needle stick injury occur.  The have trained over 100 local acupuncturists and hope to spread acupuncture, and the occasional blood borne viral illness, beyond Uganda to other African countries.  No benefit and all risk. The PanAfrican Acupuncture Project may have a commitment to philanthropy, but I am not convinced they have a commitment to preventing disease transmission.

“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!”
And waste their resources and health with CAM.

There are Chiropractors Without Borders and Naturopaths Without Borders who have three principles:

• Health care is a human right for all, not a privilege for the few.
• Everyone deserves the best healthcare, regardless of finances.
• Naturopathic Medicine is well suited for resource-poor settings.

Unfortunately, the third has no relationship to the first two.

There is Reiki Without Borders and Herbalists without Borders fortunately for the third world,  all seem to be the work of a few individuals, although Haiti appears to be the common destination.  Poor Haitians. They really need a border.

The West has a long and sordid history of exporting disaster to the third world.  It is nice to know that sCAMsters,  even if only a very small subset, are continuing the time honored tradition of maltreatment of indigenous peoples in the name of helping them.

Fortunately there are doctors, nurses, engineers, teachers, chemists and scientists without borders, who can offer substantive help.  Even Clowns without Borders would have something to offer, although not for everyone.

People aren’t either wicked or noble. They’re like chef’s salads, with good things and bad things chopped and mixed together in a vinaigrette of confusion and conflict and alternative medicine.