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Medical Forum / Diseases and Disorders / AIDS / January 2007

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The Future of Economics Isn't So Dismal

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Alex - 14 Jan 2007 02:08 GMT
" Any attack on AIDS should therefore include an attack on poverty. "

http://www.nytimes.com/2007/01/10/business/10leonhardt.html?_r=1&oref=slogin

The Future of Economics Isn't So Dismal

By DAVID LEONHARDT
Chicago

On a summer day a few years ago, a recent college graduate named Emily Oster
was talking to her boyfriend about the research that was, and wasn't, being done
on the spread of AIDS. She was an aspiring economist at the time, getting ready
to go to graduate school, and she was struck by the fact that her field had little to
say about why some countries had such high H.I.V. rates.

To most people, that may not sound like a question an economist needs to be
asking. It's more the domain of epidemiologists or public health workers, and
they were already doing good work on it. But economists have been acting a lot
like intellectual imperialists in the last decade or so. They have been using their
tools - mainly the analysis of enormous piles of data to tease out cause and
effect - to examine everything from politics to French wine vintages. As the
daughter of two economists, Ms. Oster probably understood this better than
most 22-year-olds. Her father, Ray Fair, invented a semi-famous economic
formula that has an impressive track record of predicting presidential elections.
Her mother, Sharon Oster, studies business strategy.

So during her time as a Ph.D. student at Harvard, the younger Ms. Oster took
on AIDS in Africa. Her most provocative finding was that Africans didn't really
behave so differently from people in countries with much lower H.I.V. rates.
They did not have many more sexual partners than Americans on average. And,
like Americans, Africans had cut back on unsafe sex in response to AIDS - or
at least relatively well-off, healthy Africans had. Poorer Africans, who of course
make up the continent's overwhelming majority, had made fewer changes. They
had less of an incentive to practice safe sex, Ms. Oster concluded, because many
of them could not expect to reach old age, whether or not they contracted H.I.V.
Any attack on AIDS should therefore include an attack on poverty. "This is not
the kind of thing epidemiologists would do. It's not the way they would have
framed it," Ms. Oster, now 26, said. "It's an idea only an economist would love."

Whatever you think of her conclusions, there's no denying that her subject is
more interesting - and, yes, more important - than the esoteric fiscal and
monetary models that once dominated economics. Ms. Oster is studying death,
not taxes. Last weekend, hundreds of economists gathered in Chicago for their
annual conference, where they interviewed one another for job openings,
presented new research papers and had the occasional glass of wine. This
was my sixth such conference, and I have often been stunned by how much
of the research here, like Ms. Oster's work, would interest non-economists.
As "The Soulful Science," a new book by Diane Coyle, puts it, there has
been a "remarkable creative renaissance in how economics is addressing
the most fundamental questions - and how it is starting to help solve
problems." The reams of data that computers can now crunch have
ushered the field into a new golden age, Ms. Coyle writes, yet most
of its accomplishments are not widely known.

So before this year's conference, I did an informal poll of about 20 senior
economists around the country and asked a single question: who are the
young (untenured) economists doing work that is both highly respected among
experts and relevant to the rest of us? Who, in other words, is the future of
economics? Thirteen names came up more than once, and I'm sure a scientific
survey would have produced a longer list. As it is, though, the list is incredibly
diverse. It includes Justin Wolfers, who once worked for an Australian bookie
and is now an expert on online prediction markets , and Raj Chetty, who grew
up in both India and Milwaukee and studies antipoverty policy.

Ms. Oster is on the list, and so is the boyfriend with whom she first discussed
her AIDS ideas: Jesse Shapiro, now her husband. He has done innovative
work on, among other things, the benefits of television for some toddlers.
The two of them are the inaugural fellows at a University of Chicago
research center run by Gary Becker (a Nobel laureate), Steven Levitt
(co-author of "Freaknomoics") and Kevin Murphy (winner of a MacArthur
genius award). In fact, the least diverse aspect of the list of 13 - the full
roster appears above - may be the way that its members have chosen
their mates. Six of them are married to another person in the group. In
the end, this new era of economics matters because it has a chance to
influence the world that is its subject matter. Ms. Oster, for example,
has presented her work to the President's Commission on AIDS and
others, and her findings seem to be one small part of the recent push
for better H.I.V. prevention measures.

In Massachusetts, a 41-year-old economist named Jonathan Gruber helped
design the new state program to provide health insurance for every resident,
which is a model for the California plan announced on Monday. The new
federal pension law, meanwhile, encourages employers to sign up workers
automatically for 401(k) plans largely because academic research has shown
just how costly procrastination is.

For all this success, though, there are still two big obstacles holding back
the economics revolution. The first is that the field remains too narrow in
its approach. As David Colander, an economist at Middlebury College,
notes, researchers are rewarded - with job offers, endowed chairs and
prizes - for finding statistically significant patterns that can be published
in prestigious journals. They're generally not rewarded for collaborating
with experts in other fields to put those patterns into better context. As a
result, there is too much "cleverness for cleverness's sake," Mr. Colander
says, and not enough "judgment and wisdom."

The second obstacle is that when economists do uncover a nugget of true
wisdom, they're often hesitant to follow it to its natural conclusion and to
become principled advocates for better policy. Theirs is not to judge, they
insist, only to report what they find. Otherwise, they may risk their reputation
for impartial research. Which is a fair point. But it's a risk worth taking,
because the alternative is frankly much worse. When David Hume, the
philosopher and friend of Adam Smith, called for the establishment of a
"science of human nature" in the 18th century, he helped invent modern
economics. The new generation of researchers will probably come closer
to realizing his vision, and to making economics a true science, than any of
their predecessors. But think about what scientists do when they uncover a
problem: they try to solve it. To do otherwise is to let an impressive piece
of research turn into a scientifically rigorous piece of trivia.

E-mail: leonhardt@nytimes.com
eponymous cowherd - 14 Jan 2007 04:52 GMT
> " Any attack on AIDS should therefore include an attack on poverty. "

The richest countries in Africa have the highest AIDS rates: Namibia, SA, Bots,
Lesotho, Swazi. These countries lead in per capita income and AIDS.

They also lead in the number of men who spend much of their time away from their
wives while working in the mines ...
Alex - 14 Jan 2007 20:47 GMT
> > " Any attack on AIDS should therefore include an attack on poverty. "
>
[quoted text clipped - 3 lines]
> They also lead in the number of men who spend much of their time away from their
> wives while working in the mines ...

They're also at or near the tropic of capricorn.

Look, even if you believe in the HIV/AIDS paradigm, even if you believe
that there is an HIV epidemic in Africa, you still have to believe that people
who are poor, drinking bad water, malnourished and don't have the money
to get treatment for other diseases, will be helped by avoiding these factors
that are at least aggravating their HIV/AIDS.

It makes no sense to go into communities where people drink contaminated
water and don't have three meals a day, and then start handing out antiretrovirals.

However, what is obvious and pointed out in this article, is that sexual
habits in Africa are no different from those in the West. Which is another
excuse that is claimed as a 'reason' why there is a heterosexual HIV
epidemic in Africa, but nowhere else.

Alex
GMCarter - 15 Jan 2007 10:27 GMT
snip
>It makes no sense to go into communities where people drink contaminated
>water and don't have three meals a day, and then start handing out antiretrovirals.

It DOES make sense to hand out ARV. And OI drugs. But you are
absolutely correct that these issues of clean water and food are
critical and paramount.

It is indeed something we do agree on and perhaps if we could pressure
governments to actually spend resources on assuring access to
food--and that goes from local sustainable farming rooted in FAIR
trade all the way to the US and European governments tarriff
protections--this can make a huge difference.

A rather horrible article that reveals the grisly side of Gates for
example was recently published in the LA Times underscoring that their
funds are invested in companies that turn people's lives into sh.t.

        George M. Carter
Moira de Swardt - 15 Jan 2007 15:07 GMT
"GMCarter" <fiar@verizon.net> wrote in message
> On Sun, 14 Jan 2007 21:44:13 -0000, "Alex"

> snip
> >It makes no sense to go into communities where people drink contaminated
> >water and don't have three meals a day, and then start handing out antiretrovirals.

> It DOES make sense to hand out ARV. And OI drugs. But you are
> absolutely correct that these issues of clean water and food are
> critical and paramount.

In South Africa there is no problem with clean water and ARVs.  In
places where one can access the ARVs, there is clean water.  In
places where the water is a problem, so too is access to clinics for
ARVs.

There is, however, a problem with adequate diets.  Many of the
people who are HIV positive and receiving ARVs and OI drugs from the
hospital in Johannesburg are also receiving food supplements from
the same hospital.  One of the nutritionists at the hospital is a
friend and she advises that they hand out "E-Pap", a fortified
porridge to each person in this particular programme per month.
She's concerned that the amount needed per person, which is all
they're given, is actually shared with other people.

My church has a programme where we have a DOTS system for TB.  We
have five people at any time who themselves are taking, or have
recently been taking, TB meds.  We hand them 30 eggs per week, and
money for bread or bread (together with other food parcel items as
and when we receive generous donations of food past it's "sell by"
date, but not yet past it's "best before" date from an upmarket
local store).   They then each monitor five people on TB drugs.
When the people get their drugs they also get an egg sandwich and
coffee, tea or milk etc. to help with the nausea which the
medication can cause (and, where available, something to take home).
One of these five people will become the next monitor when the
present monitor is finished with his or her course.  It works very
well.  One of wealthy people of the parish donates the money for the
eggs.  We have restricted it to five sites because we believe that
if every religious group was doing the same, all the people with TB
in our city would have regular meals while they're on TB medication.

As you know TB is an OI which hits at about a CD4 count of 350 and
most people in South Africa who live in crowded conditions and who
have a sufficiently lowered CD4 count will get TB.  It is a suitable
training for the later discipline of taking ARVs (handed out at a
CD4 count of 200 or less) and it enables someone to note who is
*really* going to need food assistance later.

It is very difficult for well fed people to understand the concept
of the need for food security.

--
Moira de Swardt posting from Johannesburg, South Africa
Remove the dot in my address to find me at home.
GMCarter - 15 Jan 2007 20:39 GMT
snip...

>In South Africa there is no problem with clean water and ARVs.  In
>places where one can access the ARVs, there is clean water.  In
>places where the water is a problem, so too is access to clinics for
>ARVs.

Moira--what a marvelous and refreshing relief to read something so
genuine and good. Thank you. It seems it's been so long that there has
been anything positive on these lists (and for which I take as much
blame as anyone).

Malnutrition was picked as one of MSF's top 10 neglected crises and
they advocate additional strategies:
http://www.doctorswithoutborders.org/news/malnutrition/malnutrition.htm

I wonder if there are things besides E-Pap that can be done. A friend
runs a program in Harare that has been doing terrific work in assuring
access to nutrition and the like; they're also very big on local
gardens etc. (And the situation there is pretty grim, due to the
political problems, inflation, etc.)

I've been thinking a lot about how there can be more systematic,
"bottom-up" approaches like this where the local problems are
identified and addressed at a community level. Yours is one example of
such a practical approach. Combining DOTS with nutrition is brilliant.

The idea is to figure out the ratio of sustainable economic
development locally to what the current need for outside assistance or
other aid resources is. And gradually shifting the ratio to more of
the latter and less of the former. For example, the outside assistance
is donation of the eggs. Could a microcredit program help some local
entrepreneurs to have chicken farms that they can make some money from
the eggs and meat which then reduces the need for donations?

That kind of thing. At least South Africa does have some degree of
resources it could put toward these type of programs (as opposed to
some other countries where the situation is much more horrific, even
might one note a place like Lesotho.)

Also--how much cow or other animal milk is used by locals? A very
inexpensive protein source that can be fortified with vitamins is whey
proteins. Very inexpensive product and add some variety to things like
the E-Pap.

        George M. Carter
GMCarter - 16 Jan 2007 00:23 GMT
>snip...
snip
>The idea is to figure out the ratio of sustainable economic
>development locally to what the current need for outside assistance or
>other aid resources is. And gradually shifting the ratio to more of
>the latter and less of the former.

Oops. I meant tother way round. Decreasing, as and if possible, the
need for donated aid, while improving local programs to alleviate
poverty/etc.

        George M. Carter
Death - 16 Jan 2007 01:20 GMT
"GMCarter" <fiar@verizon.net> wrote in message

> Oops. I meant tother way round.

I know pervert.
Death - 16 Jan 2007 01:19 GMT
"GMCarter" <fiar@verizon.net> wrote in message

> Moira--what a marvelous and refreshing relief to read something so
> genuine and good. Thank you. It seems it's been so long that there has
> been anything positive on these lists (and for which I take as much
> blame as anyone).

LOL, then you take no blame if you wait on me.
Being hungry does not cause aids or TB.

Does being hungry make aids or TB worse? You bet.
Being wet and cold makes aids and TB worse.
Alex - 17 Jan 2007 20:15 GMT
> "GMCarter" <fiar@verizon.net> wrote in message
> > On Sun, 14 Jan 2007 21:44:13 -0000, "Alex"
[quoted text clipped - 11 lines]
> In South Africa there is no problem with clean water and ARVs.  In
> places where one can access the ARVs, there is clean water.

Oh, ok. So that would make the usual drinking of contaminated
water ok. They may drink clean water in the clinic, but when
they go home...

And let's forget about those three meals per day too.

And decent living quarters.

Alex
alexkew@lycos.co.uk - 15 Jan 2007 00:32 GMT
I use Alex in soc.culture.singapore/malaysia/china/taiwan/hongkong etc.
I use my e-mail at lycos for posts here and the west.

It is the moral issue not economic issue is at stake. If laws are
enacted to punish sex before marriage, I think Aids can be reduced
tremendrously in Africa. You might call this something like the Islamic
laws but it is the only fast method to eradicate Aids.

> " Any attack on AIDS should therefore include an attack on poverty. "
>
[quoted text clipped - 107 lines]
>
> E-mail: leonhardt@nytimes.com
FreeSpirit_uk - 15 Jan 2007 09:52 GMT
>I use Alex in soc.culture.singapore/malaysia/china/taiwan/hongkong etc.
> I use my e-mail at lycos for posts here and the west.
[quoted text clipped - 3 lines]
> tremendrously in Africa. You might call this something like the Islamic
> laws but it is the only fast method to eradicate Aids.

Spoken like a true Singaporean.  How do you propose to enforce these laws?
And what do you think would the most fitting punishment for transgressors of
such laws?

<snipped>
Alex - 17 Jan 2007 20:03 GMT
> I use Alex in soc.culture.singapore/malaysia/china/taiwan/hongkong etc.
> I use my e-mail at lycos for posts here and the west.
>
> It is the moral issue not economic issue is at stake. If laws are
> enacted to punish sex before marriage, I think Aids can be reduced
> tremendrously in Africa.

There is no AIDS in Africa.

And if laws could be enacted to punish sex before marriage,
they would have been enacted in the UK by now. :)

Alex
Moira de Swardt - 18 Jan 2007 04:16 GMT
"Alex" <avdeelen.REMOFETHIS1@wanadoo.nl> wrote in message

> There is no AIDS in Africa.

Why don't you come to Africa so that you can tell that to the people
who have buried their children, their parents and their spouses and
are getting sicker every day?  I'm sure that will comfort them.

--
Moira de Swardt posting from Johannesburg, South Africa
Remove the dot in my address to find me at home.
Death - 18 Jan 2007 16:42 GMT
"Alex" <avdeelen.REMOFETHIS1@wanadoo.nl> wrote in message

> There is no AIDS in Africa.

What is it exactly that you are selling Alex?

One day you claim aids is caused by poverty
and now you say there is no aids in Africa.
Moira de Swardt - 18 Jan 2007 21:19 GMT
" Death" <Death@yourdoor.net> wrote in message
> "Alex" <avdeelen.REMOFETHIS1@wanadoo.nl> wrote in message

> > There is no AIDS in Africa.

> What is it exactly that you are selling Alex?

> One day you claim aids is caused by poverty
> and now you say there is no aids in Africa.

Alex is too, how should I put this charitably, ... *reactive*... to
actually know *what* he thinks.

--
Moira de Swardt posting from Johannesburg, South Africa
Remove the dot in my address to find me at home.
Death - 19 Jan 2007 15:46 GMT
"Moira de Swardt" <moira.ds@wol.co.za> wrote in message

> Alex is too, how should I put this charitably, ... *reactive*... to
> actually know *what* he thinks.

Here is something I found that you may want to read :

By Ian Sample
Science Correspondent
The Guardian - UK
1-19-7

Scientists have unravelled the workings of a deadly superbug that attacks healthy young people
and can kill within 24 hours.

PVL-producing MRSA, a highly-virulent strain of the drug-resistant superbug,
methicillin-resistant staphylococcus aureus, has spread around the world and caused deaths in
the UK, Europe, the US and Australia. PVL or panton-valentine leukocidin toxin destroys white
blood cells and usually causes boils and other skin complaints. But if it infects open wounds
it can cause necrotising pneumonia, a disease that rapidly destroys lung tissue and is lethal
in 75% of cases.

Thousands of infections have been recorded across the US, but scientists believe the number is
likely to rise in Britain.

In 2004 the bug claimed the life of Richard Campbell-Smith, a fit 18-year-old Royal Marine, who
died three days after scratching his legs on gorse during a training exercise in Devon. In
December an outbreak at Norfolk and Norwich University hospital killed a baby and infected five
others. According to the Health Protection Agency there were 106 cases of PVL-MRSA in England
and Wales in 2005 and one confirmed death from necrotising pneumonia caused by the infection.

Scientists at the University of Texas in Houston and Lyon University in France conducted
experiments into PVL to work out why it was so lethal. They took two batches of normal
staphylococcus aureus bacteria and modified one of them to produce the PVL toxin.

The researchers exposed mice to the different groups of bacteria, to see if they developed lung
infections. Animals that inhaled the normal staphylococcus were unaffected, but those that
inhaled the PVL-producing staphylococcus quickly developed necrotising pneumonia, with some
dying within 48 hours. Further tests on the PVL-producing bacteria showed they also produced
higher levels of proteins that caused massive inflammation and made the bacteria more "sticky",
helping microbes cling to people's skin and making it more easy to spread.

The study appears in Science Express, an online journal.

Gabriela Bowden, who lead the study, said: "We've shown that not only is PVL responsible for
causing necrotising pneumonia, but it somehow also causes over-production of these other
proteins which cause damage and help the infection spread. We now have targets to go for. We
can see if we can block the activity of PVL with antibodies, for example," she added.

Mark Enright, a microbiologist at Imperial College, London, said the new PVL-MRSA strain
probably evolved from a strain that first surfaced in the 1950s. The bug produced PVL toxin,
but had yet to develop drug resistance. "Now it's developed resistance, it has come back. We
are in the early stages of an epidemic, but this is moving very fast," he said. A fear held by
many health officials is that the PVL strain will become rife in hospitals, where it could
inflict a much greater death toll than the existing MRSA superbugs.

Marina Morgan, consultant medical microbiologist at Royal Devon and Exeter hospital, said
PVL-MRSA was a particular threat because it was spreading outside hospitals, where doctors were
not familiar with it. "A lot of patients die because it is unexpected. A doctor will probably
prescribe a standard antibiotic that won't kill it, so it has time to get worse. The bottom
line is it's coming and it's going to spread."

PVL-MRSA can only be tackled with treatments that attack the bacteria on three fronts. The
drugs must kill the bacteria, destroy their ability to make PVL toxins, and mop up the toxins
already released into the bloodstream.

Patricia A. Doyle DVM, PhD
Bus Admin, Tropical Agricultural Economics
Univ of West Indies

Please visit my "Emerging Diseases" message board at:
http://www.emergingdisease.org/phpbb/index.php
Also my new website:
http://drpdoyle.tripod.com/
Zhan le Devlesa tai sastimasa
Go with God and in Good Health

http://www.guardian.co.uk/medicine/story/0,,1994012,00.html?gusrc=rss&feed=11

http://www.rense.com

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