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post #111 of 169 (permalink) Old 09-08-2006, 11:45 AM
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There were millions of deaths due to malaria in the pre-HIV era. Mcbear is the one who brought up the issue of HIV which really isn't pertinent to the discussion. HIV may very well make malaria more lethal but, if anything, that would underscore the need to control the mosquito population with effective insecticides. Malaria deaths fall with the use of DDT and rise within a few years after it's use is abandoned. Here' s statement from The Association of American Physicians and Surgeons that says it all:

The following resolution was approved on a nearly unanimous vote during the 2004 AAPS General Assembly in Portland, Oregon, October 13-16, as the official opinion of this national association representing thousands of physicians and surgeons in private practice in the United States.

RESOLUTION 61-02, 2004: Legalizing DDT to Fight Malaria in Tropical Countries

WHEREAS: malaria has killed more people than any other infectious disease in history and is still epidemic in tropical countries – infecting 300,000,000 people and killing more than 1,000,000 every year, most of them pregnant women and children under five in sub-Saharan Africa; and

WHEREAS: more than 50 million people have died from malaria since EPA Administrator William Ruckelshaus arbitrarily banned DDT in 1972, contrary to expert testimony and a decision by Judge Edmund Sweeney that the pesticide was not harmful to humans, animals or the environment – a position subsequently affirmed by the World Health Organization and many other experts; and

WHEREAS: the WHO-UN-World Bank “Roll Back Malaria” campaign to cut malaria rates in half by 2010 has relied entirely on bed nets and drug therapies, and refused to consider the use of pesticides, even as the rate of malaria increased by more than 15% during the program’s six-year existence, killing millions, leaving others too sick to work, and perpetuating poverty in many nations; and

WHEREAS: mosquitoes are much less likely to develop resistance to DDT because it is no longer used in agriculture, and spraying tiny amounts of this pesticide on the walls of traditional huts repels mosquitoes and kills them on contact for six months or more, without contaminating the environment; and

WHEREAS: South Africa successfully used DDT to reduce malaria by more than 90% in three years, by using DDT to spray huts and in combination with artemisinin-based drugs and other strategies – a program that many poor countries want to emulate, but are prevented from doing so by threats from donor agencies and activist groups that continue to oppose the use of DDT under any circumstances;

THEREFORE BE IT RESOLVED THAT:the Association of American Physicians and Surgeons supports efforts to insist or require that agencies of the United States and United Nations permit, encourage, and fund the use of DDT in tropical countries where malaria is prevalent and health ministries wish to use it to save lives.


IMO the prohibition in the use of DDT constitues a genocide being perpertrated on Africa by the environmental lobby.
Interesting. I seem to recall as a kid that DDT was linked to birds and fish being exterminated by birth defects attributed to the chemical, as well as weakening of the egg structures so typical "handling" by the parent birds, or for fish eggs, the typical exposure they see, were reducing the number of normal offspring to levels that were described as dangerous. "Tiny amounts" on millions of huts can turn into a shitload of this stuff though. This is where environmentalists and people in the business of selling these solutions lock horns. From the perspective of the individual, the solution is harmless to the environment, while, if the solution is applied to millions of people, or billions for that matter, the effects are not always harmless. Air polution, for example, in the first thirty years of automobile use was not a particularly high priority issue. When the world began to buy and put into use more than ten million cars per year, the problem became a serious one.

Interesting issue. I wonder if the EPA would be interested in another review considering the more recent scientific evidence suggesting DDT is no longer a threat to birds and fish, or humans and only kills bugs. Jim
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post #112 of 169 (permalink) Old 09-08-2006, 12:08 PM
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Why isn't this a problem in other countries or areas of the world where DDT has been banned and we have both mosquitoes and HIV?

Opting for using DDT sounds a bit lazy, as you have described it. There may be a better word, but, if we know better and it means we have to change some behavior pattern that is optional and is part of the malaria problem, but just find it easier to use DDT, isn't allowing the behavior to continue just the path of least resistance? When did that become the goal?

Also, when the deaths from malaria plummet, what do they plummet to? Zero or what? Where is the assessment on the ill effects of DDT? Are there none in that part of the world? Is it just easier to accept using DDT because the consequences of that decision require some technical judgement that can be largely ignored until the exact consequences are apparent, and then can be argued about anyway? Why did we ban DDT in the first place?

Jim
One of the original flags that led to the banning of DDT was research into why Bald Eagles were dieing at such a record rate. Turned out that their egg shells were much thinner than normal and that they contained DDT. Following the evidence it became apparent that DDT sprayed on crops to reduce insects and other pests was 1) getting into the crops themselves and 2) overspray was getting into the watertable which was causing fish to become DDT rich and as a byproduct, the eagles were eating the fish, laying eggs that were weak...

FDA and the forerunner of HHS did studies of people who died of liver cancer and a national screening of autopsies and correlated those results with known areas of high use of DDT. Something like 80% of the autopsies showed some DDT in the tissue the national sample while bodies that were in proximity to spraying areas showed very high concentrations of DDT in their tissue samples. Liver cancer autopsies showed DDT as a strong contributor on a high percentage of those cancers.

The effects of DDT showed such compelling data that it was one of the fastest banned substances in US government history. All this happened in the late 1960’s.

EDIT: Paragraph 2 edited to make more sense -- Should read:

FDA and the forerunner of HHS did studies of people who died of liver cancer and a national screening of autopsies and correlated those results with known areas of high use of DDT. Something like 80% of the autopsies showed some DDT in the tissue in the national sampling while bodies that were in proximity to spraying areas showed very high concentrations of DDT in their tissue samples. Liver cancer autopsies showed DDT as a strong contributor on a high percentage of those cancers.

McBear,
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Last edited by mcbear; 09-08-2006 at 12:41 PM.
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post #113 of 169 (permalink) Old 09-08-2006, 12:32 PM
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Originally Posted by baby boo
There were millions of deaths due to malaria in the pre-HIV era. Mcbear is the one who brought up the issue of HIV which really isn't pertinent to the discussion. HIV may very well make malaria more lethal but, if anything, that would underscore the need to control the mosquito population with effective insecticides. Malaria deaths fall with the use of DDT and rise within a few years after it's use is abandoned. Here' s statement from The Association of American Physicians and Surgeons that says it all:

The following resolution was approved on a nearly unanimous vote during the 2004 AAPS General Assembly in Portland, Oregon, October 13-16, as the official opinion of this national association representing thousands of physicians and surgeons in private practice in the United States.

RESOLUTION 61-02, 2004: Legalizing DDT to Fight Malaria in Tropical Countries

WHEREAS: malaria has killed more people than any other infectious disease in history and is still epidemic in tropical countries – infecting 300,000,000 people and killing more than 1,000,000 every year, most of them pregnant women and children under five in sub-Saharan Africa; and

WHEREAS: more than 50 million people have died from malaria since EPA Administrator William Ruckelshaus arbitrarily banned DDT in 1972, contrary to expert testimony and a decision by Judge Edmund Sweeney that the pesticide was not harmful to humans, animals or the environment – a position subsequently affirmed by the World Health Organization and many other experts; and

WHEREAS: the WHO-UN-World Bank “Roll Back Malaria” campaign to cut malaria rates in half by 2010 has relied entirely on bed nets and drug therapies, and refused to consider the use of pesticides, even as the rate of malaria increased by more than 15% during the program’s six-year existence, killing millions, leaving others too sick to work, and perpetuating poverty in many nations; and

WHEREAS: mosquitoes are much less likely to develop resistance to DDT because it is no longer used in agriculture, and spraying tiny amounts of this pesticide on the walls of traditional huts repels mosquitoes and kills them on contact for six months or more, without contaminating the environment; and

WHEREAS: South Africa successfully used DDT to reduce malaria by more than 90% in three years, by using DDT to spray huts and in combination with artemisinin-based drugs and other strategies – a program that many poor countries want to emulate, but are prevented from doing so by threats from donor agencies and activist groups that continue to oppose the use of DDT under any circumstances;

THEREFORE BE IT RESOLVED THAT:the Association of American Physicians and Surgeons supports efforts to insist or require that agencies of the United States and United Nations permit, encourage, and fund the use of DDT in tropical countries where malaria is prevalent and health ministries wish to use it to save lives.


IMO the prohibition in the use of DDT constitues a genocide being perpertrated on Africa by the environmental lobby.
I understand your passion for this. Two of my wife's family of Docs spend a month in Africa for volunteer work per year and see this first hand. If you note in the declaration above the line “ “Roll Back Malaria” campaign to cut malaria rates in half by 2010 has relied entirely on bed nets and drug therapies, and refused to consider the use of pesticides”, the UN is refusing ANY pesticides according to the declaration. There have been entire families of pesticides that address mosquitoes developed in the past 40 years since DDT that are fully capable of producing results.

If they do start using DDT, the next problems for the Sub Saharan area are going to be birth defects, liver cancer, reduction of food capacity due to watertable pollution and the only possible positive being a reduction of birth rate.

Also, HIV/AIDS and other immune deficiency illnesses that are rampant in Sub Sahara Africa are strong contributors in these malaria deaths. Malaria, by itself tends not to kill. I have many friends who, like me, spent time in the swamps in VietNam and caught a mild case of it [I did not catch it]. It is only when associated with other illnesses that it becomes a player. It will not be until the UN, with 10s of Trillions of dollars from the developed nations bring the standard of living up in that area will the death rate start to decline from the current 300+/1000 infant mortality rate. With the current political climate where many do not even want to help those in America who can least afford to help themselves, I cannot see that mortality rate decreasing any time soon.

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post #114 of 169 (permalink) Old 09-08-2006, 12:41 PM
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World Health Organization statement on the use of DDT:

"DDT still has an important role to play in saving lives and reducing the burden of malaria in some of the world's poorest countries, states the World Health Organisation (WHO) as the international community considers phasing it out.....

For many malaria-affected countries, responsible DDT use is a vital strategy for preventing malaria transmission and controlling epidemics. Countries continue to use DDT primarily because they cannot afford reliable alternatives or do not have the capacity to develop them.....

In order to ensure that treaty restriction on DDT will not result in an increase in malaria deaths, WHO and the Roll Back Malaria partnership (RBM) are encouraging the negotiators to support time-limited exemptions for the public health use of DDT. In addition WHO is calling for new financial resources to aid in the development of and orderly transition to cost-effective alternatives to DDT for malaria vector control....."


Virtually every medical treatment (and some prevention) strategies have unintended consequences. We have to weigh the risk/benefit ratio of nearly everything we do. Look in the PDR some time and look at the long list of toxic side effects of common drugs that are used to treat high blood pressure, heart disease and even gout. I've seen people die of INH toxicity while awaiting a liver transplant. And yet the use of INH remains a mainstay in the prevention and treatment (though, for the latter, not as monotherapy) of tuberculosis.

My feeling is that the environmental lobby has done far more harm than good. They have helped make America less competitive in the world marketplace than countries without strict polution standards who do not have to incur these environmental costs. They have fostered our dependence on unreliable sources of oil and, indirectly, made America less secure by holding our foregin policy decisions hostage to the whims of countries whose values and goals are antithetical to ours. And, finally, they have blundered and caused the needless deaths of millions in Africa with their campaign to prohibit the use of DDT for mosquito control.

I'm sure there's more but I think that this thread has gone sufficiently far afield already.
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post #115 of 169 (permalink) Old 09-08-2006, 12:52 PM
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....
Also, HIV/AIDS and other immune deficiency illnesses that are rampant in Sub Sahara Africa are strong contributors in these malaria deaths. ....
It doesn't matter. If we have a population that is even more vulnerable to the lethal consequences of malaria that is all the more reason to try to prevent it. We are not going to eliminate HIV overnight.

I'm going to try and find the statistics of malaria deaths in Africa in the pre-HIV era (say before 1982). I predict that you will be shocked at the number of deaths that it caused in immunocompetent persons.
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post #116 of 169 (permalink) Old 09-08-2006, 01:09 PM
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World Health Organization statement on the use of DDT:

"DDT still has an important role to play in saving lives and reducing the burden of malaria in some of the world's poorest countries, states the World Health Organisation (WHO) as the international community considers phasing it out.....

For many malaria-affected countries, responsible DDT use is a vital strategy for preventing malaria transmission and controlling epidemics. Countries continue to use DDT primarily because they cannot afford reliable alternatives or do not have the capacity to develop them.....

In order to ensure that treaty restriction on DDT will not result in an increase in malaria deaths, WHO and the Roll Back Malaria partnership (RBM) are encouraging the negotiators to support time-limited exemptions for the public health use of DDT. In addition WHO is calling for new financial resources to aid in the development of and orderly transition to cost-effective alternatives to DDT for malaria vector control....."


Virtually every medical treatment (and some prevention) strategies have unintended consequences. We have to weigh the risk/benefit ratio of nearly everything we do. Look in the PDR some time and look at the long list of toxic side effects of common drugs that are used to treat high blood pressure, heart disease and even gout. I've seen people die of INH toxicity while awaiting a liver transplant. And yet the use of INH remains a mainstay in the prevention and treatment (though, for the latter, not as monotherapy) of tuberculosis.

My feeling is that the environmental lobby has done far more harm than good. They have helped make America less competitive in the world marketplace than countries without strict polution standards who do not have to incur these environmental costs. They have fostered our dependence on unreliable sources of oil and, indirectly, made America less secure by holding our foregin policy decisions hostage to the whims of countries whose values and goals are antithetical to ours. And, finally, they have blundered and caused the needless deaths of millions in Africa with their campaign to prohibit the use of DDT for mosquito control.

I'm sure there's more but I think that this thread has gone sufficiently far afield already.
What that WHO memo says is "Countries continue to use DDT primarily because they cannot afford reliable alternatives " It does not say they cannot use DDT. Even in America there is an exemption on DDT use in a "Public Health Emergency".

As for our environmental standards making us less competitive in the world marketplace because of wanting to keep American safe and healthy, I don't think that is the correct. American jobs have gone away due to cheap and slave labor in other countries and the absolutely retarded insistence by Wall Street that every quarter be a leap in profits which does not allow companies to focus on long term strategies.

We could go back to the mid 20th Century where lead paint and DDT and leaded gas and blacklung and asbestos and mercury and agent orange [yes it was used to kill weeds here too] and chromium oxide and all those other byproducts of American industry were a daily part of our lives. That still would not save the lives of most of the children in Africa. They have been dieing for centuries because no one really cares enough to try and bring them into either a first or second world economy. No one wants to put the time or tax money to do so. So they are going to continue to die DDT or not. That is just a sucky fact.

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post #117 of 169 (permalink) Old 09-08-2006, 02:08 PM
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We need to look at not only the benefits of interventions (whether it be active, such as the use of drugs to prevent disease) or prophylactic such as in polution controls but also at the costs associated with these interventions so that we may use our limited resources most effectively.

E.g., if I were to tell you that the cost to prevent a stroke using one baby aspirin a day for 10 years was, say, $1000, I think we would all agree that this is worthwhile. However, what if a new drug came on board that would prevent a stroke but only at a cost of $20,000,000 over 10 years, would it still be a wise use of limited ressources? (you may be asking how we get at these numbers. Here's how. Let's suppose that the mortality from a certain disease is 25% over 5 years but can be reduced to 20% by taking drug A. That is a 5/25 X 100 = 20% relative risk reduction. But this overestimates it's actual impact on disease as the absolute risk reduction is only 5% (25 - 20). From this number we can get the number needed to treat (NNT) -- an increasingly important statistic. The NNT is the reciprocal of the absolute risk reduction i.e., in this case, 1/.05 = 20. So we would need to treat 20 people over a period of 5 years to prevent one death. This is actually an excellent use of resources as few interventions in medicine have an NNT of only 20. The actual cost of saving this one life would then be equal to NNT X number of years of treatment X cost per year of therapy. As the cost per year of therapy (or NNT) increases it becomes progresssively less cost effective to use this particular treatment.)

Tengs has done several cost - benefit analysis looking at hundreds of different intervention from medical to transportation safety measures to pollution control: I'll let this abstract speak for itself:


Five-hundred life-saving interventions and their cost-effectiveness.
Tengs TO - Risk Anal - 01-JUN-1995; 15(3): 369-90

Abstract:
We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. "Life-saving interventions" were defined as any behavioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an intervention per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs $42,000 per life-year saved. The median medical intervention cost $19,000/life-year; injury reduction $48,000/life-year; and toxin control $2,800,000/life-year. Cost/life-year ratios and bibliographic references for more than 500 life-saving interventions are provided.


I have this particular article around here somewhere and I'll try to dig it up....

Last edited by baby boo; 09-08-2006 at 02:13 PM.
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post #118 of 169 (permalink) Old 09-08-2006, 02:26 PM
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Surely we should recognise that DDT is a 20th century remedy against a problem that persists into the 21st century, which should be a clear indication that it's not a solution.As is the case for many major problems, there are few 'magic bullets' and a multi-pronged approach is more likely to be effective.The following seems to hold a lot of promise, not least because of it's benign impact on the environment:
http://news.bbc.co.uk/1/hi/health/194160.stm

I also watched an Open University presentation recently extolling the virtues of the humble mosquito net and education.
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post #119 of 169 (permalink) Old 09-08-2006, 02:48 PM
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What that WHO memo says is "Countries continue to use DDT primarily because they cannot afford reliable alternatives " It does not say they cannot use DDT. Even in America there is an exemption on DDT use in a "Public Health Emergency".

.....
I know, mcbear, it was precisely my point that, although, WHO endorsed the limited use of DDT until better alternatives become available the environmental lobby fought then tooth and nail. They succeeded in getting DDT temporarily banned in S. Africa at a cost of thousands of lives until it was re-introduced.

My issue is not with WHO. It is with the environmental lobby.

As far as the appropriate use of scarce resources is concerned (i.e., in this case money) do you think that they should be spent on "toxin control" measures costing $2,800,000 per year of life saved or diverted to medical treatments which cost $19,000 per year of life saved????

You be the judge of that, but that decision is a simple one for me.....
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post #120 of 169 (permalink) Old 09-08-2006, 09:27 PM Thread Starter
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The DDT argument is a tough one. Put yourself in the position of a villager in central Africa (or any other moist tropical environment). Here is an insecticide proven to kill the vector that kills your people and also inflicts long-term degradation on many animals, especially birds.

Now here comes some rich mofo from America or Europe who says he feels your pain but really is concerned for the birds.

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