She's at it again. Our beloved Minister of Health is now questioning the validity of vaccination for "meningitis, mumps and some other diseases," according to the Jakarta Post (Minister wants to review vaccinations). She is apparently once again accusing foreign drug companies of using Indonesia as a testing ground.
The Minister is reported to want scientific proof that immunization against pneumonia, chicken pox, flu, rubella and typhoid are beneficial. At least we can be thankful that she apparently still believes in immunization against measles, polio, tetanus, hepatitis B and TB, but perhaps that's only a matter of time.
I doubt she'll get around to proposing beetroot as treatment for AIDS, as did her erstwhile South African counterpart - I've very rarely seen beetroot in Indonesia. But it could be 'buah merah' (the Papuan red fruit which is still touted as a cure for AIDS) or perhaps the 'Green Cocktail" promoted for its ability to 'control HIV/AIDS' by the State Islamic University (UIN) - I'm sure that would appeal to her.
The Post also reports that UNICEF will wait until the immunization policy is officially changed before commenting. It is perhaps understandable that they don't want to get into a shouting match with the Minister, but one would have thought that they might have felt able to provide the scientific proof she needs - I assume it exists?
Babé
Friday, 27 March 2009
Thursday, 26 March 2009
Supply and demand in strawberries and motor-cars
We can now access our Health Minister's statement to the recent meeting of the Commission on Narcotic Drugs. The achievements she claims are all in the field of supply and demand reduction. Among them, she lists the dubious achievement of a 'slight decline' in drug offence-related cases in 2008 after a massive 300% increase between 2003 and 2008. She does note that "in the area pf demand reduction, Indonesia's efforts focus on integrated comprehensive strategies as a continuum of care," whatever that means.
She notes that the economic cost of drug abuse in Indonesia was estimated to be US$32.9 billion in 2008, which she says in one-tenth of the value of global drug trade. I wonder how much of that goes to domestic corruption. Some time back someone estimated that the profits from drug dealing in Indonesia exceed the total budget of the police force. Plenty of room for a little 'lubrication.'
We should not be surprised that she does not mention harm reduction. At a cabinet meeting on AIDS a couple of years back, it is related that she omitted to deliver the parts of the statement prepared for her that referred to harm reduction. It transpired that she was uncomfortable to address this because she didn't know what harm reduction is.
Babé
She notes that the economic cost of drug abuse in Indonesia was estimated to be US$32.9 billion in 2008, which she says in one-tenth of the value of global drug trade. I wonder how much of that goes to domestic corruption. Some time back someone estimated that the profits from drug dealing in Indonesia exceed the total budget of the police force. Plenty of room for a little 'lubrication.'
We should not be surprised that she does not mention harm reduction. At a cabinet meeting on AIDS a couple of years back, it is related that she omitted to deliver the parts of the statement prepared for her that referred to harm reduction. It transpired that she was uncomfortable to address this because she didn't know what harm reduction is.
Babé
Tuesday, 24 March 2009
Consumption brought him down to the grave
It's exactly ten years since I wrote my first article in the Jakarta Post about World TB Day - which falls today. I'd been fascinated by TB since I'd first got involved with HIV. It did seem like there was a connection, but I found it difficult to understand. How did TB suddenly become active and cause all the damage? Why do people seem so much more vulnerable to active TB in the first couple of years after they are infected with HIV, even thought their immune system is still relatively healthy? Perhaps all this is beyond the grasp of a simple engineer!
But it was clear to me even then that there was a real connection between the two diseases. Indeed, as a press release from UNAIDS on World TB day in 1998 (sadly no archived on their site) noted, "TB is the biggest killer of AIDS patients worldwide." The release also noted:
I attended a meeting of activists at the TB Conference in Paris in October 2005. Amazingly, that meeting focused strongly on HIV (when will an AIDS conference ever focus on TB?). Everyone was there. Except no one from UNAIDS! So we got together and drafted a letter to Peter Piot requesting action. Happily this triggered a response. The HIV-TB guru from WHO, Alistair Reid was moved to UNAIDS to take responsibility for a co-infection program.
The recent emergence of extensively drug resistant TB (XDR-TB) has demonstrated once again the fatal nexus between HIV and TB. I concluded my first article in the Post by noting that the best policies "...simply cannot have a widespread impact on the disease without political commitment. Clearly to develop and maintain such commitment in Indonesia at present represents a major challenge." Ten years on, this remains the challenge...
Babé
But it was clear to me even then that there was a real connection between the two diseases. Indeed, as a press release from UNAIDS on World TB day in 1998 (sadly no archived on their site) noted, "TB is the biggest killer of AIDS patients worldwide." The release also noted:
"A comprehensive response to the dual TB/HIV epidemic has not yet been implemented," Dr. Peter Piot, UNAIDS Executive Director commented. "Only a dual strategy of TB control and HIV prevention can reduce the TB/HIV burden." Dr. Piot believes that this strategy must be implemented worldwide "...if we are to break the lethal combination of HIV and TB, a partnership which is adding to the suffering of millions of people with HIV, shortening their lives and helping spread TB to alarming levels."Sadly, Piot and UNAIDS then seemed to forget all about TB. Indeed, a search of their web site finds no pages on TB and HIV until May 2006, prior to the Special Summit of African Union on HIV/AIDS, Tuberculosis and Malaria. Even then, there is little effort made to connect the epidemics. As I think I have noted before, when I visited South Africa in 2004, for a pan-African workshop on Treatment Literacy, Treatment Action Campaign couldn't find anyone to speak on HIV and TB.
I attended a meeting of activists at the TB Conference in Paris in October 2005. Amazingly, that meeting focused strongly on HIV (when will an AIDS conference ever focus on TB?). Everyone was there. Except no one from UNAIDS! So we got together and drafted a letter to Peter Piot requesting action. Happily this triggered a response. The HIV-TB guru from WHO, Alistair Reid was moved to UNAIDS to take responsibility for a co-infection program.
The recent emergence of extensively drug resistant TB (XDR-TB) has demonstrated once again the fatal nexus between HIV and TB. I concluded my first article in the Post by noting that the best policies "...simply cannot have a widespread impact on the disease without political commitment. Clearly to develop and maintain such commitment in Indonesia at present represents a major challenge." Ten years on, this remains the challenge...
Babé
Monday, 23 March 2009
Full alchemized, and free
Psychiatrists reject pharmaceutical industy funding! 'Bout time! I heard this quite by chance on NPR news, and googled to get details. Found it The Carlat Psychiatry Blog - "Supporting the search for honesty in medical education." Wow! What a concept!
The article, APA Votes to Phase out Industry-Funded CME, gives some the details, although I can't find anything about it on the APA web site - or indeed on any other sites.
The NPR report noted that there are an increasing number of studies which indicate that these free lunches do impact on prescribing habits, and that they have greatest impact on those doctors who swear blind that they are not affected.
Now all we need is for this to spread to other medical disciplines - and then to Indonesia.
Babé
The article, APA Votes to Phase out Industry-Funded CME, gives some the details, although I can't find anything about it on the APA web site - or indeed on any other sites.
The NPR report noted that there are an increasing number of studies which indicate that these free lunches do impact on prescribing habits, and that they have greatest impact on those doctors who swear blind that they are not affected.
Now all we need is for this to spread to other medical disciplines - and then to Indonesia.
Babé
Sunday, 22 March 2009
Iron bars a cage
No more prison for drug users, Supreme Court tells judges - a headline in yesterday's Jakarta Post. The 1997 narcotics law provides for the option of rehabilitation rather than prison for drug addicts, but this sentence is rarely offered.
Sounds like good news. But where are the rehab centres for the 100,000 or so drug addicts currently incarcerated? And who will pay? If history is a guide, there will be a mushrooming of 'commercial' rehab centres; anyone with a largish house will cram four or five three-high bunk beds into a bedroom, put bars on the windows, and charge as much as Rp 5 million ($400+) a month for 'rehabilitation'. This happened a decade ago, when parents looked for any way to 'get the junkies out of the house.' Several centres chained up the addicts (I personally saw a teenage girl in leg shackles in a rehab centre in North Sumatra). Many feed them 'legal' drugs to keep them sedated, adding another level of addiction.
We then asked which government entity is responsible for registering and monitoring such rehab centres. No one seemed to know.
My understanding is that this is the policy in Malaysia, which has set up 'boot camps' as rehab centres for addicts. Reports I have heard suggest that the regime there is worse than in prison.
There is ample evidence that rehab at best 'cures' 10% of voluntary 'patients', and little more than 0% of those who are forced. Even those who become 'clean' usually relapse within months. So we need a revolving door. Or we apply the option only to first time offenders (I think that is indeed the intent of the law), and lock up recidivists. Same difference!
This policy might empty the prisons, but will (I fear) do nothing to solve the problem. Indeed, I fear it make exacerbate human rights violations. Like it or not, legalization of drugs is the only solution.
Babé
Sounds like good news. But where are the rehab centres for the 100,000 or so drug addicts currently incarcerated? And who will pay? If history is a guide, there will be a mushrooming of 'commercial' rehab centres; anyone with a largish house will cram four or five three-high bunk beds into a bedroom, put bars on the windows, and charge as much as Rp 5 million ($400+) a month for 'rehabilitation'. This happened a decade ago, when parents looked for any way to 'get the junkies out of the house.' Several centres chained up the addicts (I personally saw a teenage girl in leg shackles in a rehab centre in North Sumatra). Many feed them 'legal' drugs to keep them sedated, adding another level of addiction.
We then asked which government entity is responsible for registering and monitoring such rehab centres. No one seemed to know.
My understanding is that this is the policy in Malaysia, which has set up 'boot camps' as rehab centres for addicts. Reports I have heard suggest that the regime there is worse than in prison.
There is ample evidence that rehab at best 'cures' 10% of voluntary 'patients', and little more than 0% of those who are forced. Even those who become 'clean' usually relapse within months. So we need a revolving door. Or we apply the option only to first time offenders (I think that is indeed the intent of the law), and lock up recidivists. Same difference!
This policy might empty the prisons, but will (I fear) do nothing to solve the problem. Indeed, I fear it make exacerbate human rights violations. Like it or not, legalization of drugs is the only solution.
Babé
Saturday, 21 March 2009
With tired backs we bring you gifts
She's at it again. Our revered Minster of Health is again lashing out at the foreigners, according to the Jakarta Globe (Minister Wary of Foreign ‘Attack’, although the print version has the headline 'Minister Attacks Foreign Funding', with the subhead "Paranoia? 'World will use our viruses or DNA do attack us'").
As I have noted before, her decree banning export of viruses and DNA samples has put the kibosh on the offer by Australia to detect HIV in babies within weeks of birth using dried blood spots. It is increasingly clear that very early diagnosis and immediate treatment can have a major effect on survival of babies born with HIV. The reported 'policy' of the Ministry of Health is to support early testing, but as yet no concrete steps have been taken to implement it. So you could say that the Minister's ban is costing lives - of babies. What a great record for a Minister of Health! She and Manto are a right pair! Except that Manto is no more Health Minister in South Africa. We'll have to wait until October to get a replacement.
Paranoia it may be, but this is also evidence of an increasing xenophobia. If I was alone in this feeling, perhaps I'd put it down to cantankerous old age. But none other than Endy Bayuni. Chief Editor of the Jakarta Post (and someone I particularly respect), referred to it exactly three years ago to the day, following the Jogjakarta earthquake (What's with this post-disaster xenophobia?).
One reported comment by the Minister is telling: "Trust me on this one, there is no such thing as free help. When people offer big money to help you, they undoubtedly expect to benefit from it," Supari said. This reflects a trait that I notice here; If someone offers help, it is assumed to be for their own benefit, and thus thanks are not required. Quite the reverse: the donor should be offering thanks if the gift is accepted. I wonder what she thinks the Global Fund will demand...
Babé
As I have noted before, her decree banning export of viruses and DNA samples has put the kibosh on the offer by Australia to detect HIV in babies within weeks of birth using dried blood spots. It is increasingly clear that very early diagnosis and immediate treatment can have a major effect on survival of babies born with HIV. The reported 'policy' of the Ministry of Health is to support early testing, but as yet no concrete steps have been taken to implement it. So you could say that the Minister's ban is costing lives - of babies. What a great record for a Minister of Health! She and Manto are a right pair! Except that Manto is no more Health Minister in South Africa. We'll have to wait until October to get a replacement.
Paranoia it may be, but this is also evidence of an increasing xenophobia. If I was alone in this feeling, perhaps I'd put it down to cantankerous old age. But none other than Endy Bayuni. Chief Editor of the Jakarta Post (and someone I particularly respect), referred to it exactly three years ago to the day, following the Jogjakarta earthquake (What's with this post-disaster xenophobia?).
One reported comment by the Minister is telling: "Trust me on this one, there is no such thing as free help. When people offer big money to help you, they undoubtedly expect to benefit from it," Supari said. This reflects a trait that I notice here; If someone offers help, it is assumed to be for their own benefit, and thus thanks are not required. Quite the reverse: the donor should be offering thanks if the gift is accepted. I wonder what she thinks the Global Fund will demand...
Babé
Monday, 16 March 2009
Always at the infectious disease roulette table
Those days before AIDS. I've written about them before, but this time from a different perspective. I'm currently in Singapore on another visa run, and something took my mind back more than 40 years to when I was with the British Army about 100km north of here, at Kluang in Johore State. I was then working for the Army Air Corps (AAC), and the base in Kluang was used for 'theatre conversion.' This involved young lads who had gone through basic helicopter flying training at the AAC base in Middle Wallop (yes, that's really the name of a village in Southern England), but we're still wet behind the ears - "a year ago I couldn't even spell 'Heliocopter Pilot' and now I are one."
Of course, flying over Salisbury Plain is a tad different from flying over a tropical jungle, so they had to learn about this - hence theatre conversion (theatre of war, not other forms of drama). So these kids, most of whom had never been out of Europe before, spent a month or so flying all day over the local jungle. Of course in the evenings they were ready for anything.
But Kluang didn't offer much in the way of exotic entertainment. So we used to bundle them into our cars of an evening, and drive for about an hour over to the west coast, to a small town called Batu Pahat. In theory this was out of bounds, but since there was no garrison near, that was never a problem. We'd always end up at the Hawai Kedai Kopi (Coffee Shop), a dingy place with the floor covered with peanut shells - and 'waitresses' who would do what I think now is called 'lap-dancing.' After a few minutes of this came the offer: 'ten dollars, upstair, you come?' Of course, our intrepid helicopter drivers, having imbibed more than a few cans of Tiger, were ready for anything.
Next morning, over the hangover breakfast in the Mess, we'd start talking about the local prevalence of pox and other nasties, and tell them that we were sure they'd used condoms last night - of course they hadn't. The fact that our mess was shared with the local military hospital, so usually there were one or two doctors present, added spice to the discussion. I never heard that any actually picked up any disease, but they were sure worried for a couple of days.
One certainly wouldn't want to play that form of Russian Roulette today...
Babé
Of course, flying over Salisbury Plain is a tad different from flying over a tropical jungle, so they had to learn about this - hence theatre conversion (theatre of war, not other forms of drama). So these kids, most of whom had never been out of Europe before, spent a month or so flying all day over the local jungle. Of course in the evenings they were ready for anything.
But Kluang didn't offer much in the way of exotic entertainment. So we used to bundle them into our cars of an evening, and drive for about an hour over to the west coast, to a small town called Batu Pahat. In theory this was out of bounds, but since there was no garrison near, that was never a problem. We'd always end up at the Hawai Kedai Kopi (Coffee Shop), a dingy place with the floor covered with peanut shells - and 'waitresses' who would do what I think now is called 'lap-dancing.' After a few minutes of this came the offer: 'ten dollars, upstair, you come?' Of course, our intrepid helicopter drivers, having imbibed more than a few cans of Tiger, were ready for anything.
Next morning, over the hangover breakfast in the Mess, we'd start talking about the local prevalence of pox and other nasties, and tell them that we were sure they'd used condoms last night - of course they hadn't. The fact that our mess was shared with the local military hospital, so usually there were one or two doctors present, added spice to the discussion. I never heard that any actually picked up any disease, but they were sure worried for a couple of days.
One certainly wouldn't want to play that form of Russian Roulette today...
Babé
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