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OK, it’s been ten thousand years since I’ve posted on The Wisdom site; I apologise for the long silence, which is explained by my being AWOL doing other things. For a while, I went totally off topic, spent a year on tramp steamers, and wrote a book about Indonesia. For the last four or five years, I’ve been back in public health, but haven’t been working much on the sex, drugs and HIV issues which interest readers of this blog. Instead, I’ve been working on fake and substandard medicines, including how they drive antimicrobial resistance. Needless to say, the whole COVID situation creates a paradise for the crooks who make fake medicines, but it’s also going to eat in to the quality of medicines — for cancer, depression, diabetes, and more or less everything else — made by legit manufacturers, too.

Our research team has just started blogging (and, rather more diligently, tweeting) at http://MedsWatch.org and @MedsWatch, so if you’re interested, please follow us there. For now, I’m cross-posting our second ever post, because, well, it’s also “on topic” for Wisdom readers.

Covid and condoms: the MedsWatch view

COVID-19 continues to slash through international supply chains that were previously much lauded for playing to the comparative advantage of different economies, increasing efficiency, and generally laying rich offerings on the altars of shareholder value.

The pandemic has underlined not just the fragility of our supply lines, but their interdependence. So I couldn’t help but smile, as I walked through the aisles of a large chain pharmacy in the suburbs of New York last week, at the juxtaposition of the shelves either side of me.

On my right, despite panicked reports from Malaysia that coronavirus will cause a global shortage of condoms, a dizzying array of rubbers to suit every taste. With the bars empty and even Tinder warning people off meeting in real life demand for condoms, at least in the suburbs of New York, seems to be slowing.

Meanwhile, on my left, directly opposite the shelves groaning with condoms:

Supply chains for baby products are clearly struggling to keep up with demand, even now. That rather begs the question: if there’s no run on condoms and other contraceptives, will it mean that nine months from now, the shelves that should hold nappies will be swept barer still ? It seems likely that the reverse could hold equally true: shelves and pharmacies cleared of contraceptives might reinforce the pressure on wet-wipes and baby powder. Data analysed by The Economist, which offset the birth rate by nine months from the time of a major epidemic, suggest an “N” curve: major epidemics seem to lead to a fall, then a rise, in babies.

The shutdown will probably also have a knock-on effect on demand for treatments for other sexually transmitted infections. My own guess is that COVID will lead to a rapid fall in STIs, followed by a rapid rise, the moment restrictions on movement are lifted. Unless, of course, the shelf on my right very quickly begins to look like the one on my left.

Most people spend long summer evenings in Paris strolling arm in arm around the boulevards, sitting in cafes or lolling in parks. I spent this weekend in the sewers. Am I odd in finding drains a sexy subject? Perhaps. But they’re my number one candidate for a Song of Contagion.

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Whether this story gets selected or not is up to Tony Haynes and his song-writers and musicians in the iphone怎么永久上外国网站. But it is also up to you, and whether you have better ideas about which diseases would best illustrate the different social, political and physical forces that shape our perception of the importance of a specific illness. In our current thinking, the list of parameters which affect our perception of disease fall into four categories. They look like this:

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I’ve just emerged from three days buried in a bunker at the Geneva Health Forum, which focuses on health in lower income countries. There was a great cartoonist, but otherwise it was all quite po-faced: power-point presentations, incomprehensible posters and much thanking of sponsors. LOTS of rather earnest, mostly white people suffered from the Public Health Fallacy: the idea that if only they had the (technical) evidence, all governments would do the best thing for their poorest and most neglected. Despite all of the (historical, political, social) evidence (.pdf) that the poorest and most neglected mostly get, well, neglected by those that govern them.

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Does that sound crazy? Maybe. Will it change the world? Of course not. Will it allow us to think a bit more creatively than another powerpoint presentation in a bunker conference? Probably. Will it be a lot of fun? Certainly!

Come along tomorrow, Saturday April 23, and add your voice to the project, which we’re calling Song of Contagion. (It’s supported by the Wellcome Trust, and most of what they support turns out pretty well.) We’re meeting in Hackney, East London, to begin to decide which diseases to songify, and what, besides the technical evidence, we should be adding to the musical mix. The fact that the Minister of Health’s wife owns a Pharma company, maybe? We didn’t hear THAT at the Geneva Health Forum…

If you’re wondering about the illustration, I was in Geneva to discuss with colleagues how we might turn the asteroid field of public health data sharing into a nice, tidy solar system. Right now, if you played public health data sharing in music, it would sound so cacophonous that many people would just switch it off. To turn it into a symphony, we need to appoint someone to act as conductor, and start investing in more players in the orchestra. But that’s a whole separate post…

Today is World Health Day. Judging from what’s in the Song of Contagion Twitter stream (@songfocontagion), this is above all an opportunity for a lot of lobbyists and marketing specialists to promote their specific cause. Greenpeace has been quite active, because of course you can always make a health issue out of the environment.

There’s quite a bit from the Indian government, a lot of it focusing on diabetes (the prevalence of which, we will learn from The Lancet tonight, has more than doubled in India since 1980). But there are also Indian companies trying to convince us that ghee, or clarified butter, is good for us after all.

We’ve got single-disease NGOs all clamouring for our attention to “their” disease, often with recourse to statistics. This from the Mental Health Foundation for example:

Finally, you’ve got marketers of fads and gizmos, all capitalising on World Health Day.

All of this is part of the clamour that leads to really important decisions about what research gets done and which interventions get funded. (Oddly, I’ve seen little today from Big Pharma, who I thought would be all over Twitter — maybe they are promoting their wares through the NGOs and foundations they fund?) If you want to help us make sense of how much influence initiatives such as World Health Day really have, then turn the results into music, please join us on the Song of Contagion project. Details here of our April 23rd launch workshop — which will discuss how priorities are set in global health.

Yesterday, during a visit to the thought-provoking Museum of the Mind, on the premises of the Bethlem hospital (still active but now renamed), I was reminded both how far we have come in the treatment of mental illness since the ‘Bedlam madhouse’ was first opened, and how far there is still to go.

At the entrance to the new museum stand the two statues which sat over the gates to the old hospital from 1676 to 1815: “Raving Madness” (pitcures above) and “Melancholy”.
When they were carved, these just about covered the range of diagnoses for mental illness. Many centuries later, we have a far better understanding of all the ways in which the mind can be ‘broken’, as well as the different manifestations of mental illness. Today, for example, is World Autism Awareness Day; although first coined by a Swiss psychiatrist in 1911, the word autism wasn’t used in its current sense until the 1940s, long after the building that houses the latest iteration of the Bethlem Hospital was built.

It made me wonder: how has the divvying up of mental illness into infinitesimally narrow diagnoses affected those who live with it? Have some types of mental illness or their manifestations become more ‘acceptable’ than others? Does that affect how much research we do into them, or how much treatment is available?

These are the sorts of questions we’ll be discussing at Song of Contagion as we try to turn different diseases and illnesses into music. Please come and join us at the launch workshop on April 23rd, 2016, or any time along our musical journey.