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December 31, 2006
Don't Say We Never Do Anything For You
A Washington Post article notes that President Bush has tripled aid to Africa. The piece cites the encouragement of evangelicals, who have long been involved in Africa, and the strategic value of a stable continent, as two influences.
Posted by Adam Graham-Silverman at 10:40 PM | Comments (0)
December 30, 2006
Teritiary News
Some recent stories of note:
Poz: Stories from the front lines: High school students and abstinence-only education
IHT: Anti-Americanism spreads across Africa
NYT: Nick Kristof on PEPFAR
Mark Dybul's response
Posted by Adam Graham-Silverman at 10:25 PM | Comments (0)
December 28, 2006
Drug Developers, or Just Advertising Firms?
Long is the quest to put a dollar figure on the cost of developing a new prescription drug. Pharmaceutical companies often pin the high costs of some drugs on the R&D that it took to bring them to market. But many doctors have argued that much of the research is federally subsidized and goes on in universities. Once developed, the companies buy the new drug and sell it, making profits rivaled only by big oil.
A new GAO report (summary) lends some credence to these claims, pointing out that as research expenses have grown, fewer drugs are getting to market. And most FDA approvals are for new uses of existing drugs -- say, in children's doses -- that preserve a company's market.
UPDATE, Feb 26: A Boston Globe opinion piece from former New England Journal of Medicine editor and prominent drug firm critic Martha Angell argues that the FDA has fallen into the hands of the drug companies.
Posted by Adam Graham-Silverman at 10:28 PM | Comments (1)
December 25, 2006
Our Watchword is Accountability
Internal auditors at PEPFAR are reporting that the "management and evaluation" plank of the program is not exactly up to snuff. One hallmark of Bush's global AIDS plan was its focus on accountability. Rather than measuring results in dollars spent, it would measure people on treatment, infections prevented (a tough thing to tabulate) and people cared for. The initial benchmark to treat 2 million, prevent 7 million infections and care for 10 million people by 2008. The audits show that the reported numbers were sometimes too high while others were too low. PEPFAR head Mark Dybul makes the reasonable point that waiting to have perfect accounting systems in place would have cost lives. But some of the inaccuracies made their way into reports to Congress.
Posted by Adam Graham-Silverman at 9:34 PM | Comments (0)
December 20, 2006
Good God!
A massive, incredibly thorough and deep study confirms what PEPFAR critics have often alleged: a conservative, pro-Christian bias affects the agency's grantmaking and programs all over the world. It might be easy to dismiss a stray organization or two promoting a heavy Christian message or pushing false information about condom use. This study suggests that this type of behavior gets U.S. funding in every PEPFAR focus country.
The study comes from the Center for Public Integrity, a pretty unassailable nonpartisan investigative reporting unit. They reviewed tons and tons of public health manuals and financial documents and conducted interviews in most of the focus countries.
CPI also posts PEPFAR's grant databases, which it had to sue the State Department to obtain. "The picture presented is one of an extraordinarily disorganized operation," the report says. PEPFAR's response: No comment.
Posted by Adam Graham-Silverman at 9:44 PM | Comments (0)
December 13, 2006
A Cut in Time Saves Nine?
Two new studies in Africa confirm that circumcised men are less susceptible to acquiring HIV than uncircumcised men. This makes some sense, since foreskin cells are especially receptive to HIV. This doesn't mean circumcised men are immune or that women who have sex with circumcised men are at less risk either. The battle ahead in adopting circumcision is both medical and cultural. Dangers include doing the procedure with tainted blades or without antibiotics around in case something goes wrong, and overcoming any cultural resistance about the practice.
Posted by Adam Graham-Silverman at 8:38 PM | Comments (0)
December 12, 2006
Holdout to Adopt Needle Exchange
New Jersey, the only state without a needle exchange program of some sort, will soon lose that distinction. The state legislature cleared a bill that would establish six exchange sites.
Posted by Adam Graham-Silverman at 8:32 PM | Comments (0)
Off-Label Illegal?
The U.S. attorney has subpoenaed ARV-maker Gilead over for documents around its marketing practices, says the Contra Costa Times. Though no one would say much, the subpoenas may be related to attempts to encourage off-label use for drugs. For example, Gilead drug Truvada, in addition to treating HIV, may also prevent its transmission -- though that use has neither been proven nor licensed.
UPDATE: The AIDS Healthcare Foundation has taken several steps to criticize Viagra makers Pfizer for similar alleged behavior. Their marketing, the foundation says, encourages people without genuine sex problems to seek out Viagra, which in turn encourages unsafe sex. One particular group that uses Viagra, they say, are gay men who seek to prolong sex while using crystal meth. AIDS advocacy groups usually try to promote scientific, not moral stands, often based on the reality that people will have sex no matter how hard you try to prevent it. But this sounds like a case where activists are trying to limit sex in certain situations.
UPDATE II, Jan. 29: The foundation has now sued Pfizer for its marketing pratices. Slate has the text of the complaint.
Posted by Adam Graham-Silverman at 8:18 PM | Comments (1)
December 10, 2006
Congress Clears Ryan White
The House cleared the compromise Ryan White CARE Act that the Senate announced and passed just a few days ago. A key House chairman had seemingly engaged in some quid-pro-quo dealmaking: He would accept the Senate Ryan White bill if the Senate in turn passed his bill to restructure the National Institutes of Health. The Senate, which had been cool to that idea before, obliged. The moves came as part of one of those fun marathons that come at the very end of a session and last nearly all night. Whatever Congress did not pass now must start anew next year, when the 110th Congress convenes.
Posted by Adam Graham-Silverman at 8:09 PM | Comments (0)
December 6, 2006
Wait Wait, We Have a Deal
Lawmakers said it was hopeless. Then lawmakers changed their minds. Senators struck a deal to reauthorize the Ryan White CARE Act. In order to appease those from states with large urban centers and corresponding heavy HIV burdens, the compromise would assure that these states never get less than 95 percent of the money they get now.
The law also would expire in three years, forcing a complete re-write at the time. Given the lack of one national AIDS policy (HHS is supposedly working on it), the advances in treatment and the changing demographics of the disease, this last piece sounds quite wise. Details here.
There's also the issue of premature celebration, since the Senate is forgetting one thing: The House, which passed its own careful but different compromise earlier in the year.
Posted by Adam Graham-Silverman at 3:23 AM | Comments (0)
December 5, 2006
Democrats Begin to Flex Muscle?
Congressional Democrats are looking to overturn perhaps the most contentious part of President Bush’s global AIDS plan: The requirement that a third of prevention money be spent on abstinence programs. The Boston Globe reports that Rep. Barbara Lee, a Democratic leader on AIDS issues, is building support for striking the requirement. She's introduced legislation to do so, and will no doubt do so again when Congress convenes anew in January. The bill will serve as a barometer of support for the idea, since any actual changes will probably become part of a reauthorization of the law that is due next year. See how many cosponsors it attracts, and how far Democrats will go to pursue aims like this one now that they will wield the gavels.
Posted by Adam Graham-Silverman at 3:02 AM | Comments (0)
Congress to New York: Drop Dead?
Despite hopes raised by the lame-duck session, Congress is likely to go home without reauthorizing the Ryan White CARE ACT, which provides most of the federal money for domestic HIV and AIDS programs. The standoff between urban and rural states continues over dividing up the money continues. The House passed a bill favoring the rural areas, which lack any HIV infrastructure but are seeing a rapidly increasing number of cases. Compromises that have been floated and popped: Extending the law for one year; or extending it for three instead of the standard five to forestall the biggest hit to urban areas. Key lawmakers say that resolution is unlikely.
Posted by Adam Graham-Silverman at 3:02 AM | Comments (0)
Report Faults WHO Campaign
The 3x5 initiative was the catchy name for the WHO's effort to get three million people on antiretroviral drugs by the end of 2005. They failed.
A year later, a couple of think-tank scholars produce a report critical of various parts of the process. Some of the criticism, like the complaint that the program overtaxed countries with weak health infrastructure, might better be attributed to growing pains of any program of this size. (see also: PEPFAR)
Posted by Adam Graham-Silverman at 2:59 AM | Comments (0)
December 4, 2006
Kenya Boasts 'Best' PEPFAR Program
Kenya's program under Bush's global AIDS plan is both successful and sophisticated, according to an AP story. Its $200+ million budget is, I think, the second-largest PEPFAR country program, behind South Africa. It's run by Buck Buckingham, who has run a long list of successful ventures in HIV-related programs -- not least of which is himself. He was diagnosed with HIV in 1988.
Posted by Adam Graham-Silverman at 2:54 AM | Comments (0)
December 3, 2006
Big Pharming Deal
A deal among a group of big pharmaceutical companies to pledge to sell AIDS medicine at low cost has fallen through, according to one of the negotiators. While the top of a story from The Independent makes it sound like drugmakers are reneging on promises, it seems more that the companies never reached any agreement. It appears that a union was the prime force trying to bring the companies together, and it is the union rep who says the deal is dead. The companies complained the union's plan did not have enough details. As the story notes, drug companies have sponsored many individual efforts to lower prices or distribute free medicine, so it's not clear why signing an agreement to do so in principle would constitute a major step.
Posted by Adam Graham-Silverman at 2:52 AM | Comments (0)
December 1, 2006
WAD: Activism Alive?
The Washington Post reports sardonically on the protesters arrested near the White House today, describing the choreography on both sides of the law. A moving bell-ringing ceremony at a nearby church gets a mention, too.
Posted by Adam Graham-Silverman at 2:49 AM | Comments (0)
WAD: Celebrate World AIDS Day by Demanding Some Funding Cuts
John Donnelly again scores with a thoughtful piece about some of the Saddleback evangelicals asking the United States to cut funding for the Global Fund. The Geneva-based group tries to be scientific and secular, which these Christian conservatives claim causes discrimination against faith-based groups in the field. Promoting condoms is also an unpopular view with them.
Posted by Adam Graham-Silverman at 2:46 AM | Comments (0)
WAD: Worth the Wait?
Barack Obama's address to the Saddleback evangelical church in California was far less controversial than all the fuss leading up to it. The Los Angeles Times reports the standing ovation he got as he told a group of pastors assembled at Rick Warren's megachurch about the role that science, sex ed and religion could play in slowing the spread of HIV.
Posted by Adam Graham-Silverman at 2:44 AM | Comments (0)
WAD: Twice as Many People on Treatment Worldwide
The incomparable John Donnelly reports that the number of poor people on AIDS treatment has roughly doubled in the last year. One million people have had their lives extended, though 10 million more need treatment.
Hidden headline: President Bush ended a 20-year-old ban on short-term travel into the United States by HIV-positive foreigners. This ban was a remnant from Reagan-era days of discrimination against people with HIV and, by implication, gays. It had also prevented major research and activist conferences from taking place in the United States, since many prominent people in the field are HIV-positive.
Posted by Adam Graham-Silverman at 2:43 AM | Comments (19)