Wal-Mart and more

[Curtis Burisch]

Dan, I live in Africa. I lived in Zimbabwe for more than half my life.
There's no denying that Malaria is a big problem. But DDT is definitely NOT
the answer.

 

Other preventative measures are cheaper, and far less damaging. Wikipedia
again:

 

"The relative effectiveness of IRS (with DDT or alternative insecticides)
versus other malaria control techniques (e.g. bednets or prompt access to
anti-malarial drugs) varies greatly and is highly dependent on local
conditions.[15]

 

"A study by the World Health Organization released in January of 2008 found
that mass distribution of insecticide-treated mosquito nets and artemisinin
based drugs cut malaria deaths in half in Rwanda and Ethiopia, countries
with very high malaria burdens. IRS with DDT was determined to not have
played an important role in the reduction of mortality.[105]

 

"Vietnam is an example of a country that has seen a continued decline in
malaria cases after switching in 1991 from a poorly funded DDT-based
campaign to a program based on prompt treatment, bednets, and the use of
pyrethroid group insecticides. Deaths from malaria dropped by 97%.[106]

 

"In Mexico, the use of a range of effective and affordable chemical and
non-chemical strategies against malaria has been so successful that the
Mexican DDT manufacturing plant ceased production voluntarily, due to lack
of demand.[107] Furthermore, while the increased numbers of malaria victims
since DDT usage fell out of favor would, at first glance, suggest a 1:1
correlation, many other factors are known to have contributed to the rise in
cases.

 

"A review of fourteen studies on the subject in sub-Saharan Africa, covering
insecticide-treated nets, residual spraying, chemoprophylaxis for children,
chemoprophylaxis or intermittent treatment for pregnant women, a
hypothetical vaccine, and changing the first line drug for treatment, found
decision making limited by the gross lack of information on the costs and
effects of many interventions, the very small number of cost-effectiveness
analyses available, the lack of evidence on the costs and effects of
packages of measures, and the problems in generalizing or comparing studies
that relate to specific settings and use different methodologies and outcome
measures. The two cost-effectiveness estimates of DDT residual spraying
examined were not found to provide an accurate estimate of the
cost-effectiveness of DDT spraying; furthermore, the resulting estimates may
not be good predictors of cost-effectiveness in current programmes.[108]

 

"However, a study in Thailand found the cost per malaria case prevented of
DDT spraying ($1.87 US) to be 21% greater than the cost per case prevented
of lambdacyhalothrin-treated nets ($1.54 US),[109] at very least casting
some doubt on the unexamined assumption that DDT was the most cost-effective
measure to use in all cases. The director of Mexico's malaria control
program finds similar results, declaring that it is 25% cheaper for Mexico
to spray a house with synthetic pyrethroids than with DDT.[107] However,
another study in South Africa found generally lower costs for DDT spraying
than for impregnated nets.[110]

 

Right, so we've established that DDT is not always effective, that it's
often more expensive than other methods of preventing malaria, but most
importantly that alternative treatments exist that don't cause cancer or
riverfuls of dead fish.

 

Martin's quote sums up my position:

 

"Overselling a chemical's capacity to solve a problem can do irretrievable
harm not only by raising false hopes but by delaying the use of more
effective long-term methods. So let's drop the hyperbole and overblown
rhetoric -- it's not what Africa needs. What's needed is a recognition of
the problem's complexity and a willingness to use every available weapon to
fight disease in an informed and rational way."

 

>> Second, the hard bit. " ... done more to aid or more to harm ... ". This

>> is

>> the tricky part. Without a complete assessment of Walmart's entire impact

>> on

>> poor people (and in fact the whole ecosystem of humanity), it's nearly

>> impossible to answer accurately. I'm in no position to have much of an

>> opinion on this one. But then again, nor is anyone else, much.

> 

>Actually, there are good data on this....I've read on this subject for

>years.  One good source is Kerry's former economic advisor

>http://www.americanprogress.org/kf/walmart_progressive.pdf

>One can also do very straightforward mathematical modeling that indicates

>this general trend. 

 

Fair enough. I don't have the data. I've only been in a Walmart once. I have
noticed that they're trying to go carbon-neutral, however.

 

>Actually, I read fairly extensively on the subject for years before making

>this post. 

 

I hadn't realized that it seems to have been an ongoing debate for some
years. The answer seems painfully obvious to me, so why there should have
been any debate on the subject at all, escapes me.

 

>>you'd have seen that it is VERY nasty stuff. 

 

>Can you quantify VERY nasty stuff?  One of my differences with many folks
is

>that I do not think we can go to a zero risk world.  For example, I'd take
a

>med that cut my chances of a heart attack in half even if increased my

>chances of cancer by 1%.  But, I'm a research physicist who deals with

>probability in a manner that I think differs from others.

 

I'm a software architect, and the specific job I am working in involves
computationally answering questions very much like this, trading off numbers
against each other. I don't have any numbers in this case, sorry - I'm not a
chemist / epidemiologist. What I do know is that these are hard sciences,
and that they have advanced enormously in the past twenty years since the
EPA's butt-covering statement of 1987:

 

"The EPA, in 1987 , classified DDT as class B2, a probable human carcinogen

based on "Observation of tumors (generally of the liver) in seven studies in

various mouse strains and three studies in rats. DDT is structurally similar

to other probable carcinogens, such as DDD and DDE." Regarding the human

carcinogenicity data, they stated "The existing epidemiological data are

inadequate. Autopsy studies relating tissue levels of DDT to cancer

incidence have yielded conflicting results." [42] "

 

You can bet your bottom dollar that today, epidemiological data are indeed
adequate.

 

>So, we probably have a small risk from DDT to humans that is small enough
to

>be hard to measure on one hand, and a known killer of millions per year

>right now on the other.  Indications are that the deaths due to DDT were

>from very large doses/exposures...while simply returning to Africa for two

>weeks resulted in Neli getting malaria.

 

There are much better options that don't wreck the environment or cause
cancer. I used to take antimalarials, when I was in Zim. It's no big deal.
Malaria is fairly well understood.

 

>Given this, if it was someone you loved, would you want their country to
use

>DDT in house spraying against malaria?

 

Absolutely not! I'd rather they didn't go, or they simply got Malaria. Which
is curable, as you might remember. Which liver cancer often isn't. Also, you
would have to wipe out all or nearly all the mosquitoes. Have you any idea
how big Africa is?? That's a heck of a lot of DDT, and a heck of a large
environmental catastrophe.

 

Regards,

Curtis.