Hope is not a plan

It is often nigh-impossible to deconvolute preconceived notions and moralistic (but neither moral or ethical) ideas from good public health practices. Many Americans are still opposed to sex education that includes safer sex practices, despite the fact that 95% of those Americans engaged in premarital sex. Similarly, people in the porn industry are at great risk of disease because they don't have assistance from powerful unions. Another moralistic stance is taken despite the fact that some large chunk of Americans are right out there, consuming the products of that industry.

My own home state has taken matters into its own hands, moving to repeal a ban on state funding of needle-exchange programs. Laudably, the state legislature was able to distance itself from the moralistic argument that all drug users should be punished, and from the unfounded belief that needle exchange would lead to a massive boom in drug use, to recognize the proven facts that needle exchange programs massively reduce HIV prevalence and save billions of dollars in public health costs.

In their PLoS Medicine policy forum article titled The US Anti-Prostitution Pledge: First Amendment Challenges and Public Health Priorities, Nicole Franck Masenior and Chris Beyrer tell us about a substantial, problematic hiccup in the President's Emergency Plan for AIDS Relief (PEPFAR). Started in 2003, PEPFAR was an appropriation of $15 billion to be disbursed globally to fight HIV/AIDS. This program expires in 2008, and the president has called for a renewal and an increase in funding to $30 billion over the next five years. The hiccup, however, is this:

In order to receive AIDS funds from the US, all grantees must have (1) a policy explicitly opposing prostitution and sex trafficking and (2) certification of compliance with the “Prohibition on the Promotion and Advocacy of the Legalization or Practice of Prostitution or Sex Trafficking,” which applies to all organization activities, including those with funding from private grants [1,3]. “The Prostitution Pledge,” as this requirement is often called, has evoked strong and mixed reactions. It has led some grantees, most prominently the government of Brazil, to reject US AIDS dollars altogether [4]. But it is the breadth of the requirement and its application to privately funded activities that has led to legal challenge of its constitutionality.

In short, if you accept any PEPFAR money, then you must promote the idea that all prostitution must be eradicated -- even in efforts that use your own, private money. Two groups challenged this ruling as an unconstitutional limitation of free speech, and a district court agreed, despite the opposing argument that government money is allowed to come with policy strings attached.

The greater issue here is that, once again, of evidence-based harm reduction versus intuitive, moralistic arguments. Intuitively, prostitution is a problem. This makes natural sense -- sex with multiple partners is an HIV transmission risk. However, as the authors of this policy piece point out, conflating sex workers with sex traffickers -- the latter being the human traffickers, pimps, and others who organizationally promote sex work -- is a big problem. They point specifically to the example of the Lotus Project in Cambodia:

The Lotus Project began by offering a range of services to sex workers, from primary health care to English and computer lessons, while receiving funds from USAID for operations research. Within two years after the project's launch, Médecins Sans Frontières handed it over to a local organization, whose funding came primarily from USAID, in an effort to ensure sustainability. Around the same time, the Lotus Project had come on the radar of US activists working on human trafficking issues. After a number of raids on brothels in the area by US-funded anti-trafficking groups, sex workers experienced severely restricted mobility, resulting in limited access to health care and a reduced ability to earn a livelihood. The project's ability to respond effectively to the new situation was hindered by fear of being seen as promoting prostitution. Their freedom to deliver services based on best practices was limited. Eventually, funding from USAID diminished and the Lotus Project closed [24].

In short, an effective harm-reduction tool was driven out of existence because of the explicit demonization of prostitution in the PEPFAR pledge.

One of the key steps in understanding the value of harm reduction is in understanding that it plays a slightly longer game, but it plays a game that wins. It's natural to imagine that if you could magically end prostitution right now, then that route of HIV transmission would end. That's also complete nonsense, since you can no more magically end prostitution than you can magically end the need of those women to eat food. Here, as in other contexts, the "traditional" American approach is fast, direct, and utterly ineffective.

It's time for our avowed capitalist-in-chief to take a cue from an investment banker and help to end prostitution by empowering women, keeping them safe and healthy, and attacking the sex trafficking trade. It makes moral sense. It makes financial sense. There is no downside.

This Time Magazine was on the rack last week in gas stations throughout California. The intent of the imagery is clear, blatantly so -- the star-spangled "A" that represents America is shown being hoisted out of Iraq. The choice of a helicopter is particularly evocative, since it's a call-back to the classically tragic images of the last helicopter leaving South Vietnam.

But let's talk about that helicopter. The silhouette on the Time Magazine cover is clearly that of a Soviet-made Hind helicopter. Now, that could be a subtle meta-statement comparing America's presence in Iraq to that of the Soviets in Afghanistan. It could be, but I find myself doubting it. Instead, I suspect that the cover artist just pulled up reference on military helicopters irrespective of national origin, and the editors at Time didn't fact-check properly, or didn't care to make a correction.

Either way, Time is once again placing itself firmly in the mainstream of sloppy journalism. If you can't pick the right reference for a magazine cover -- especially when the silhouette of one American helicopter is so well known -- why should we trust you to handle actual news?

In a recent paper in PLoS One, Lenoir, Serre, Cantin, and Ahmed make the startling discovery that sugar and artificial sweetener are both more addictive than cocaine.

In previous studies, it's been shown that animals will consistently choose cocaine over food. However, that worked used conventional feed for the animals in question -- in other words, healthy food. Lenoir et al did a head-to-head comparison between intravenous cocaine and the artificial sweetener saccharin, and found that over 90% of animals choose saccharin. They then repeated this test using the natural sugar sucrose. Once again, the sweetener won over cocaine.

This result -- that has not yet received any significant publicity -- suggests just why the abundance of high-fructose corn syrup and other sugars in our food products is so destructive. It may not be a simple matter of abundance that leads to obesity in developed nations, but instead a matter of exactly what we put in our foods. This could also help explain why obesity has not been as much of a problem in developed Europe, Korea, and Japan, but is a problem in other nations ascending to developed status.

As in any large organization with a substantial body of equipment and ever-changing needs, the Department of Defense frequently finds itself in the possession of items that it no longer needs. Rather than just eating the loss and junking these things, DOD auctions them off at govliquidation.com. Auction items today include 71 different forklifts, over a thousand lots of electronic testing equipment, 15 different small boats, and tens of thousands of other items, all typically sold at generously low prices.

In a report titled Sales of Sensitive Military Property to the Public, GAO follows up on an earlier report in which they showed that an unacceptably high number of demil-required items (items that are of a sensitive nature) were accidentally sold to the public. Notably, this included F-14 parts, which, as GAO reminds us, are in high demand in Iran, along with potential interest by less hostile nations.

Fortunately, there's a lot of upside to this report. Following the initial observation, DOD has worked to change its operating methods to better catch demil-required items before they go on sale. Changes include consolidating the way property is grouped into lots, including physically inspecting all lots to check on what they actually contain, increasing scrutiny of items before they are sold, adding a post-sale review and retrieval process (in case demil-required items are accidentally sold), and qualifying additional items as sensitive. They also added an incentive and disincentive system to their contract with the liquidation company. Now, removal of sensitive items before sale yields a financial bonus, whereas sale of sensitive items results in a financial penalty.

This chart from the report shows DOD's recent progress in avoiding sale of sensitive items:

It's good to see DOD leap on a problem like this, and to see a contractor's income tied directly to performance. Perhaps the people in DOD who handle liquidation can speak with all the folks over in procurement.

Islamist insurgents attacked a military base and a police station in Mogadishu yesterday, leading to a two-hour gun battle. This kind of violence has been ongoing since Ethiopian troops drove the Islamic Courts Union out of power and re-instituted the nominal official government of Somalia.

More than 1,000 clan representatives from all over the fractious Horn of Africa country have been gathered in the restive capital since July 15 for a reconciliation conference sponsored by the interim government.

The meeting is being boycotted by the government's main Islamist foes, who are planning their own meeting in the Eritrean capital Asmara next month.

Notice that location for the alternative meeting. Once again, it looks suspiciously like Somalia is at least partially serving as a proxy battleground between Ethiopia and Eritrea -- not that Somalia needed the help to be a complete mess.

BBC article
al Jazeera

Mr. Bush --

Time and again, you emphasize that we are at war. We are at war against terror, and specifically at war in Iraq. You like to think of yourself as a wartime president.

Maybe it makes you feel special.

But clearly, you don't actually believe we're in a real war. At the very least, you're deeply ignorant of how America actually wins wars.

Despite saying we're at war, you have not made the war part of our regular budget. You continue to cheat much of the cost in as special expenditures, as if that means we're not actually spending the money. This is the first time we've ever let a conflict stretch this long without putting its costs into the regular budget. Even the Vietnam and Korean Wars, both "police actions," were put into the regular budget quite soon after they began.

Despite saying we're at war, you've pushed for lower taxes. Perhaps you don't know your history. I understand you weren't a very good student. During the first World War, the marginal tax rate went as high as 77%. During the second World War, the marginal tax rate went even higher, up to 94%. During Korea, it went up as high as 87%. During Vietnam, up to 70%. Presidents Roosevelt, Truman, Johnson, and Nixon all understood that wars can't be won without true sacrifice on our part -- at the very least, taxes must go up. None of these men would have actually tried to fight a war on credit, with that credit coming from another, not necessarily friendly, power.

I learned these numbers from the U.S. Treasury. They're part of the Executive Branch. Maybe you can ask them for a refresher.

Despite saying we're at war, you're trying to cheat on how many troops we send. Despite historical precedent and smart men telling you what to do, you chose to send half as many troops as we needed to hold Iraq. Now our soldiers are hit every day by munitions that we didn't have enough soldiers to secure. Now they clear an area only to have it retaken by our enemies a week later, because we don't have enough soldiers to leave a garrison behind.

I understand that we aren't likely to have a draft. It would be too politically damaging for you. But if this war on terror were a real war to you, you'd aggressively recruit new soldiers. You'd offer large pay increases and solid family support. You could even support this with the taxes you would have raised.

If this were a real war to you.

I understand you were a poor student. You probably turned in essays that were just barely long enough, and copied your math and science homework from someone who actually put in the time to learn the material. I understand that you think that the appearance of trying should be good enough, success be damned. I understand that you're just putting in the time, collecting your paycheck, clocking in and out until your time in office is done.

I understand that you quit when things get hard. I understand this because if you weren't this kind of person, then you'd treat this war like a real war.

If you did that, we might even win.

Vladimir Putin announced this week that Russia will start Soviet-style long-range bomber flights.

"We have decided to restore flights by Russian strategic aviation on a permanent basis," Mr Putin told reporters at joint military exercises with China and four Central Asian states in Russia's Ural mountains.

"Flights by other countries' strategic aircraft continue and this creates certain problems for ensuring the security of the Russian Federation," he said.

As the article notes, the original cessation of threat flights like these wasn't done for peaceful reasons, but rather because Russia could no longer afford the fuel costs. Now that they have the cash again, Putin is able to restart the practice.

The State Department was fairly blase about the announcement, which is an appropriate response. During the Cold War, the very immediate possibility of nuclear war made these shadowing flights a real problem. These days, they're much more a symbol of Russian prestige, and that's fine.

BBC article

With a turnout of just below 58%, voters in Thailand gave a lukewarm 58% "yes" to the newest proposed Constitution -- the 18th in 75 years or so. The average doesn't tell the real story, which is one of regional divides, as the rural northeast voted roughly two-thirds against the new constitution. The simple figures also miss some of the "quirky" features of the referendum:

Human rights groups have criticised the poll as a sham, given that nearly half of Thailand's 76 provinces remain under martial law and that a "No" vote would have allowed the army to impose any one of the previous 17 constitutions.

So it wasn't so much a "yes or no" vote as it was a "pick the one in column A, or we pick one of the seventeen in column B" vote. Even so, quite a few people turned out to cast a symbolic "no" as a protest against the military's effective rule in Thailand.

After all, as long as the military can keep hitting the big reset button, you're not really a democracy.

al Jazeera article
CNN article

Chinese state media reports that sexual transmission has, for the first time, overtaken other methods of transmission for HIV within China. China officially saw 70,000 new HIV cases in 2005, with about half due to sexual transmission. This is especially problematic in policy terms, as it moves HIV transmission out of somewhat neater "high risk" boxes such as intravenous drug users and into the "general risk" population. The epidemiological difficulty this represents is enhanced by decades of policy and even older social traditions that stand in the way of having an open discussion about sex. Sexual transmission of HIV is also likely to accelerate in the face of a large, migrant bachelor population and a concomitant pool of sex workers.

The high degree of stigma associated with HIV - and a lack of confidentiality - can also deter people from being tested at all.

China, like the United States, has serious issues with accepting the value of harm reduction.

BBC article

The government of Iran just released from custody two Chinese nationals who were arrested for taking pictures of a military complex in the town of Arak.

The Chinese foreign ministry said: "In early July, two people from Chinese companies mistakenly took some pictures of some sensitive buildings when they were helping local owners to conduct field measurements in Iran.

"They were detained by Iranian police and now they have been freed. The foreign ministry and Chinese embassy in Iran have warned Chinese citizens in Iran to behave so as to prevent misunderstandings."

Indeed. It's always good to prevent these misunderstandings.

BBC article

Mr. Bush --

In a speech before the Veterans of Foreign Wars national convention today, you tried to describe the potentially disastrous consequences of an American withdrawal from Iraq by relating it to the Second World War, the Korean War, and the Vietnam War. You also showed your usual comfort with screwing up the facts, leaving out the inconvenient ones, and generally just saying what your speech writers wrote for you, totally at peace with your ignorance.

Naturally, you led with the ever-present conflation of September 11th with the Iraq war, and your gigglingly strident declaration of yourself as a war president. I must say I've been hard-pressed to find examples of Truman and Roosevelt spending that much time lauding themselves for that role.

You then moved on to rise of democracy in South Korea and Japan, hoping to highlight the possibilities in Iraq. After all, if we defended South Korea and occupied and rebuilt Japan, why wouldn't it work in Iraq?

But Iraq is not post-war Japan. In Japan, there was no active insurgency. Our troops were not under constant attack every time they went on a street patrol. Japan was largely ethnically and religiously homogeneous. Roving murder squads and ethnic militias didn't walk the streets, torturing and killing people of other sects and ethnicities. Japan was, at heart, a single country. Iraq has for decades been a compilation of unrelated peoples, held together by a torture regime.

Nor is Iraq the Korean war. We did not come in to stop a totalitarian power from overtaking a nascent democracy. We ousted a frankly brutal dictator, but did so with no coherent plan for what happened afterward, and with an arrogant misunderstanding of local culture and civilization. We took an impoverished, unhealthy nation and brought down on it a plague of sectarian violence that you even now try to blame on al Qaeda alone.

Oddly enough, Iraq is not the Vietnam war, either. It made much more sense for us to come to the aid of South Vietnam than it ever made for us to invade Iraq in 2003. The threat to South Vietnam was clear and present, in a way that your wishful thinking about changing the Mideast through war, backed by the lies of Ahmed Chalabi, never was.

You argue that the after-effects of our withdrawal from Vietnam were harsh. This is unarguably true, but we must also match it against the millions of Vietnamese who died during the war. Unfortunately for Iraq, it is still not Vietnam. In Vietnam, the divide was purely political. In Iraq, sectarian violence may lead to a partition of peoples, whether we stay or go. In staying, we keep the vultures of al Qaeda in Iraq in business, and lose our own soldiers on a daily basis.

You point to the killing fields in Cambodia as the ultimate example of the disastrous effects of the American withdrawal from Vietnam, with the clear implication that these fields will be repeated in Iraq. I, in turn, remind you that the killings in Cambodia were stopped by the 1978 invasion of Cambodia by Vietnam.

Maybe you didn't know that.

Let me say it clearly. You are incompetent, and arrogantly so. As long as you are in charge, we must press for our soldiers to leave as soon as possible, because you will bleed them dry to save your image. You will conflate Iraq and al Qaeda, Cambodia and Vietnam, and anything else you possibly can to confuse people for just a little bit longer.

Do please learn your history. Read about these vital parts of the American story before you misuse them in aid of your ill-conceived ideas. Perhaps then you'll start thinking, really thinking, about what it means to lead a nation at war.

(Letter sent today.)

In a report titled Defense Contract Management: DOD's Lack of Adherence to Key Contracting Principles on Iraq Oil Contract Put Government Interests at Risk, GAO examines the $2.5 billion "Restore Iraq Oil" (RIO I) contract awarded to KBR in 2003. This dual-purpose contract was intended to help restart the oil industry in Iraq -- remember that paragon of planning Paul Wolfowitz said that Iraq would be able to pay for its own reconstruction -- as well as ensuring a continuing supply of fuel into Iraq. A recent audit by the Defense Contract Audit Agency identified $221 million in questionable contract costs stemming from ten task orders included in the overall RIO I contract. GAO was, in turn, asked to look at these questionable costs, and how DOD addressed them.

Notice that about two-thirds of the questionable costs are fuel delivery overcharges. You may recall hearing about those on the news last year. GAO did not address the nature of disputed charges in this case (DCAA did that); GAO was simply tasked with figuring out in what ways DOD dealt with DCAA's findings, how often DOD payed award fees (bonuses for good performance), and if they followed their set procedure for doing so.

As it happens, DOD formally decided that most of the disputed fees found by DCAA were just fine, and paid them. Apparently, there's still a lot of leeway given to KBR despite their corporate tendency to cheat us.

In looking at award fees, GAO found that DOD regularly did not follow their own procedures for assigning awards, failed to have reviews at proper intervals, and instead just handed out awards at the end of the task with no input before then. DOD retorted that it's awfully hard to put together review boards in present-day Iraq.

GAO agrees, and has officially recommended that DOD be more realistic when writing its own rules. Given that the original rules were written in 2003, it's entirely likely that some optimistic soul within DOD really thought Iraq was going to be peaceful enough to have regular review boards and routine oversight of KBR's mission. Instead, of course, we have Iraq as it is now, with massive violence and very little oil flowing.

DOD agreed, in writing, with this recommendation from GAO. Perhaps the forces of deliriously blind optimism are finally waning.

In their paper titled Marburg Virus Infection Detected in a Common African Bat, Towner et al describe an extensive evaluation of bats collected in Gabon and Republic of Congo that turned up Marburg virus infection in a common fruit bat, Rousettus aegyptiacus.

Marburg virus, like its cousin Ebola, causes incredibly deadly outbreaks of hemorrhagic fever in both human and ape populations. Given their near-absolute lethality, it's a given that these killers don't just reside in the human and ape populations and then "go nuts" every so often. This research by Towner et al finally points the way toward understanding the natural reservoir for hemorrhagic fevers in Africa. In so doing, it may also point the way toward mitigating future epidemics or even wholly preventing them in the first place.

And, as befits the inherently dual-use nature of all pathogen research, it also tells you where to go if you want to collect some Marburg virus and can't convince USAMRIID to give you any.

For the past few years, the National Science Foundation has been looking at American science and engineering publications and how they're trending in comparison with publications from other nations. The results of their analysis are presented here.

From the report page:

The study was prompted by evidence that the numbers of U.S. S&E articles, after increasing for decades, had leveled off in the early 1990s while funding and the number of researchers continued to increase.

The study comes back with no clear answer about why American publications are making up a smaller slice of publications overall, but there are some highlights:

• The study used the Thomson Scientific ISI Web of Knowledge cited publication database, which has traditionally been heavily biased toward American publications. As foreign scientists become better trained and behave "more like scientists from the United States" they're publishing more often in American journals.
• Science and engineering funding has spiked in some other nations, such as China - this correlates with their substantially increased chunk of the publications, however...
• ...American publications are still cited far more often than foreign publications. For example, China was fifth in 2005 in terms of number of publications, but was still 124th for cited publications in the 1994-2004 period. European science and engineering articles are also cited far less often than American articles. The thought here is that even if American publications are a smaller slice of the overall pie, they're still the only high-quality slice.

So what does this mean? It's hard to say. It might mean one of these:

• The rest of the world is catching up to us scientifically
• America's growth in R&D investment is slower than in other countries
• American research is more often cutting-edge than research in other countries, and as such is increasingly expensive over time - more so than research in other countries

At the end of the day, the official panel conclusion is a big, if thoughtful, shrug. There isn't enough information to say what the exact implications of this flattening off are, both in terms of the quality of American research and in terms of what the country should do in the future. I'm inclined to think that it's not a fundamental problem. At some point, developing nations become developed nations, and the publication space simply won't expand as quickly as the expansion in publications.