SEATTLE — Here is a development mantra that’s worth repeating: when it comes to alleviating global poverty, there are no silver bullets.
The recent debunking of a too-good-to-be-true study on parasitic worms reinforces the idea that complex public health issues cannot be solved by oversimplified solutions.
While it feels good to be optimistic about apparently miraculous cures or ways to alleviate poverty, staying grounded in reality keeps the development agenda on track and efficient and effective.
The study, conducted in Kenya from 1998-99, correlated the distribution of inexpensive deworming medication with improved educational outcomes, not just for children who took the medication, but for kids in neighboring school districts who did not.
On a superficial level, this kind of correlation makes sense. If a child is in poor health, they can’t attend school. Curing them allows them to take advantage of their educational opportunities, perhaps even improving their contribution to the economy and society in general.
The results of the study made deworming seem like quite a low-cost, high-impact solution.
Many of the modern attitudes surrounding deworming were formulated based on this one particular study. There is great temptation in the development community to chase after simple, but effective solutions.
After all, who wouldn’t be attracted to an apparently inexpensive and fast way to address a persistent public health issue?
The deworming strategy promoted by the study was particularly appealing at the time, so much so that the expert panel of the Copenhagen Consensus (which included several Nobel laureates) declared deworming as the fourth most impactful public health intervention in the world.
This has led to very robust funding of deworming programs, especially by the World Bank and the U.K. However, the London School of Hygiene and Tropical Medicine (LSHTM) has re-examined and tried to replicate the results of the Kenya study — to no avail.
While the original study correlated deworming with increased attendance in schools that weren’t given the drugs, the LSHTM found that this correlation was due to calculation errors.
The London school used statistical analysis techniques typical of health research rather than the economic statistics used in the original study. This revealed that the original study had exaggerated the increased school attendance and that there was actually no evidence to support the original findings that test scores had improved.
The Cochrane Collaboration, a global network of health professionals dedicated to analyzing the effectiveness of public health practices, also conducted a review of the Kenya study.
They found that in regards to deworming “there is now substantial evidence that this does not improve average nutritional status, hemoglobin, cognition, school performance, or survival.”
Professor Garner of the Liverpool School of Tropical Medicine summarized the conclusion of the Cochrane review more poignantly when he said “the belief that deworming will impact substantially on economic development seems delusional when you look at the results of reliable controlled trials”.
Public health issues are intertwined with other poverty indicators, such as income per capita and education. It makes sense; if you are not in good health, you can’t attend school or hold a job. Likewise, if you have no income and are not educated about health risks, you cannot maintain your health.
However, the Kenya study was slightly too optimistic in their correlation between deworming and school attendance as well as the overall impact on economic development and health outcomes.
The truth is that the depth and breadth of health and poverty issues in the developing world probably require a set of highly equally complex, multi-layered, and probably expensive solutions. It certainly makes sense to seek out efficient and cost-effective cures, but these alone won’t save the day.
It’s important to keep solutions to global health issues grounded in reality; apparently miraculous treatments should be regarded with skepticism, as they tend to detract from truly efficient, effective, yet complex and difficult ways to alleviate the disease burden on the poor.
– Derek Marion
Sources: Vox, The Guardian, Copenhagen Consensus, Cochrane Review
Photo: Flickr