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The Appendix – not so useless in the developing world

Appendicitis is a weird illness. It’s more common in the wealthy world than the developing world, even though it doesn’t seem to be lifestyle based. Poor people in wealthy countries have the same low appendicitis rate. It’s more common now, all over the world, than it was fifty years ago but it isn’t contagious from person to person.

We used to blame the appendix for this. We called it vestigial, and removed it at the drop of a hat. Charles Darwin himself told us it no longer had a purpose.  We don’t need it to digest, and you don’t find it in other mammals.

We’ve got new research, though, and it’s not the appendix causing the trouble – it’s our modern lives. The appendix only started getting useless about a hundred years ago. It’s a reservoir for the healthy bacteria we need to recover from revolting intestinal ailments like diarrhea. When we don’t get sick that often, however, the immune system doesn’t have enough to do. Appendicitis is one result; allergies are another.

That’s also why appendicitis rates are lower in the developing world. Without consistent access to clean water, our immune systems – and our appendixes - have work to do.  They help us fight off cholera and dysentery instead of getting all wound up and attacking our own bodies.

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Progress on the MDGs?

The 2009 MDG Report (pdf), leading into the 2010 MDG review conference that represents the last major recommitment before 2015, is both promising and disturbing.  Actual progress has been made, but the economic crisis is cutting severely into those gains, and, at this pace, the world will fall far short of achieving the Goals.

Overall, the number of people living in poverty (under $1.25 a day) had dropped by 400 million from 1990 to 2005 (1.4 billion) despite the growth in world population, an astounding number that, on its own, is proof that the Goals are achievable. However, the economic crisis chiseled away at that progress, and 90 million more people are expected to be added back to those rolls this year.  Success in reducing hunger worldwide is likewise being reversed.

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The most neglected Millennium Development Goal… #5, the agreement to reduce global maternal mortality levels by 75%, according to a moving appeal in The Huffington Post by Ethiopian model Liya Kebede.  She sounds a welcome call for a "Global Fund for Moms," whom she rightly calls "our best stimulus package":

In times of economic crisis, it is tempting to turn inward, to ignore or postpone the problems of the outside world and focus on ourselves. But, if we hope to thrive once again, we must realize that there are no outside problems in today's interwoven, globalized world. Each mother who dies leaves behind a devastated family and weakened community that will eventually, somehow, affect each of us. Each mother who dies deepens the financial and social strain on our world and puts economic recovery further away. Mothers are our best stimulus package because they invest in their families and in our collective future.

Half a million women and girl, disproportionately in the developing world, die in childbirth every year, yet funding for maternal health programs from wealthy nations has actually decreased.  While this sad statistic may not be surprising, given the desperate humanitarian funding shortage that has accompanied the slumping economy, it is nonetheless counterproductive.  Helping mothers around the world ensures a better future for all, in this generation and the next.

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One case of swine flu, two cases of swine flu…

Eh, who's counting anyway? Not the WHO any more (h/t Passport). But before your flabbergasted reaction -- the World Health Organization is not tracking the number of cases of a disease it has called a pandemic?!? -- consider that this is actually a sensible step.

On the one hand, unfortunately, it's only practical to stop counting; new cases are popping up all over, and, with different countries' reporting standards, keeping track would essentially be a fool's errand. On the other, the number of cases is a much less significant fact than HOW the virus is spreading, and how it is being treated. These, of course, the WHO continues to track rigorously.

There are many cases of swine flu; we know this, and we'll still have a good enough estimate of the number as it grows. But counting the global caseload can lead to a feverish panic over an ever-increasing number. I'd much rather the WHO focus on how to decrease this number.

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Swine flu vaccine hysteria

I have no doubt that the H1N1 virus is still very dangerous. I am also confident that the World Health Organization is continuing to take extreme precautions to ensure that the pandemic does not reach catastrophic levels. But this Reuters article seems designed expressly to conjure up baselessly apocalyptic fears:

Saying the new H1N1 virus is "unstoppable", the World Health Organization gave drug makers a full go-ahead to manufacture vaccines against the pandemic influenza strain on Monday and said healthcare workers should be the first to get one.

Every country will need to vaccinate citizens against the swine flu virus and must choose who else would get priority after nurses, doctors and technicians, said Dr. Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research.

The "unstoppable" comment was made in reference to the spread of the virus, not, oddly enough, its inevitable decimation of humankind. That H1N1 already isn't contained in one place should be obvious to just about anyone who's read the (equally frantic) reports of swine flu popping up in dozens of countries, or who can conceive of how keeping tiny little viruses from spreading all over an interconnected globe might be a trifle difficult.

As for vaccines, Reuters' depiction suggests a terrifying movie scene: government bureaucrats choosing who lives and dies while millions die for lack of the precious vaccine. These vaccines are necessary, yes, particularly for certain vulnerable populations, but they are not the only method of preventing contagion. The WHO describes the current severity of the pandemic as "moderate," with "most patients experiencing uncomplicated, self-limited illness." Instructing countries to implement vaccination strategies depending on local conditions is not leaving patients at the whims of capricious bureaucrats; rather, it reflects a smart realization on WHO's part that every country's epidemiological situation is different, and that each will have to incorporate vaccine and non-vaccine related strategies differently.

But an "unstoppable" virus with not enough vaccines makes for a better movie headline, I suppose.

(image from Center for Disease Control and Prevention, via Wikimedia Commons)