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Published in The Atlantic on Tuesday, April 3, 2012. Read the full article here. An excerpt is pasted below.

A man ponders a potato chip purchase in an East Harlem bodega. Photo credit: Sarika Bansal

“Healthy food in bodegas?” asked Ibrahim Hilou, owner of a convenience store in Central Harlem. “You’re wasting your time. Go 96th and down. Over here, they like it sweet. I made a coffee today with eight sugars.”

Like most bodegas in New York City, Hilou’s store is relatively small — the customer area measures about 400 square feet — and its shelves are stocked with non-perishable goods like potato chips and canned soup. The refrigerators are filled with artificially sweetened beverages, full fat milk, and beer. A counter sells hot sandwiches lathered with mayonnaise and cheese. The register is decorated with lottery tickets and candy bars.

Meanwhile, in a neglected corner, a self-standing metal shelf contains an assortment of fruits and vegetables. The bananas are overly ripe and the potatoes are of poor quality. Few people buy produce in Hilou’s shop; most of the onions end up in breakfast sandwiches, the store’s most profitable product.

New York City has over 10,000 bodegas like Hilou’s. In some New York neighborhoods, particularly lower income ones, bodegas are often the default option for groceries. In parts of Brooklyn, they comprise over 80 percent of food retail (PDF).

Published in the New York Times on Thursday, January 26, 2012. Read the original article here.

A woman edits the Guatemalan radio drama K'ulb alib' Tz' Ixamal (“Around the Fire”), which discusses food security and child malnutrition. Photo credit: James Rodríguez (mimundo.org)

Every Sunday evening, seven million Kenyans sit in front of their television sets to watch “Makutano Junction,” a soap opera set in a fictional village. In one episode, audiences watch as a woman, Mama Mboga, holds her crying infant. “I need some money to take Joni to hospital,” she tells her husband, Erasmus, after he wakes up and takes a swig from a bottle. “I think he has malaria.” Erasmus insists that his son is healthy, that she is overreacting and that he has no money to give her.

Erasmus eventually gives her some money, but only enough for chloroquine, which is not always effective in fighting malaria. When Joni gets sicker, Mama Mboga takes him to the emergency room, but he dies even before seeing the doctor. Her friends rush to console her as she begins crying, “My baby is dead!” in the waiting room.

As with traditional soap operas, the above story line is full of emotion, conflict and suspense. Scattered cliffhangers leave the audience wondering what will happen next. As I watched it, I found myself beginning to wonder, Will Joni survive? Will Erasmus stop drinking? Will Mama Mboga stand up to her deadbeat husband?

The difference with this narrative is that it deals with a crucial social issue. By placing characters in situations not uncommon to the audience, producers hope viewers will think twice before spending money on alcohol rather than on lifesaving medicine.

“Makutano Junction” is not unique. Around the world, from North India to South Africa, there are dozens of television and radio shows that tightly weave social themes into entertaining narratives, a technique often referred to as “entertainment-education.” Writers develop fictional characters that model positive or negative behaviors, and through their stories and struggles, audiences learn about issues ranging from domestic abuse to personal bankruptcy. Unlike American daytime soaps, these shows usually air during prime time to entire households.

Successful soaps tend to be smartly written, sexy and replete with plot twists and love triangles. In the best-case scenario, the show becomes popular, and viewers begin to incorporate some of the themes into their lives.

“We’ve used storytelling that combines engagement and learning for thousands of years,” said Arvind Singhal, professor of communications at the University of Texas, El Paso, and the author of several books on entertainment-education. Ancient myths, parables and Aesop’s fables are all examples of stories intended to teach valuable lessons or pass on cultural values between generations.

However, said Singhal, the intentional placement of educational messages in mass media is relatively recent. Within television, many experts pin the origin to a Peruvian telenovela called “Simplemente María” (“Simply Maria”), which aired in 1969. The show, which ran five nights a week for two years, followed the story of María, a humble farmer who migrated to the city and began working as a maid. Through hard work and determination, she learned how to read and sew, and eventually became a famous fashion designer. The show became so popular that when María married her literacy teacher Esteban on the show, 10,000 fans gathered outside the church where the wedding sequence was being shot, dressed in their Sunday best and ready with gifts for the “newlyweds.” Enrollment in literacy classes shot through the roof soon after the show aired, as did sales of Singer sewing machines.

“Simplemente María” inspired the Mexican television writer-producer-director Miguel Sabido to try to replicate its success. Sabido created several telenovelas in Mexico, including “Ven Conmigo,” which promoted adult literacy. Ratings for the show were higher than any of the network’s previous telenovelas and enrollment in literacy classes in Mexico City increased ninefold the year it aired.

Perhaps Sabido’s most lasting contribution to education-entertainment was his framework of character types. Sean Southey, executive director of PCI Media Impact, a nonprofit group that has been developing entertainment-education content for more than 25 years, said that Sabido-inspired soaps have three basic character types: positive, negative and “transitional” characters. The transitional character – the one with whom the audience is meant to identify – endures the most twists of fate and is most easily swayed by others. “When [the transitional character] hangs out with a good character, she gets rewarded, and when she hangs out with a bad character … she ends up with unprotected sex in the back of a car,” Southey said.

Versions of entertainment-educational television and radio shows have appeared around the world, many based on Sabido’s methodology. Some, though not all, have also been successful commercially and have resulted in documented changes in behavior. The long-running South African television series “Soul City” has 12 million viewers and is as familiar as Coca-Cola to black South Africans. Regular viewers are almost four times as likely to use condoms than others. In Saint Lucia, the radio drama “Apwé Plézi” (“After the Pleasure”) became so popular that producers had to set up a separate helpline for people requesting information on family planning. Brazilian women with exposure to soap operas, which usually portray small families, have been found to have significantly lower fertility than others.

In many ways, soap operas are the optimal vehicle to spread important social messages. Soaps have many characters and intersecting plotlines, making it possible to tackle multiple issues simultaneously. They can broach issues that would otherwise be taboo, as it is often more acceptable to discuss things like unwanted pregnancy through the guise of a fictional third party. Some producers have even started talk shows to gossip about a soap’s most recent episode and ask experts sensitive questions.

Successful socially conscious soaps have a few things in common. One is a good topic. “The big human issues resonate well,” said Garth Japhet, creator of “Soul City” and other entertainment-education content in South Africa. Anything related to sexuality, violence or substance abuse, he says, usually contain the needed conflict and emotion required for a good soap opera. By contrast, “trying to create drama out of a topic like nutrition is not easy.” Even unpromising topics, however, can sometimes work.

Singhal told me of a show in the Netherlands, “Sound,” that addressed hearing loss by developing a heart-wrenching story around a deaf composer.

It’s also important to make the educational content a seamless part of the story. “The drama will always relate around the relationships between characters, never about the issue itself,” said Lindsey Wahlstrom, PCI Media Impact’s communications manager. “You don’t think, This [soap opera] is about deforestation. You think, Will Felipe and Elena get together at the end of this?” A safe-sex message, for example, is more powerful if H.I.V. isn’t an abstract idea but something that happens to a beloved character.

Successful producers also emphasize the importance of working with local organizations to make sure that the audience can act on the soap’s message. Without a window into ground realities, soaps may inadvertently point people to services that do not exist. “How do you, for example, get persons to say they want to use condoms, but then there are no condoms available?” asked Alleyne Regis, the creator of “Apwé Plézi” and other Caribbean radio dramas. “How do you tell a woman who’s being abused to see a counselor, but there are no counselors available?”

Educational soaps can go beyond selling advertising to get financing. They may also get financing from governments or international donors like U.S.A.I.D. Each of those sources of financing, of course, can affect content. When the producers of “Makutano Junction” took American funds to produce a soap on H.I.V. and tuberculosis co-infection in 2007, they had to sign an agreement that they would not promote abortion in any way.

Commercial considerations also matter, though, so to get high ratings, soaps sometimes limit or avoid certain topics. The producers of “Makutano Junction” faced significant resistance when they tried to address homosexuality. “What we were ideally trying to do was to get a basic conversation going, that there are gay people and they have rights,” said David Campbell, the show’s producer. After filming an episode in which a young woman supports her best friend after he comes out of the closet, the head of the television station advised Campbell to drop it altogether. To avoid potentially losing a significant chunk of its audience, the team wrote and filmed a new episode to take its place.

It isn’t always easy to predict the audience response to certain characters or situations. For this reason, producers spend significant time and resources evaluating their soap’s impact. One thing they check for is the “Archie Bunker effect,” named after the infamously bigoted “All in the Family” character that audiences loved, despite producers intending otherwise. Producers of the Jamaican radio soap “Naseberry Street,” for instance, found through surveys that young males idolized Scattershot, an irresponsible philanderer intended to be negative. They quickly added new elements to his character, like him being bad to his mother. This, they hoped, would help engineer the audience response toward the desired social outcome.

There are many elements to creating a successful socially conscious soap opera. On-screen, a good soap requires relatable characters and believable story lines. At the back end, it needs dedicated writers, supportive producers and considerable financial resources. Most important, a show will not run without an audience willing and able to tune into the next episode.

These elements do not always come together, but when they do, they can help improve individuals’ knowledge, attitudes and behaviors. In doing so, Japhet said, “soaps can be a real catalyst for social change.”

Published in the Guardian on Tuesday, December 13, 2011. Read the original article here.

Last Wednesday, the Food and Drug Administration (FDA) recommended that emergency contraceptive Plan B One-Step, commonly known as the “morning-after pill,” be available over the counter without age restriction. The FDA researched the pill and concluded that it was safe and effective for nonprescription use and that adolescents could use it properly without intervention of a healthcare provider.

The same day, Health and Human Services (HHS) Secretary Kathleen Sebelius overruled the FDA’s recommendation.

Sebelius said she was concerned that the manufacturer had not studied whether 11-year-olds, some of whom are capable of bearing children, would fully comprehend the product’s label and appropriate use. As a result, the emergency contraceptive will continue to be sold behind the counter at pharmacies, and women under the age of 17 will continue to require a prescription to access it.

Soon following the decision, President Obama said that he supported Sebelius’ stance. “As the father of two young daughters,” he said, “I think it is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine.” He said that 10-year-olds should not step into a drugstore and be able to buy, “alongside bubble gum or batteries,” a medicine that could have adverse effects if used incorrectly.

Though the health secretary has the authority to overrule the FDA, this is the first time one has ever done so. This exercise of power signals a worrisome trend in the Obama administration.

Since Obama’s election, he has stated time and again how his administration would rely on science and not ideology. When Obama overrode the Bush-era ban on stem cell research, for instance, he said, “Promoting science isn’t just about providing resources, it is also about protecting free and open inquiry…. It is about ensuring that scientific data is never distorted or concealed to serve a political agenda and that we make scientific decisions based on facts, not ideology.”

In her statement, Sebelius used the logic of science to justify her decision. Specifically, she claimed that the data submitted by Plan B’s manufacturer did not “conclusively establish” that young adolescents could safely use the drug. However, the preponderance of evidence behind Plan B’s safety, efficacy, and comprehension suggests that the decision was determined not by science but by ideology.

Plan B primarily works by suppressing ovulation, and though some have suggested it can induce abortion, the most recent studies have shown that it is only a contraceptive. It is 89% effective in preventing pregnancy if taken within 72 hours of unprotected sex and has no serious side effects. There are important societal benefits to this: notably, increased availability of Plan B has been linked to a decrease in abortion rates (pdf).

Moreover, most women, including adolescents as young as 12, have consistently demonstrated a good understanding of how the drug is used and the occasions that warrant its use. In one qualitative study, researchers found that “neither younger nor older teens revealed an intention… to use Plan B as their primary form of contraception.” In any case, the drug’s price – a single dose costs between 30 and 50 dollars – would likely deter most sexually active adolescents from using it frequently.

Sebelius used scientific uncertainty to justify her stance on Plan B. Yet she and previous health secretaries have made countless decisions in the face of uncertainty, including some more consequential than the uncertainty of Plan B label comprehension by 11-year-olds. When the FDA approved cholesterol-lowering Lipitor for the prevention of heart attacks in 2004, the data had not conclusively determined whether it would be effective for women or people over 65. Despite these populations being significantly larger than the population of sexually active and menstruating 11-year-old girls, the FDA and health secretary still approved Lipitor.

Henry Pollack, author of Uncertain Science, Uncertain World, warns that policymakers excessively use uncertainty as an excuse to delay or reject scientific decisions. In a talk at the University of Michigan, he said, “Waiting until uncertainty is eliminated is generally impossible. When you hear a call for postponing decision making because of scientific uncertainty, it’s an implicit endorsement of the status quo.”

In this case, the decision to “maintain the status quo” appears to be based on ideas of the importance of parental oversight and the unease of adolescents having sex lives. When Obama chose to mention his role as “the father of two daughters” in a policy discussion, he essentially, in the eyes of one feminist writer, “recast the debate as an episode of ‘Father Knows Best,’ reaffirm[ing] hoary attitudes about young women and sex.” Obama aides even admitted to reporters that the decision was rooted “less in science than in a gut feeling that teenagers might not be ready to make decisions about pregnancy.”

Not surprisingly, many supporters of the decision have congratulated the administration on similarly non-scientific grounds. One editorial discussed how approving the pill for nonprescription use would have sent a “bad message” to preteens, namely that “risky sexual behavior can be undone by simply taking a pill in the next day or so.” Others have noted how allowing minors to buy the pill “would [have] undermined parental oversight and set minors up for exploitation by adult sexual predators.”

The decision to keep Plan B off drugstore shelves is an unfortunate one. Wider access to the drug would have been a safe and effective way to reduce teenage pregnancy rates, which have been on the rise. As long as the Obama administration continues to make its decisions on women’s health issues using ideology and not science, it will continue to see similar trends.

Published on Dowser on November 29, 2011.  Read the original article here:

Directed at budding social entrepreneurs, Social Enterprise Bootcamp, a recent two day workshop organized by students at Columbia, NYU and the School of Visual Arts, offered practical advice from an impressive array of speakers. Here are a few of the key take-aways:

A social enterprise can change the world, but only a part of it.

Greg van Kirk, founder of the New Development Solutions Group and of the micro-consignment model, told participants, “Social entrepreneurship is when people tell you you’re crazy, that your idea will never take off, but you decide it’s important enough to do anyway.” With a lofty vision, deep conviction for your cause, and solid execution capability, almost anything is possible. At the same time, however, the best social enterprises know their limits. No business can change everything, van Kirk said, and businesses that attempt to do too much will inevitably fail. Instead, he advised participants to pick what they want to influence and do it well.

Expect bumps along the way.

Starting a business, especially a social enterprise, is not easy. The speakers, many of whom were social entrepreneurs themselves, had no qualms about sharing their past and current obstacles in getting their businesses off the ground. Joanna Opot of TerraCycle, for instance, discussed the challenges all businesses face as they begin to scale up, and mentioned some ways her business is currently trying to overcome them. Joyce Meng of Givology advised participants to “keep it cheap” for as long as possible, so as to survive the unavoidable growing pains. “Do you really need an office in the early stages?” she asked. Or will it make your business more likely to sink if something goes wrong?

Do what you love.

Keynote speaker Jeffrey Hollender of Seventh Generation spoke to the importance of “doing what you love.” The process of opening a social enterprise is difficult, he said, and without a deep commitment to your cause, it will be easy to find exit opportunities. He also discussed the importance of developing a strong mission and set of values. In many cases, he said, these intangibles are more important and longer lasting than the product.

Design your business around your consumer.

Design thinking, or “human-centered design,” is important for almost any social enterprise. Jeff Chapin of IDEO explained how design thinking goes far beyond the aesthetics of a product or service, and often requires re-engineering entire business models and processes to focus on the consumer. He gave the audience examples from the water and sanitation world, where design thinkers made water filters, latrines, and mobile toilet systems with the consumer’s needs and preferences in mind.

Don’t undervalue your product/service.

It is common for social entrepreneurs, especially new ones, to undervalue the novelty of their offerings, and therefore undercharge for them. To illustrate this point, Opot of TerraCycle told participants her own story. “When we started making partnerships, we found that everyone was interested in partnering with us,” she said. It’s exciting in the beginning, Opot said, but after a point, she realized the real reason for the interest was that their prices were too low. “When we hiked up our prices, nobody even blinked,” she said.

Dot your i’s and cross your t’s.

Without basic logistical details in place, even social enterprises with rock star leaders and revolutionary business models can fail. To avoid this, some workshops focused on the legal, financial, and other backend processes needed to bring businesses to success. Speakers gave advice on how to register their businesses, how to forecast financials, how to engage good lawyers, and more.

Reflect.

One session asked participants to put everything away and spend the next forty-five minutes simply reflecting on what they had learned. Some rolled their eyes and left the session (“this isn’t what I paid money for!”), smartphones in hand, but I heard very good feedback from those who sat through it. “We’ve learned so much this weekend,” one participant told me, “and we never take time to just sit and consider what it all means.”

Published in Forbes on November 22, 2011. Read the original article here

My last post discussed the reasons why neglected diseases have historically been neglected, the growing efforts to eradicate them, and why pharmaceutical companies should develop more drugs for them.

Unfortunately, the traditional economics of drug development are stacked against neglected diseases, which disproportionally affect the world’s poorest populations. Drug development is a costly and time-consuming process, and even if a pharmaceutical company did develop a viable drug for a neglected disease, they would have virtually no way of recouping their investment.

Luckily, there are many other ways the private sector can address neglected diseases (which are defined here as the seventeen neglected tropical diseases, malaria, and tuberculosis). I spent last week speaking with top officials from pharmaceutical companies, research groups, and intellectual property organizations to understand what the for-profit pharmaceutical industry can realistically do to push research forward on these diseases. All of the solutions presented below have, importantly, already been tested in the real world.

Without further ado, here are – in no particular order – the top five ways Big Pharma can address neglected diseases.

1) Create cross-sectoral research partnerships for neglected diseases
Though pharmaceutical companies have generally shied away from independently developing drugs for neglected diseases, several are open to creating drugs with partners. Just this past Thursday, Novartis and collaborators, including Scripps Research Institute and Swiss Tropical and Public Health Institute, discovered a new dual-acting class of anti-malarial compounds. “It was a multi-disciplinary, multi-continental effort,” said Paul Herrling, head of corporate research at Novartis. “Each partner brought unique knowledge and skills needed to obtain the common goal.”

Other pharmaceutical companies have also created partnerships for neglected diseases. Sanofi has, for instance, partnered with non-profit drug developer DNDi to develop medicines for up to nine NTDs. GSK has similar partnerships with foundations including Medicines for Malaria and the Global Alliance for TB Drug Development. In most cases, the partnerships are funded through a combination of sources, including the private sector, government, and other donors.

Partnerships for neglected diseases appear to be on the rise across the pharmaceutical industry. The International Federation of Pharmaceutical Manufacturers and Association (IFPMA) found that partnerships for neglected diseases have increased five-fold from 2005, and that today, 80 percent of neglected disease research efforts are done through collaborations. Mario Ottiglio, Associate Director of Public Affairs and Global Health Policy at IFPMA, said, “[Partnerships are] basically a very pragmatic solution to address market failure in neglected diseases. Pharmaceutical companies bring adequate resources, while academia and government bring the epidemiological context.”

This does not mean, of course, that every research partnership is guaranteed to succeed. Scientifically speaking, neglected diseases are quite complicated and few efforts will yield positive results. Robert Sebbag, Vice President of Access to Medicines at Sanofi, also discussed how strong relationships are crucial to the success of a partnership. “Each partner has to respect and trust each other,” he said. “They must also have a common objective.” Without those fundamentals, he said, everyone will assume the worst in each other and the fruits of collaboration will be lost.

2) Join patent pools for neglected diseases.
Patent pools are created when two or more companies agree to cross-license certain products or technologies. Recognizing the need for shared progress in neglected diseases, the World Intellectual Property Organization (WIPO) and BIO Ventures for Global Health recently created a patent pool, WIPO Re:search, for neglected diseases. In addition to maintaining a searchable database of relevant intellectual property, it will also facilitate new research partnerships.

“Most pharmaceutical companies have some form of CSR programs. They also have intellectual property. This is basically an effort to put those two things together,” said Francis Gurry, Director General of WIPO.

Since it was only created this year, the potential of a patent pool is yet to be seen. However, Gurry has high hopes. “In the best case scenario,” he said, “[WIPO Re:search] will help create partnerships between public and private entities… which over a five or ten year period will create good candidates for products.”

Many pharmaceutical companies have responded positively to the effort, and seem generally willing to share intellectual property related to these unprofitable disease areas. Sebbag from Sanofi believes it is a “very good step forward” in neglected disease research, and a GSK spokesperson said the program was “a natural evolution” of existing efforts in the field.

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Published in Forbes on November 9, 2011. Read the original article here.

What do schistosomiasis, cysticercosis, and lymphatic filariasis have in common?

Besides verging on the unpronounceable, they are all classified as neglected tropical diseases (NTDs). NTDs are a set of diseases – seventeen, by the World Health Organization’s count – that collectively affect over a billion people, but have historically received little attention. The most common NTDs, including those listed above, are caused by parasitic worms or protozoa. Others, such as leprosy and trachoma, are the result of bacterial or viral infections.

Though caused by a range of pathogens, NTDs share some important characteristics. First, many are diseases of rural poverty. Most neglected diseases affect the poor in the developing world, particularly in Africa and Asia, but some have also been found in “pockets of poverty” in the United States. For instance, hundreds of thousands of Americans, most of whom are Hispanic immigrants, suffer from Chagas disease. Second, most NTDs cause bodily impairment and disability (i.e., they have high morbidity) but are not very lethal (i.e., they have low mortality). Some result in blindness, others in unseemly swelling, and still others in impaired cognitive development. Most patients do not die, but the morbidity often hinders wage-earning capacity, thereby creating a vicious cycle of poverty.

These and other characteristics have unfortunately led to neglected tropical diseases being, well, a bit neglected. Since most policymakers live in urban centers, geographically separated from the rural areas with high NTD prevalence, there has traditionally been limited awareness of NTDs. Similarly, because NTDs cause more disability than death, they have historically flown under the radar of many public health efforts. Perhaps most importantly, the populations NTDs disproportionately affect have little money to spend on medicine, resulting in what Peter Hotez, President of the Sabin Vaccine Institute, calls “the business plan from hell.”

How can we change this status quo? What needs to happen for the pharmaceutical industry, academic researchers, and other key players begin investing more seriously in diseases that debilitate over a billion people?

To some extent, the status quo has already begun to change. It has not yet changed nearly enough, and there is ample room for the pharmaceutical industry to invest more in NTDs, but it is important to acknowledge how far the fight against neglected diseases has come.

The term “neglected tropical diseases” was only coined in 2005; before that, each unpronounceable disease fought its own uphill battle with limited success. WHO Director-General Margaret Chan explained in 2007 the benefits of having a catch-all term: “When these diseases are viewed together, we gain critical mass. We get a better grip on the scale of the economic and social consequences as well as the health burdens. Arguments for giving these diseases higher priority become more powerful, more persuasive.”

Since the term was coined, there has been considerable activity in the neglected disease space from governments, donors, pharmaceutical companies, and nonprofits alike. The US government, the UK government, and the Bill & Melinda Gates Foundation have collectively pledged or spent over $200 million on NTD prevention and treatment by 2013. Pharmaceutical companies have donated billions of doses of drugs to various NTD control programs. Some, such as GSK and Merck, have also entered “patent pools” to allow cross-licensing of NTD innovations. The Global Network for Neglected Tropical Diseases has engaged in NTD advocacy and on-the-ground coordination efforts. They also run a frequently updated blog, End the Neglect, that discusses NTD news and reminds readers that “just 50 cents” will provide a year’s worth of treatment against several NTDs.

There has also been a marked increase in NTD product development. The nonprofit pharmaceutical company OneWorld Health, which is partly funded through the Gates Foundation, conducts R&D for drugs against kala-azar (visceral leishmaniasis) and hookworm. It also ties up with for-profit pharmaceutical companies, such as Sanofi-Aventis and Anacor, to develop and manufacture some of their medicines. “Pharmaceutical companies have become more interested in NTDs than they were five to ten years ago,” said Richard Chin, CEO of OneWorld Health. “They would have sent us to their PR department before, but now they send us to their research department.”

Chin noted how their for-profit partners have invested significant time and money into the partnerships: they put their scientists on NTD projects at their expense and allowed OneWorld Health to manufacture drugs in their facilities. Many other product development partnerships (PDPs) for NTDs, such as PATH and the Sabin Vaccine Institute, seem to function along similar lines.

These developments are impressive, especially given the short time frame, but there is still a long way to go. This is perhaps most evident in the product development space. Hotez believes the pharmaceutical industry is “generally doing very well” in donating drugs, manufacturing space, and time to NTDs, but says most have invested relatively little in developing NTD drugs and vaccines themselves. Direct pharmaceutical investment has greatly helped the fight against the “big three diseases” (that is, HIV/AIDS, tuberculosis, and malaria): most recently, GSK invested in a malaria vaccine that is in final rounds of a large-scale clinical trial. Similarly, pharmaceutical companies can invest in drugs and vaccines that spur improvements in NTD morbidity rates.

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Published in Huffington Post on November 1, 2011. Read the article here or below

On November 8, Mississippi voters will be faced with the following yes-or-no question regarding their state constitution: “Should the term ‘person’ be defined to include every human being from the moment of fertilization, cloning, or the functional equivalent thereof?”

If a majority votes “no” on the measure, known as Initiative 26 or the personhood amendment, reproductive rights in the nation’s most conservative state would essentially remain unchanged. Mississippi’s one abortion clinic would continue operating, women would continue having access to a suite of contraceptive measures, the state’s three doctors who do in vitro fertilization (IVF) would continue following standards generally accepted in medical circles, and unborn fetuses would continue having fewer legal rights than fully formed humans.

On the other hand, if a majority votes “yes,” as it seems poised to do, Mississippians’ reproductive rights would drastically change. It may also fuel personhood movements in several other states, including Michigan, Florida, and Ohio.

The most publicized difference is with abortion, which would be considered murder and effectively banned — without exceptions for rape, incest, or when the woman’s health is compromised but not at immediate risk of death. OB-GYN doctor and “Yes on 26” advisory board member Freda Bush said in a press conference, “Women who have borne a child conceived in rape testify that the baby is a blessing, rather than have an abortion, which essentially continues the assault. Adoption is always a loving option.”

Limiting abortions is a popular idea in Mississippi, which has a thriving anti-abortion movement and a prominent Christian majority. Perhaps as a result, much of YesOn26’s advocacy appears designed to appeal to this audience. One YesOn26 commercial reminds Mississippians, in a manner similar to many pro-life campaigns, “No matter how small, every human life has infinite value.” Another shows the audience a 24-week-old fetus named “Lyza Kate Freeman.” Local newscasters have also highlighted the abortion element of the amendment, telling viewers, “[Initiative 26] would make abortions illegal, which is what’s at the heart of this debate.”

These segments do not, however, tell the full story. The implications of personhood — that is, of granting a fertilized egg legal rights — go far beyond limiting abortion. Regardless of one’s stance on abortion, personhood is an extreme measure that pushes against many commonly accepted reproductive and human rights.

With full legal rights, destroyed eggs are essentially treated as murder victims. This is why abortion is illegal under personhood. This is also why personhood would outlaw all contraceptives that interfere with the implantation of fertilized eggs — including intrauterine devices (IUDs), some forms of the birth control pill, and the “morning-after pill,” which YesOn26 proponents call “human pesticide.” Personhood would also prohibit scientists from destroying embryos they create in laboratories, a process often necessary during in vitro fertilization and in types of scientific research.

Personhood would also change how doctors treat women undergoing difficult pregnancies. On its website, YesOn26 advocates write, “Under personhood, a doctor would be required to save both lives if possible; but in the hard cases where the baby is unviable, the doctor would save the life of the mother.” However, doctors often have to make judgment calls on when either life is in danger, and when they should begin prioritizing the mother over the unborn baby. This is particularly true in ectopic pregnancies, a complication in which the fertilized egg implants outside the womb. Under personhood, some doctors may become wary of prioritizing the mother’s health, fearing legal ramifications if they “murder” the unborn fetus in the process.

Perhaps most worryingly, personhood may begin to criminally implicate some women for having stillbirths and miscarriages. Though YesOn26 insists personhood will not prosecute women for having miscarriages, this trend has already begun in some states, including Mississippi. Rennie Gibbs, who had a stillbirth in 2006 when she was 15, was charged with “depraved-heart murder” after prosecutors discovered she had a cocaine habit. The charge carries a mandatory life sentence.

In an extreme case, personhood could be even used to justify legal measures that most would otherwise consider preposterous. For instance, according to a recent New York Times editorial, a zygote under personhood may “be eligible to inherit money or be counted when drawing voting districts by population.” Given how many laws use the terms “person” and “people,” the editorial argued, the implications of personhood could be endless.

Within Mississippi, some groups have been trying to distinguish between the pro-life movement and Initiative 26. A grassroots organization called Parents Against MS 26, which claims to take no position on elective abortion, has been spreading its belief that “there are many valid reasons for pro-life AND pro-choice Mississippians to vote No on 26.” In addition to providing FAQs on ectopic pregnancies and IVF, the site offers several personal stories and guest bloggers. For instance, Reverend Todd Owen Watson wrote, “It would be nice if the changing of one or two words in a state constitution would solve all of our concerns about life, its sanctity, and its meaning, but this ill-written and ill-advised amendment might destroy more life than it saves because of its… heavy-handed impact across all aspects of our daily existence.”

Freda Bush hopes the personhood amendment will restore a “culture of life” in the United States. “It’s unfortunate,” she said, “that for the last forty years, the pre-born person has been marginalized and made legally irrelevant.” Sadly, by granting equivalent legal rights to fertilized eggs, the personhood amendment may tip the scales and begin prioritizing the zygote over the post-born person. Personhood is not a simply change in nomenclature; its consequences are perverse, many of them reaching well beyond abortion.