Philip Musgrove, one of the authors of the paper that Amir Attaran misunderstood writes:
The one--and only--point on which Attaran and his co-authors are right
is that in the Appendix to the Booster Program document, someone at the
World Bank who had not participated in the analysis of the Brazilian
program failed to notice that the data for 1996 referred to only half a
year. This is because the paper by Akhavan et al., of which I am a
co-author, developed a cost-effectiveness analysis and the cost data for
the Bank project ran only through half of that year. It was a mistake
to interpret the 1996 data as if they referred to a whole year, and the
Bank has since corrected that error. It was not, as Attaran et al.
assert, a deliberate attempt to mislead anyone by claiming that malaria
cases fell by 60% in one year. It is perfectly clear in Akhavan et al.
that no such claim was ever made; it is inexcusable to cite our article
so as to give the impression that it was made. Authors who were intent
on learning what actually happened, rather than looking for an excuse to
attack the World Bank, would have pointed out the mistake to the Bank
and waited for the necessary correction, rather than falsely accusing
the Bank--and by implication, Akhavan and his co-authors--of chicanery
and bad faith.
The more important point on which Attaran and co-authors are completely
wrong, and on which they would have been wrong even if the analysis had
stopped at the end of 1995, is their insistence that "[a] declining
trend in malaria cases during and after the Bank's program...ia
necessary to adjudge it a success." That would be appropriate, if
malaria incidence had been stable in the years before the program, but
it wasn't; as Figure 1 in Akhavan et al. shows, the number of cases had
been increasing every year from 1975 to 1988. The program is rightly
judged a success because it reversed that trend, overall, and more
dramatically in the case of falciparum malaria. The estimates of 1.73
million cases prevented and almost 231,000 deaths averted are the
difference between what actually happened and what we take as the
counterfactual, what would have happened in the absence of the program
and particularly without the change of strategy in 1992-93. Our
assumptions about that counterfactual--about what would have happened to
incidence, severity and lethality--are carefully spelled out in our
paper, and had the support of Brazilian and other malaria experts. I
can only conclude that Attaran et al. do not understand the concept of a
counter-factual and have failed to notice what was happening to malaria
cases in the whole decade preceding the program. People who do not
understand such basic matters, and who do not trouble to read carefully
before launching into an attack, should refrain from criticizing those
who do understand them.Philip Musgrove
Ex-World Bank (retired)
Deputy Editor, Health AffairsMr. Lambert, please feel free to add this note to your weblog. This same
explanation has been provided, at somewhat greater length, for
publication in the Lancet. I and my co-authors hope that will put an
end to this discussion. It remains only for Attaran and his co-authors
to apologize for accusing the Bank of deliberate falsification.
Dear Dr Musgrove, sadly as ever your efforts match the invariably specious nature of WB evaluations by rate of return calculations and the like that would never pass the scrutiny of even the slackest stock exchange. Is it really true that normal life expectancy in Brazil (in the absence of malaria) is 80 as you assumed to get your DALYs? Data from WHO shows that the WB program was not sustainable or sustained, with standardized malaria rates per 1000 higher in 1999 and 2000 than they had been at the beginning of the WG intervention; rates have only dropped below the WB's trumpeted success rate of 455,194 in 1996 since the 610,878 achieved in 2000.
Meantime the WB's Roll Back Malaria (2005) is so scared of mentioning DDT that it manages only one en passant in 300 odd pages. Hamlet without the Prince indeed! There is one further ref (by mischance) in the biblio - and of course no mention of the studies around the world showing its crucial significance in achieving eradication (even in Eritrea where WB claims credit for the results attained in critical areas by IRS with DDT). Evidently the WB does not subscribe to Am.J.Trop.Med.Hyg, so its RBM (2005) avoids mention of Breman et al., Conquering the Intolerable Burden of Malaria: what's new, what's needed: a summary (2004). Breman et al cite the study of the Solomon Islands I quoted from here yesterday (Lancet thread) with its striking findings that "spraying with DDT, use of ITNs, and health education were all associated with disease reduction [but that while] the use of nets permitted a rduction in DDT spraying, [it] could not replace it without an increased malaria incidence".
As for Ian Gould, be sure that it was neither bednets nor pyrethroids that eliminated malarial mosquitos from northern Australia.