'Rx for Survival: A Global Health Challenge'

Philip J. Hilts
Author, 'Rx for Survival: Why We Must Rise to the Global Health Challenge'
Wednesday, November 2, 2005; 1:00 PM

The series "Rx for Survival" highlights public health breakthroughs and interventions that have more than doubled life expectancy in developed countries within the past century. The series, filmed in more than 20 countries, also explores how the lack of access to basic health interventions leaves many impoverished countries plagued by preventable diseases. The series airs on PBS Tuesday, Nov. 1 - Thursday, Nov. 3. (Check TV Schedules.) Brad Pitt narrates.

Philip J. Hilts, author of "Rx for Survival: Why We Must Rise to the Global Health Challenge," is interviewed throughout the series "Rx for Survival." Hilts was online Wednesday, Nov. 2, at 1 p.m. ET to discuss the first episode of the series.

About Episode I: (Aired Tuesday, Nov. 1, 9-11 p.m. ET)

"Disease Warriors" -- The first hour of the episode chronicles the work of 19th-century researchers, such as scientist Louis Pasteur, who discovered that germs cause illness and who developed the first vaccines. It also looks at how despite the progress in combating disease, the world still faces major challenges in getting basic care to those who need it and in creating new ways to combat modern diseases such as AIDS.

"Rise of the Superbugs" -- The second hour of this episode chronicles the fight against new resistant bugs and the search for "magic bullets" -- the wonder drugs that have become a mainstay of modern medicine. From the development of the first drug to treat syphilis to the discovery of penicillin and new classes of antibiotics, this program recounts the successes of today's medicines while examining the growing dangers presented by antibiotic-resistant strains of diseases such as tuberculosis.

About Philip J. Hilts:

Hilts, author of five books, has been a prize-winning health and science reporter for both the New York Times and The Washington Post. He has covered HIV/AIDS since the first report from the Centers for Disease Control in the summer of 1981. His stories over the years have been on a broad range of health and science topics.

The transcript follows.


Philip J. Hilts: Hi, I'm Phil Hilts, and right now I'm sitting in a hotel room in NYC between sessions at the Time Magazine Global Health Summit. I'm ready for Qs.


Boston, Mass.: Can you explain your thesis that as societies develop, health produces wealth -- rather than our traditional understanding that wealth produces health?

Philip J. Hilts: There is something of a revolution going in Economic thinking about health and development. For more than a hundred years, economists have assumed that the way to build societies is by building up capital, then investing it in physical plant---roads, factories, docks---and that eventually the success of businesses based on this kind of investment would lead to higher incomes and healthier people.

But work of the past twenty years shows that this was an incomplete formula. In fact, the biggest driver in getting an economy going is health of the people at the bottom. That was the source of the Asia miracle. Human capital, as Nobelist Robert Fogel reports accounts more more than half of all the wealth generated in Britain between 1790 and 1980. All the other stuff--technology, roads, railroads---put together is less than half. It is the doubled life span and the greater physical stature and strength, as well as education that makes the human engine the most powerful one in growth and development of nations.

That's why we need to rethink aid, and deliver health aid first and foremost.


Bethesda, Md.: Access to quality reproductive health services and information (including family planning) remains a critical component in efforts to improve global health. In the current domestic political climate, what do you see as the key arguments for increasing support for these programs in our federal budget.

Philip J. Hilts: People in the US and elsewhere all need good reproductive services, and Americans have always broadly supported their availability. Since this is a political question, and the restrictions have come largely through the action of elected officials, right now the way people must deal with these issues is in speaking to your representatives and in voting. I don't think the arguments themselves have changed much, except that we now have more data showing that theses services are fundamental to health, and not just reproductive health. I developing countries I visited, such as Bangladesh, this is a lynchpin for families---when some health services are available and children are healthy, families on their own decide to limit the number of children they have, and then each family member in turn is more health and productive.


Arlington, Va.: I was disappointed that during the segment on anti-biotic resistant microbes, the documentary suggested that the answer to the problem was simply to make more antibiotics. You did not mention that superbugs more or less came into being by the overuse of antibiotics - both in medicine and in agriculture. Why did you not send the message that doctors need to prescribe antibiotics judiciously, and that people need to stop demanding them for inappropriate reasons (i.e. to cure a cold)?

Philip J. Hilts: Sorry about the confusion: I did not make the series. I wrote the book, which is significantly different than the series. Your point, though is right. Mis-use of antibiotics has caused a great deal of trouble, and though doctors are now being educated to avoid it, that education has so far not taken. IN the end, though, even if we do a better job of hanging onto drugs by using them more sparingly, the bugs will evolve and we will have to make new antibiotics. It will be a continuous tug and pull. Unfortunately quite a few years and many bucks will be lost in the careless practices that have grown up.


Montreal, Canada: My question is related to people who are infected with bacteria that are resistant to any antibiotics. Has there been any questions asked whether the bacteria is a new resistant strain before it enters the body or could something cause it to mutate into a resistant strain once in the body. The question is asked because of the infection of the football player in the first show and that, from what I see, there is no other players infected even thought they could have been easily exposed.

Philip J. Hilts: Yes, I wondered about the football player myself and what was done to check the source of the infection. If you are interested in following up, I can get a detail or two so that you can locate where and when the case occurred to find more history on it. For the series, they were trying to sick just to the main points of the stories; TV is very demanding.


Arlington, Va.: Why did you decide to write this book?

Philip J. Hilts: I had done some work in Africa, reporting on HIV, and found that there were a number of really hopeful things going on. And the more I looked, the more surprised I was to see project after project succeeded and changing things on the ground in poor countries. We have actually learned how to do this stuff. But while we now have the know-how, and the medicines, and even the money, we haven't made the big push to get the basics done in the poorest countries. Just delivering some basic health projects would be an enormous boost across the 30 or so countries that might benefit. So the book is an attempt to report on the new knowledge, and let people know what we can now do if we decide to. It was an attempt to help get a discussion going on these topics, which I think are more vital than many of the things which distract us day to day in American politics.


Harrisburg, Pa.: Have you explored the topic of the need for medical researchers and pharmaceutical company executives need to better share data and information, on an international basis?

Philip J. Hilts: I have done some reporting on that issue, but not for this book. It is a real problem, and in fact I was thinking of taking on medical information and its control for my next book. The system is broken, and it is time to try to address it, I think.


Washington, D.C.: Can you expand on some of the "hopeful things" you witnessed going on re: HIV in Africa when you were there? Thank you.

Philip J. Hilts: Yes. The delivery of HIV drugs to Africa is astonishingly successful; it started in Botswana where I lived and is now happening in 15 African nations. The book contains half a dozen stories of other successes, several of them at length, such as the several programs in Bangladesh run by the group called BRAC; they started with diarrhea in children and were successful in getting mothers in villages to make up their own oral rehydration solution and give it to their babies; the death rate dropped from 50 per cent in the cases of the sickest babies, down to less than one percent after the mothers were trained .There are many more stories, and citations of other articles and books that describe large, successful projects that changed, not just minor indicators, but death rates in these countries.


Chicago, Ill.: Hello--

Can you give any perspective on that bugaboo that's on everybody's mind -- the bird flu?

Thank you.

Philip J. Hilts: The bird flu is kind of a preview of coming attractions. It is in birds, but as we watch it we can see how a serious human epidemic would move. One of these big human epidemics will come at some point, and so we need to pay attention. For three decades, the amount of money and effort put into public health has crashed. We didn't get where we are in medicine and health by ignoring the problems, so we need to recommitment ourselves. Put the docs and epidemiologists back into the health departments, built the labs, work with people in each of the other countries to track and derail diseases as they happen. We've let research on vaccines and the genetics of these diseases go, and so we are using decades-old technology. We need to rebuild. I think we will have bird flu in the US, but I think there probably will not be a human epidemic coming out of it this year, thought that is a guess.


Silver Spring, Md.: I just wanted to comment that taking into the consideration that TV is very demanding, I think that the programmers did a great job in bringing out the main challenges and in discussing what is being done to address those challenges. As a global public health professional, of course I realize that there are many things that couldn't have been included for the sake of time, but I was wondering if, given the audience and the aim of the series (to mobilize the American public), why there wasn't more done to show the disparities between the west and the developing world, in order to bring home the fact that we have benefited by chance of where we were born? Maybe this will be brought out on tonight's show.

Philip J. Hilts: Those matters are addressed in the book. The folks doing the series felt it was best to tell the human stories on television, and then in town meetings, curricula, discussions, the other news outlets doing projects, to discuss more of the politics and the background.


Takoma Park, Md.: I work in public health and occasionally speak with elected officials about health concerns. Recently, I've heard several policymakers argue that the government shouldn't spend so much on preventative health issues because people should be more responsible for their own health. This argument was made regarding investment in family planning programs, with one federal official saying that the government should save money by encouraging married couples to be periodically abstinent.

Could you comment about the roles of personal responsibility and government investment in preventative public health?

Philip J. Hilts: We went from an era in which we created the Marshall plan and the peace corps, eliminated polio in the West and smallpox in the world, and over the past century built the great longevity and robustness in the species that we now enjoy. The basis was all in public enterprises. In the 1970s we began to turn away from cooperative ventures, to private concerns and enterprises, and have lost track of what got us here. I believe we are now beginning to realized this.


Montclair, Va.: With AIDS killing so many people in Africa, what programs are available to the orphaned children? How can a country continue to function properly when so many parents are dying? Who will be able to raise the next generation and spur change?

Philip J. Hilts: Countries can't continue to function well in those conditions. Right now in several African nations two people must be hired for each job because one is likely to die soon. It is a catastrophe. The hope is that the delivery of HIV drugs now will be able to cut down on the deaths, giving those infected another 10 years or more of life. We're late, but it is happening.

That doesn't mean there wont be great damage; that has already happened. Life expectancy has dropped from 63 to 30-something in Botswana already. It was the least corrupt and most successful nation financially in Africa. Now it is sliding backward fast. It is an emergency, and the political leaders there are now addressing it---we need to help.


Greenbelt, Md.: Hi,

I believe I remember reading about how TB has made a comeback in prison populations -- is that true? And if so, why is that?


Philip J. Hilts: Yes, TB had gone down to very low levels in the United States. But the money to monitor and treat TB was cut from the federal budget. (Details are in the book). This happened just as the Soviet Union Collapsed and TB grew dramatically there. One strain of resistant bug made it from Russia to New York and became a part of a mini-epidemic in 1990-1992, ---28,000 new and unexpected cases. It cost a great deal to stop that outbreak, but now TB is back in small pockets that can break out from time to time---in prisons and in immigrant populations in the cities. Again, we lost track of how we succeeded and let the bug in the back door again.


Washington, D.C.: What programs have you seen that could and should be scaled up to a national level, and that could have a widespread health impact? What about funding large scale national projects, what are your ideas on international health care financing in this regard?

Philip J. Hilts: I found half a dozen large-scale programs that were working, and have seen good data on another 17---these are all projects that have these things in common---national scale, inexpensive to deliver, and changing actual rates of disease or other first-line indicators. These projects are spread around in many countries. The organization called the Global Fund to Fight AIDS TB and malaria now routinely funds projects in a results-oriented, locally controlled but carefully monitored way, so that the successes are now multiplying. The book outlines the successes, and goes into detail on the money---but briefly, it costs peanuts. Right now we are spending less than one percent of our budget on good aid projects like this, and in economic terms about 0.16 percent of our GDP. If we want to deliver good basic projects in each of the poorest countries, we could do it by going up to 0.70 of our GDP (the Marshall plan cost us 3 full percent of our GDP). Other countries have agreed to do that. The US has agreed to put in more, but we don't have details yet.


Chicago, Ill.: I am glad this series came out. I always hear so much about the problems of disease but not so much about the solutions, the unique and innovative solutions coming from the very countries that are facing these problems themselves.

I would encourage the media to report more on these innovations so that the image of developing countries is not one of destitution and helplessness but of creative innovation, advancement and high achievement in public health arena that all countries can learn from.

Philip J. Hilts: Thanks for the encouragement. That's how I feel. When I started on this project I was really surprised at how hopeful the situation is, so now I'm trying to pass along the news with this book.


Washington, D.C.: Given that we're a political town, and that there is only so much money to fund many needed things, what is the most important global health intervention demanding funding?

Also, because questions about health often intersect with questions of morality (e.g. the whole family planning debate), how can we make funding global health inventions seem in the public's best interest?

Philip J. Hilts: I think we can go along with the European nations and commit to spending 0.7 percent of our GDP to deliver the basics to countries that apply for aid. We don't need to identify one problem, or two, because if we put forward the money and the rules, the people in the countries (often not the governments, or not the governments alone) make their own proposals about the things they need most.


Norfolk, Va.: Mr. Hilts,

What do you think is the biggest single threat to global health? AIDS? Something else?

Philip J. Hilts: I think the biggest problem is letting people know that we have the tools and knowledge to deliver on several key things all at once; people tend not to believe that, but we do. We can help each poor nation deliver on the most important things in each place, and just monitor and assist to make sure they are successful. The plan is already working now, but at a lower level and so we need to commit more fully to it.

For the US the problems are different that for other countries, and then we will all share some trouble---like avian flu if it goes human.


Alexandria, Va.: Mr. Hilts,

What are the chances that HIV/AIDS will mutate into a resistant version that the current cocktail of drugs can't keep in check? Could HIV/AIDS become something like the flu and be an airborne virus? Brrr.


Philip J. Hilts: HIV is evolving and changing all the time; the strain in southern Africa is much more fierce than the one in the US. It will keep changing. But it's transmitted by body fluids and I don't think it will go airborne


Encinitas, Calif.: Three of our family members were infected with the superbug "MRSA" Although we have survived, I am very appalled at how un-educated doctors in Southern California are of this disease. What is the CDC and other govt. health officials doing about this? My husband and I have self educated ourselves and we know the United Kingdom has a very large outbreak and their government is doing more to get the root of this disease than ours.

Philip J. Hilts: Yes, we are a little behind here. We have neglected public health infrastructure, research and education for quite a few years. We used to be very proud of our knowledge and abilities in these great public health enterprises; I hope we'll get back to leading on these things.


Chicago, Ill.: What is your opinion on the debate to eliminate mercury from vaccines? In a recent issue of parenting magazine in Chicago there was an article about a mom with an autistic child who thinks there is a link between vaccines and autism. She is trying to influence the governor of Illinois to eliminate vaccines with mercury in them. Is this a good idea?

Philip J. Hilts: I've spend some time reporting on the issue, and looking at the data. I haven't seen a connection. The data I've seen doesn't convince me at all. Many anecdotes, no real evidence. On the other side, it's clear that vaccines save a very large number of lives. What's puzzling is that the people who don't want to take the vaccines seem to be ignoring that, or perhaps they are saying they will let other people's children get immunized, and everybody will be protected, and then they don't need to participate themselves.


Capitol Hill, Washington, D.C.: Here's another funding question: why doesn't our government just help to pay for US health programs? Poor countries will always have some problem - if it isn't hunger, than it's AIDS. Seems better just to invest at home!

Philip J. Hilts: I don't agree. We are all part of the world, and we are the richest nation in it---if we want to use others as customers, or be their customers we have to share the same basic hopes and successes. If we get even richer while they suffer and die, the injustice will eventually haunt us or worse. No, we're all in this together.


Staten Island, N.Y.: How does capitalism undermine global health care issues? In respect to major drug companies, would you say that their aim is to treat rather than prevent illness? If drug companies were to make their prime focus disease prevention, wouldn't the health industry take a major cut in profit? How can we work in the interest of both drug companies and citizens to prevent and treat disease?

Philip J. Hilts: Capitalism, as a theory on its own, doesn't undermine or aid in health. It's the detailed policies. So if international companies pay attention to the social and health situations of their workers, it can be a great boost in that country, while internationally profitable. If instead the policies are things like the "user's fees" charged for poor people to access clinics and education (an IMF practice), then it will be very destructive. I think we have to make the choices now. If we don't push an enlightened, sharing globalization, I think we're all going to be in trouble.


Dumfries, Va.: What is being done in AIDS-ravaged countries to help all the children orphaned by AIDS?

Philip J. Hilts: Each country is dealing with the problem on its own, and so the responses are varied, but for the most part the orphans are the last in line when countries think about what to do on AIDS. So there are fews orphanages being started in southern Africa, but they are a new kind of institution there; families are used to taking care of all their own. But with HIV, often all the key family members have died, and so there are left a number of children and perhaps a grandmother. So orphanages are getting started; church groups particularly are starting them. But there is also a very large growth in street kids in African cities, unlike anything before.


Philip J. Hilts: Have to go now. I got to many questions, but not all. Sorry. If there's interest we can go back around again soon.


Phil Hilts


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