Evolution denier Ray Bohlin is in Liberia telling the Liberians their salvation lies with DDT, at least in fighting malaria. Wholly apart from the theological problems of elevating a chlorinated hydrocarbon killer to the level of idolic deity, DDT can’t solve the many problems that conspire to keep Liberia in the grip of DDT as a killer of children and pregnant women.
What an odd conflict of faith and science. Bohlin is a Christian. His strong faith in DDT is a double puzzle.
[And, what is it with all this denial? Creationist/IDist/evolution deniers tend heavily to be HIV deniers as well, and global warming deniers — now DDT deniers? Have they all had close encounters of the third kind, too? Is it a virus? Is it a cult?]
Fighting malaria in Africa requires a concentrated, integrated plan that provides appropriate medical care to cure any human who contracts malaria, thus breaking a key link in the malaria cycle. Malaria kills children under 5 and pregnant women in larger percentages than other people. Bohlin correctly notes that malaria kills, and that the disease disrupts the nation’s economy. But his recommendation that Liberians increase DDT use, in the absence of an integrated pest management plan, is a prescription for dashed hopes at best, and disaster at worst.
Bohlin seems to urge junk science. DDT offers significant dangers, which Bohlin seems blithely to ignore.
Why won’t DDT help much in the fight against malaria?
Wholly apart from the inherent problems of DDT — mosquitoes develop immunity, or already are immune; DDT kills beneficial insect and arachnid predators of malaria vectors, so the mosquitoes come back in geometrically increased numbers; DDT kills the food fish of people who live on fish; DDT kills reptile, mammal and bird predators of mosquitoes, so the mosquito population roars back with increased killing efficiency — DDT cannot solve the other problems that play a greater role in frustrating the fight against malaria. DDT doesn’t treat the disease once humans catch it; DDT is just one, small tool to prevent infection, and perhaps not the most effective.
Some of the problems were highlighted by Liberia’s long civil war. Stories about Liberia around that time highlight the difficulty of fighting malaria, and an outbreak of malaria among U.S. Marines who were sent in to restore and maintain order in 2003 showed that DDT alone can’t do the job. In three articles, the New York Times revealed the problems in 2003.
First, DDT cannot fix Liberia’s broken health care system. Health care is essential in fighting malaria. Humans form a pool of infection, a key link in the life cycle of malaria parasites. If infected humans are not treated to eradicate the parasites, malaria is waiting for the next generation of mosquitoes to reinfect themselves, and spread the disease again. There must be good access to health care facilities for infected people, and those facilities must have the proper medicines and staff to dispense the medicine appropriately to effect a cure.
Before the civil war there were too few health care clinics and hospitals — after the war, existing hospitals and clinics were left in shambles . (“In Torn Liberian Town, Hospital Itself is a Fatality,” July 18, 2003)
Set among sheltering old trees, across the road from a small church with blue stained-glass windows, Ganta United Methodist Hospital took in patients from all over Liberia’s sprawling, rural northeast and from across the river, in Guinea.
Today, the hospital lies in ruins. Its anesthesiology machine is shot up. Grenades have blown off the roof of the eye clinic. The hospital floors are littered with syringes, blue surgical gowns and empty crates that once contained Kalashnikov ammunition.
For three months, as government and rebel forces fought over Ganta, the hospital was turned into a base. It has since been stripped of everything useful — generators, computers, even sterile gauze, surgical clamps and antibiotics.
Liberia’s health care system struggles to get back to merely inadequate levels. Money must be spent to create the equivalent of the old health care system just to get back to a level of health care where malaria was a major problem.
DDT doesn’t build hospitals, it doesn’t train doctors, it doesn’t create medical supplies.
Second, DDT is no more a panacea against all forms of malaria and all malaria-carriers than anything else is. The parasites are drug resistant, the mosquitoes are insecticide resistant, and people get infected even when several steps have been take to prevent it. This is illustrated amazingly well by the fact that an extremely high percentage of the U.S. Marines deployed to Liberia contracted the disease — despite their having drugs to prevent infections, training on how to avoid being bitten, and sleeping quarters that should have protected them from bites. According to a Department of Defense news release, this mystified authorities.
About 80 members of the approximately 200-strong U.S. contingent that served ashore at various times during the Liberian peacekeeping mission developed malaria, noted Dr. Michael E. Kilpatrick, the Defense Department’s deputy director of deployment health support, in an interview with American Forces Radio and Television Service.
The mystery, Kilpatrick said, is that U.S. personnel who’d contracted the disease — a potentially fatal, mosquito-borne malady common in tropical climates — had been provided anti-malarial drugs.
“Very quickly, in a matter of a few weeks, we started to see cases of malaria in those individuals we thought were adequately protected,” Kilpatrick recalled.
Initially, 33 persons came down with malaria in Liberia and were evacuated for treatment, Kilpatrick said. Two were taken to Landstuhl Regional Medical Center in Germany, he noted, while the others were sent to the National Naval Medical Center in Bethesda, Md. Now, however, the total is 80 cases among the people who went ashore, the doctor pointed out.
In contrast to the bombed-out hospitals which can provide no care for Liberians, the U.S. soldiers got the best of care; and still there were problems:
Tests performed aboard the amphibious ships showed that some marines had falciparum malaria, the deadliest form of the parasitic infection. Ordinarily, malaria does not require health workers to don such protective gear because it is spread by mosquitoes and not contagious. But the doctors worried that the variety of symptoms suggested that some marines might also have contracted any of a long list of other infections common in West Africa.
”Our greatest concern was that this was Lassa fever,” said Dr. Gregory J. Martin, a Navy captain and the program director of infectious disease fellowships at Bethesda Naval Medical Center and Walter Reed Army Medical Center. Dr. Martin led the military medical team that examined the marines at Andrews Air Force Base and later cared for them at Bethesda.
Lassa fever is a viral infection that can cause fatal bleeding and that can be spread easily in a hospital setting. Because of the possibility of importing Lassa fever, Bethesda officials activated a seldom-used plan to treat victims of emerging infections and biologic warfare agents.
Before the marines boarded their flight to Andrews, scientists at biologically secure military laboratories began preparing to perform tests to detect the viruses that cause Lassa fever, dengue fever, yellow fever and other microbes.
Every U.S. Marine made a full recovery. Liberians who contract the deadliest form of malaria may not be so lucky. DDT could have done little in these cases.
Third, as the cases among the Marines show, prevention is the key, and education and follow-through are the keys to prevention. Hypothetically, the U.S. Marines had every protection against malaria. It turns out that regular human non-feasance contributed to the disease: Marines, having avoided malaria in Iraq and Afghanistan and other places, did not take the risk seriously, and did not take the preventive medicine as needed to prevent infection.
The 53 marines sickened by malaria after 12 days in Liberia in August caught the disease because they did not take their pills properly, Navy officials said on Thursday [December 4, 2003] at a conference on tropical diseases.
Although many of the marines swore to Navy doctors that they had religiously taken their weekly mefloquine pills, blood levels showed that they had not, a Navy spokesman said. The three sickest marines, who nearly died of brain and lung complications, had almost undetectable levels.
”The reality was that it just fell by the wayside,” said Lt. Cmdr. Tim Whitman, an infectious-disease specialist at the National Naval Medical Center in Bethesda, Md., who spoke to the annual conference of the American Society of Tropical Medicine and Hygiene. ”These men had been in Iraq and Djibouti; if they’d gotten away with not taking their mefloquine there, they assumed they’d get away with not taking it here.’
So, once again we pledge to do better working against malaria.
But to fight the disease, we need education and follow-up programs to make sure the proven methods work. The Marines had not been sleeping under bed nets aboard Navy ships — bed nets have proven to be one of the essential things to do to prevent malaria, with DDT or without it. Appropriate and quick medical care remains the keystone, however.
In the confusion after 53 of the 133 marines became ill, they were first misdiagnosed as having dysentery because so many initially had diarrhea. The chief medical officer on the Iwo Jima had been trained in pediatrics, not tropical diseases, Commander Whitman said.
Dr. Gregory J. Martin, a Navy captain who led the military team that cared for the marines at Bethesda, said the lesson of the episode ”went like a shot” to the top levels of the Department of Defense.
But Commander Whitman seemed slightly more cynical.
”The hard lessons are learned over and over and over again, in Somalia and Vietnam and World War II,” he said, adding jokingly, ”This will go to the top of the list after fuel and bullets and everything else.”
DDT is a suitable part of an integrated pest management program, where DDT is applied indoors, in appropriate places, against appropriate mosquito species. Such applications are recommended by the World Health Organization (WHO) and environmental organizations, and most public health agencies. The programs are expensive, requiring trained people to apply the chemical safely and appropriately. DDT may be inappropriate if trained applicators are not available, if follow up is not possible, and if other parts of the program are not in place, including especially good medical care and bed nets.
Bohlin does not say what type of use of DDT he advocates. If he advocates nothing more than the WHO guidelines, he’s offering nothing new. If he advocates broadcast outdoor spraying, however, he steps into crank science and crackpottery advocacy.
How much of Bohlin’s advocacy for DDT is due to his failure to comprehend the problems, and how much is due to his political agenda, which is opposed to hard science at almost every turn?