Leprosy Mailing List – December 11, 2019
Ref.: (LML) Identification of authors of LML postings
From: Joel Almeida, London and Mumbai
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Thanks to Prof. Frankel and Dr. Deepak for their thoughtful contributions. (LML 3 and 7 Dec 2019). The reflections below might be relevant.
I believe it can be helpful to hear from people who have experienced Hansen's Disease (HD). Similarly, from front-line workers in endemic countries who see exactly how the rubber hits the road. Not everyone with valuable insights has qualifications or titles, and not everyone with qualifications or titles gets the right end of the stick.
Conventional notions of prestige are not always a good indicator of reliability. A notable example is Einstein, who was employed in a patent office as he developed the special theory of relativity. HD bacilli do not respect our notions of prestige. In the end, only the truth works. I once visited and learnt from the largely illiterate village women health workers (shashto shebikas) in Bangladesh that the key to high cure rates in TB was to minimise the delay between a missed dose and corrective action. They were bold, and justifiably proud of their high success rate. They said to patients: "Come to me and you will be cured. Go to the urban doctors and you will die." Observed cure rates showed that this was not entirely an exaggeration. Nobody is too humble to be believed, nor too grand to be questioned.
It can be useful also to hear from highly talented people from endemic countries. They are over-represented among the CEOs of major corporations (such as Microsoft, Mastercard, Adobe etc). However, they are often under-represented in various global HD committees, and not always due to lack of knowledge or ability. It has sometimes taken decades or more for mind-sets to shift, and for world-class researchers in endemic countries to gain global prestige and financing commensurate with their contributions. The hard-nosed major corporations have been quicker to shift their mind-sets, and have been reaping the benefits (which they measure in dollars). If we invested core funding in the great population-based field programmes in endemic countries plus local high-tech facilities, we too would probably attract more top-notch talent into HD and reap the benefits (which we measure in DALYs saved per dollar invested - meaning less suffering among the people we all strive to serve, and a quicker end to HD).
Endemic countries can be a useful source of top-notch young talent. In order to attract new faces, it can help to foster an environment that gives greater weight to the merits of what is said than to who is saying it. Otherwise we might lack a critical mass of talent participating in HD work. Then, healthy discussion could be replaced by a "country club" approach where we merely reaffirm errors among ourselves and sometimes end up swimming against the tide of scientific knowledge. That might lead to stagnation, or worse, in the incidence rate of HD. It is better to keep learning from unexpected successes and failures. A field programme with dramatic positive impact is like a lighthouse that indicates a safe harbour. Whereas unexpected failures are like signals marking the location of dangerous rocks.
Reliability of contributions here (as elsewhere) can often be assessed from the quality of evidence and logical analysis. A contribution can be viewed together with dissenting voices, if any. The quality of evidence and logical analysis in each can be weighed. LML enables that process to happen openly and rapidly among nearly all of the world's knowledgeable HD experts. Errors tend to have a short half-life on LML. This boosts our chances of success.
However, there remains a good reason for examining authorship: to identify conflicts of interest, declared or undeclared. Our shared interest is to do what is best for the people we are all trying to serve. There can be other interests. It is good to remain alert to those, so that we can understand the context, and assess views appropriately.
We are all human, fallible, and we all make mistakes. There is no shame in that. We are all also capable of great things. We can keep helping and encouraging one another to correct errors, awaken our best selves, and get back on track, so that we can devise and implement programmes with excellent outcomes. Each of us can keep our minds open to valuable insights regardless of the authors. It's worth getting all this right because Shandong and Uele showed that 17 to 20% annual decline in incidence rate of HD is achievable. We understand the critical elements in those dramatically successful programmes. Therefore, we too can devise and implement programmes that succeed. Imagine a 20% decline per year in the incidence rate of new HD patients, as in Shandong. Wouldn't that be wonderful?
Regards, appreciation and gratitude to all,
Joel Almeida
PS. For those curious enough, the following paper illustrates some of my previous work in HD. Almeida, JG. A Quantitative Basis for Sustainable Anti-Mycobacterium leprae Chemotherapy in Leprosy Control Programs. Int J Lepr (1992) 60(2):255-268. Anyone who would like to know more is welcome to write to me through the LML editor.
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder editorlml@gmail.co
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