[Stoves] Off-topic: Alcohol, drugs or stoves? WHO is the new Vatican?

[Traveller]

Dear Dr Karve:

Thank you so much for writing. Let me respond to you from first principles
rather than research, which I may do later. I have only read your first
sentence as I start writing this, so please bear with me. I will respond
one at a time. Just so I do not mix in my policy biases against the
cookstoves mania. (I would like to think, as the Clintons say they do, that
policy has nothing to do with politics.)

On Sat, Oct 29, 2016 at 3:13 AM, Anand Karve <adkarve at gmail.com> wrote:

> Dear Nikhil,
>


> "I am not an expert in these matters, and am also unable to cite
> the relevant literature, but it seems that the death rate among
> villagers is higher in India than that of Indian city dwellers."


** Depends on what you mean by death rate. Annual deaths per 1,000 can be
higher in villages because rural areas have relatively higher shares of
both the young and the elderly (working age men go to cities, sometimes
with their wives) and because access to medical care and quality of such
care are sometimes lower. Besides, death statistics and reports on causes
are not that good. (As GBD folks readily admit, and WHO DG warned, but
let's ignore these expert debates.) **


> "This has definitely nothing to do with air quality, because the air in
> the cities is more polluted than that in the villages."


** Not necessarily. It is the composition of pollution and exposure
profiles that influence disease and death. I just re-read a piece by Naeher
et al. (Woodsmoke Health Effects: A Review, 2007) yesterday. I suggest you
skim through the tables and read the last few pages of discussion and
recommendations. There are serious deficiencies in the literature and I
think also a tendency to presume - "If there is no evidence otherwise, we
will continue to assume what we feel like." I respect science too much to
fall for the abuse that follows such serious papers - by the usual suspects
including some at WHO, who ignore all the qualifiers and go on asserting
"air pollution kills". That is deceit, dumb deceit. We just do not have
good data on air pollution and disease incidence, leave alone the
epidemiology research examining causality between the two. The chemical
composition of pollutants does matter - whether specific molecules, which
we know about, or PM2.5, which we do not - as does the intake.

Just think of meals. It does matter what the ingredients are and how much
one eats. The air pollution literature is a mix of finely baked pies and
burnt breads. Do not take expertise third, fourth and fifth hand. That is
like borrowing recipes fifth hand, who eats anything that is served and
doesn't know how to light a fire or chop onions. I am serious. This is what
the Queens of Chappaqua and Washington, DC or Geneva do. **


"One has to really know the village dwellers intimately to understand the
> causes of higher death rate among villagers.


** ABSOLUTELY. That is science and that is the proper practice of medicine.
Why, I recently quoted a Dr Rudolph Virchow,"Medicine is a social science,
and politics is nothing else but medicine on a large scale.” It is a
stunningly beautiful statement of the ideals of medicine and politics; I
know its validity from my personal experience. **


 "There were recently reports from a part of Maharashtra state of
aboriginal tribal babies dying due to malnutrition, a euphemism for
starvation. The same news also had photographs of the parents of the dead
babies. The parents did not look malnourished. Should one therefore assume
that the parents deliberately starved their children? The answer in many
cases is in the affirmative."

** I had no idea I would read this from you. But then again, I am not at
all surprised at the news or your opinion. I happen to know some anecdotes
about children's health in predominantly "tribal" areas. (I would take
exception to the term "tribal", though. I use that term for Washington, DC
and the aid and research industries of which I have been a beneficiary. We
are all weird tribes.) And I also remember some literature going back
30 years on "intra-household allocation of food." When it comes to
survival, babies and mothers are considered dispensable, "renewable energy"
so to speak. (Sorry for being grotesque. Some of this is too close to
heart.) I would only add that this is not deliberate starvation, unless the
baby is physically or mentally deformed. Very poor people do not know
enough, and mothers themselves are anemic and do not produce enough milk.
You may have read recent news item on the prevalence of anemia in Indian
women. Our Dear Leader dismissed such news on girls being "beauty
conscious". What the **** does he know about girls? He will get enough
votes by his "universal access to LPG" and the Queens of Chappaqua and
Washington, DC would clap, do research on averted DALYs from air pollution
even as children die of pneumonia or worse. Another thing to keep in mind
is that many tribes in India suffer from Sickle Cell Anemia due to close
intermarriage. (Why, I would say the aid industry tribes also intermarry a
lot and suffer from the same genetic disease.)

"A medical doctor working with tribals wrote in her book that although
these people ate wild tubers, roots, fruits and also ate fish, birds,
amphibians, reptiles and even arthropods, they had a lot of dietary taboos
about infants. She wrote in her book that the list of foods that the
infants were not supposed to eat was longer than the list of substances
that the infants were allowed to eat."

** I happen to think there is another complementary reason (apart from
genetic reasons I mentioned) - their access to the traditional products
such as tubers, fruits, fish, birds, reptiles, etc. has been severely
restricted due to expansion of farming and real estate development. Again,
I know only some anecdotes and obscure research on such populations in the
Pacific Islands or Africa. One relevant anecdote - some people changed from
wild tubers to rice because - why, rice is easier to cook on a regular
stove. (I was too dumb to figure this out till the then-stranger I was
talking to told me, "Nikhil, you are not as smart as you think you are."
and explained to me. I always make friends with people who show me how dumb
I am.)

There may be very good reasons for the taboos this doctor mentions. Cecil
here may have some examples. But let me also say this - mothers' health and
the frequency, quantity of mother's milk may have a lot to do with the
disease and death of infants. After all, some of these infants become
mothers in 10-15 years.

Oh, heck. Why should this List bother? We are all believers in the Gods of
Big Things - :"global" priests who don't care a hoot about locals. Context
is everything. To claim that "dirty cooking" is a global crisis is, well,
baloney. Of all people, the WHO division on Social and Environmental Health
must be concerned with what you have pointed out here. But no, they are out
galavanting with EPA and BAMG on averted DALYs by HAPIt. WHO ought to be
ashamed.**


Yours
> A.D.Karve
>

** Thank you so very much for giving a reality check. If WHO is the new
Vatican, let's wait for the new Pope in Geneva and new heads at GACC (which
will lose the prime members of its Leadership Council - Mrs Clinton and Mr
Gueterres so far, plus some more. I write like a jerk, because I am very
angry at the academic and regulatory capture of the subject of cooking,
divorcing it from other sources of air pollution and other determinants of
health. I do hope GACC and WHO get some sense, very soon. That is what
medicine and politics demand. Enough of this insanity and inanity, the
"fundamental folly" of ISO IWA and EPA shenanigans. (Yes, my bile is
reserved for EPA; poor WHO and GACC are just intermediary actors.) **


Nikhil

>
> On 10/27/16, Traveller <miata98 at gmail.com> wrote:
> > Some recent news items below. WHO has no jurisdiction to set of implement
> > any air quality standards or stove standards - or for that matter
> standards
> > for nutrition, alcohol, health sector staffing - but like the Vatican it
> > can put some people out of the church of "clean cookstoves". I can
> foresee
> > the consequences but need to look into IOR accounts.
> >
> > It is the abuse, or selective use, of the IHME theatrics in the Global
> > Burden of Disease (GBD) - that "super-human" effort of "killing by
> > assumptions" - that risks undue policy biases by the implication of
> > causality.
> >
> > All that GBD does is assign - via dubious or at least debatable methods -
> > causes of death and "risk factors" that individual diseases and
> > disabilities can be attributed to. Attribution to risk factors is an
> > incentive for irrational exuberance.
> >
> > When the database for deaths, diseases, and environmental influences -
> > quality and quantity of clean water to emissions or concentrations of air
> > pollutants or to exposure to polluted air or water or soils - is itself
> > fictional, we transcend the earth and the earthly science, to join Godly
> > Association of Catholic Charisma. (I mean Catholic as catholic; no
> offense
> > intended to Francis or other priests and nuns.)
> >
> > First below a WSJ (22 August 2016) item on alcohol; businesses are
> > beginning to take notice that GBD is injurious to their health. I am not
> > suggesting that people drink unlimited alcohol, just that "clean
> > cookstoves" could reduce employment in the commercial wood and charcoal
> > supply chains just as kerosene/LPG subsidy reforms in India could
> eliminate
> > jobs linked to corrupt diversion. Women will be better off not carrying
> > wood or water on their heads - bicycles and carts are available, if not
> > small trucks (even with diesel soot emissions). And cooking beer or
> > distilling liquor with "clean stoves" might even avert DALYs; I will
> write
> > a grant.
> >
> > Then some pieces on choices in policies as well as behaviors - from
> mental
> > health (the Hindu piece) to improved nutrition (First Post piece) to
> > infrastructure and human resources for health services (WSJ 6 September
> > 2016) to burden of disability from pain (the Atlantic 7 October 2016 and
> > NYT 16 October 2016). These are also informed by GBD.
> >
> > Why are these relevant to cooking? Because the drudgery of cooking with
> > unprocessed solid fuels collected with no direct expense - the whole
> > syndrome of "traditional cooking" that is far beyond mere stoves - is
> > likely a cause of hopelessness and depression in millions of women if not
> > tens or hundreds of millions (along with other drudgeries). A Miracle
> Stove
> > won't fix that. Also added to their burden of disease from Household Air
> > Pollution is that due to poor nutrition, poor access to or poor quality
> of
> > health care services, and, yes, even the aches and pains from carrying
> wood
> > or the physically demanding tasks of cooking. A Miracle Stove won't fix
> > that either.
> >
> > The intellectual apparatus of "Evidence Base" for the benefits of "clean
> > cookstoves" consists of a magician's wizardry. Or the Vatican's
> catechism.
> >
> > To run up alleys just to check if they are blind is sophomoric. To
> > deliberately pursue dead ends is deceit.
> >
> > The premise of ISO IWA exercise - that boiling water in labs will open
> the
> > way for rapid adoption of "clean stoves" powered by solid fuels by the
> > masses - is speculative. Yes, testing protocols and performance standards
> > can help in ordinal ranking of such stoves. However, the ISO/IWA method
> has
> > no consideration for actual usability of the stoves - the point made in
> > VividEconomics report to ESMAP on the Mirt mtad - or the "contextuality"
> -
> > what fuel types where for what type of actual cooking.
> >
> > As Cecil says, it is "fundamental folly" and "premature". The real work
> has
> > to begin at the national, regional, local levels - understanding how
> people
> > cook as well as how people and cooking have changed over time and how
> they
> > might change in the future.
> >
> > When "biomass stoves" (I prefer coals when sustained heating is required)
> > are seen as tools for pleasure, not as pills delivering averted DALYs -
> for
> > which they must compete with NSAIDs and meditation for pain,
> > micro-nutrients and fresh foods for nutrition, and end of conflicts for
> > mental health - we might at last have a purpose to our work. Yes,
> cleaning
> > up cooking - with fuels, stoves, operating practices - is to be pursued
> in
> > terms of usability and contextuality, along with supplementary strategy
> on
> > local biomass management and air quality management. Whether the trees
> are
> > saved or the climate is saved is incidental and cannot be attributed to
> > individual stoves or users.
> >
> > That is, the premise of EPA/BAMG work on HAPit, etc. is also no more than
> > speculative. A speculation that will never be proven in real practice.
> Just
> > bear in mind that there is no specific evidentiary basis for assigning
> any
> > particular "averted DALYs" to the transition of roughly 3 billion cooks
> who
> > changed to "clean fuels" (gas, electricity) cooking over the last 100
> > years.
> >
> > I think the mental imagery - or the poverty pornography - of cooking and
> > stoves has remained unchanged for decades. I see mindless surveys and
> > thousands of academic papers but very little in terms of setting the
> > contexts of women's lives, the place (physical and mental) of the kitchen
> > (if there is such a designated space) and of cooking, of feeding and
> > eating, of all the variables of health and economy that are merrily
> ignored
> > in pursuit of the Miracle Stove.
> >
> >
> > Nikhil
> > With Moderate Drinking Under Fire, Alcohol Companies Go on Offensive
> > <http://www.wsj.com/articles/with-moderate-drinking-under-
> fire-alcohol-companies-go-on-offensive-1471889160>
> > , WSJ 22 August 2016
> > "One of the first signs came when WHO officials set out nearly a decade
> ago
> > to develop a new alcohol policy. They planned to focus on “global burden
> of
> > disease,” assessing a broad range of possible effects, including indirect
> > ones such as rates of accidents and certain infections.
> > “It was that sort of thing coming out of the WHO that made us fear for
> our
> > lives,” said Mitch Ramsay, then an executive at SABMiller PLC."
> > ---------------------------------
> >
> > Economic Nonsense From the U.N. on Drugs
> > <http://www.wsj.com/articles/economic-nonsense-from-the-u-
> n-on-drugs-1474064319>
> > WSJ
> > 16 September 2016
> >
> > "Convincing developed and developing nations to invest more in the health
> > care of the poor would go a long way toward better addressing the real
> > barriers to access, like substandard infrastructure. Many nations are
> full
> > of impassable roads. Corrupt officials routinely steal donated drugs to
> > sell in the black market. Health-care professionals are in short supply.
> > Africans, for instance, suffer one quarter of the global burden of
> > disease—but the continent is home to only 3% of the world’s health-care
> > workers, according
> > <http://apps.who.int/medicinedocs/documents/s17815en/s17815en.pdf> to
> the
> > Cameron Institute.
> >
> > The U.N. has yet to take issue with the iPhone 7, which just hit the
> market
> > for $649, because we still live in a world where profits from innovations
> > outside health care are applauded and admired. But those who invent cures
> > for deadly diseases are routinely shamed for making money. I cannot think
> > of a better reason to financially reward someone than for helping to
> extend
> > and save lives."
> >
> > ----------
> >
> > Huge gap between policy and practice: Vikram Patel
> > <http://www.thehindu.com/opinion/op-ed/huge-gap-
> between-policy-and-practice-vikram-patel/article8630543.ece>
> > , The Hindu 22 May 2016
> > "The *Lancet Psychiatry* established in three new papers that a third of
> > the global burden of disease for mental, neurological and substance use
> > disorders occurs in India and China, more than in all high-income
> countries
> > combined."
> > India tops the list of nations with most anaemic women and children
> > <http://www.firstpost.com/living/india-tops-the-list-of-
> nations-with-most-anaemic-women-and-children-3075578.html>,
> > First Post 27 October 2016How Back Pain Took Over the World - The biggest
> > cause of disability around the world is surprisingly banal
> > <http://www.theatlantic.com/health/archive/2016/10/how-
> back-pain-took-over-the-world/503243/>
> > Atlantic
> > 7 October 2016 and, also on pain, Millions of Men Are Missing From the
> Job
> > Market
> > <http://www.nytimes.com/2016/10/17/opinion/millions-of-men-
> are-missing-from-the-job-market.html?>
> > NYT
> > 16 October 2016
> > .
> > --------------
> >
>
>
> --
> ***
> Dr. A.D. Karve
>
> Chairman, Samuchit Enviro Tech Pvt Ltd (www.samuchit.com)
>
> Trustee & Founder President, Appropriate Rural Technology Institute (ARTI)
>
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