[Stoves] Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves

[Nikhil Desai]

For any dis-ease there can be distinct multiple causal pathways and accordingly many risk factors. 

It is only with medical treatments - drugs, surgery, therapies - that RCTs help reach some conclusion about what may work for whom and probably how. 

"Environmental Health" RCTs are often dead-end alleys. Effects of water pollution are far better studied and hence individual-level standards or solutions - boiling water, say - are possible. 

Even for air pollution, active smoking seems to be causally linked to some cancers or CVD, IHD. 

Otherwise, composition of pollutants and dosage (ingestion) patterns seem to have little biological link to a wide range of episodic or chronic diseases, many of them with multiple risk factors. Eye and respiratory irritation are obviously known to be caused by excess pollution - smoke or, for respiratory problems, ozone. 

What Fresh Air may find for a quantum reduction in indoor concentrations is not applicable to all diseases, particularly chronic diseases. 

Kirk Smith/WHO kill millions via IERs for chronic non-communicable diseases. There is no causal theory, nor any data on exposures - even 48 hours, leave alone multiple years that some chronic disease take to develop and last - or morbidity. 

From policy perspective, all this is academic monkeying around for advocacy purposes. I have no problems with that for Kirk Smith's stance, just ask that his own cautionary language be considered. (And his fundamentalism about stove emission rates, stacking, and objections to chimneys or any use of coal). But when WHO takes up such theology and third rate models, it is taking a huge reputational risk. 

In short, dump all IERs for PM2.5 and all modeling of exposures based on PM 2.5 emission rates for boiling water. Dump all results, published literature. One needs no marketing for LPG or electricity, and the technology options for the poor and dispersed populations will not be as attractive as gas and electricity. 

All talk about cooking and loss of forests or lives is red herrings. The poor need not be guinea pigs for epidemiologists. Just develop marketable, usable stoves appropriate for local solid fuels (primary or processed); simple subsidy rules can be applied, and local entrepreneurs incubated. 

Rich ideologues have theories for fund raising, not for improving the livelihoods of poor people. Making money from poverty by advancing poor claims. 

Nikhil 

Nikhil Desai
Skype: nikhildesai888

> On Nov 3, 2017, at 10:21 AM, Crispin Pemberton-Pigott <crispinpigott at outlook.com> wrote:
> 
> Dear Nikhil
>  
> The protocol is used by FRESH Air and it is worth a visit to that little site to see what they are doing and why.
>  
> I have seen their outputs and they include 48 hr monitoring for PM and CO. The prevalence of COPD is high, approaching 100% for adults over 40 in the high areas like Naryn. That is why we were conducting stove swaps there.
>  
> What is not clear is a relationship between certain types of smoke and asthma. There is very little smoke in the USA and asthma is very common. As the air has become cleaner over 40 years, asthma cases have spiked. It is a good job correlation is not causation.
>  
> See the linked report. The guy on the left in photos 3 and 4 is Talant Sooronbaev who is leading the field investigations. The PM numbers are not prepared by them – the Micro-PEMS go back to the providers.
>  
> Regards
> Crispin
>  
>  
>  
> Crispin: 
> 
> Sorry to say, such studies produce nothing of value in design and promotion of household cookstoves for the masses in the developing countries. 
> 
> Just because something gets published in EHP on "rural areas of Montana, Idaho, and Alaska, where residential wood combustion is a major source of ambient and indoor PM2:5 and the primary source of home heating during cold-temperature periods" and pays homage to Kirk Smith doesn't make it worth giving a dime for it. Fortunately this was free. 
> 
> I was impressed by the description of tools for "two, 48-h observation periods during each of two winter periods, before and after intervention". Seems like this kind of stuff is acceptable in "epidemiology" studies in US. I kept scratching my head as I read the conclusion - "This trial was conducted across several rural communities in three states, but translation of these findings to other settings with similarly exposed child asthma populations would require further study and inquiry into the challenges associated with dissemination of in-home PM reduction strategies."
> 
> As an asthma sufferer, I don't see just what difference such studies would make when to whom. This was said to be the first RCT. In recent years, a lot of economic policy research is marketed in the name of  "first RCT on this subject. Why, there is this piece by a trio at Harvard-MIT-Chicago (now) about an RCT on "improved cookstoves" in Odisha, India published as an MIT e-con department Working Paper a little over five years ago. I think we should have Cecil get some money to do an RCT on rich theorists of stoves and health. 
> 
> Unfortunately, I have not yet found any associational epidemiology study that has taught me anything but how poor rich science is. 
> 
> Nikhil
>  
>  
>  
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