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<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Dear Crispin,<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><i><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>« </span></i><i><span style='font-family:"Calibri","sans-serif";
color:#1F497D'>I agree with the thrust of your points: do something, and no
one was planning to do nothing »<o:p></o:p></span></i></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Happy to hear that!<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>It is just that, after so many posts for Nikhil, and reading his
rhetoric for so long, one might get ideas. Ideas that WHO is a complete farce,
that there is no problem with air pollution, that it is a massive lie, or that
we don’t know, at all, if there is any problem. That everything is a smoke
screen. And that premature deaths from respiratory diseases might either not
exist, or if they do, they might come from cars, buildings, volcanos,
sandstorms, comets, the cat …<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>OK, I am being a bit caricatural, but you get the picture. I am
not familiar with the air pollution question and epidemiology. I have an
external point of view, so the discussion gets confusing at some point. Clarification
is needed like asking: « ok, there might not be exactly 7 million
premature deaths from AP, but there are chances that AP has potentially a large
impact on the health of many individuals, yes or no? »<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>This is the only point I wanted to clarify.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><i><span style='font-family:"Calibri","sans-serif";
color:#1F497D'>« The problems arise when false or exaggerated attributions
substitute for knowledge. »<o:p></o:p></span></i></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Indeed. However good the cause, there is never a good
justification for false claims. False claims always come back to bite the good
cause in the ass.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal style='background:white'><i><span style='font-family:"Calibri","sans-serif";
color:#1F497D'>« "But force them to smoke 4 packs of cigarets a day,
and many will die or be severely sick."<o:p></o:p></span></i></p>
<p class=MsoNormal><i><span style='font-family:"Calibri","sans-serif";
color:#1F497D'>While is is de rigeur to compare inhalation of bad air with
'smoking cigarettes' »</span></i><i><span style='font-family:"Calibri","sans-serif";
color:#1F497D'><o:p></o:p></span></i></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Actually I wasn’t saying that AP was like smoking cigarets. I was
using the image of cigarets to reply to Nikhil’s post. Nikhil’s post was giving
the impression (maybe this was not what he meant) that one external factor couldn’t
have a clear effect on human health, because all humans are so different
anyways. I was saying individuals are different, but they have also so much in
common.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>I could have used the image of poison. However different the
individuals, give each of them cyanure, and they will react in the same way.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal style='background:white'><i><span style='font-family:"Calibri","sans-serif";
color:#1F497D'>« If you can claim anything, any correlation no matter how
tenuous, all is 'alarm' and nothing is alarming. »<o:p></o:p></span></i></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Indeed, one must have something solid before crying wolf.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>For me, even with the imperfect data we have, the air pollution
problem seems alarming enough.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Best,<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Xavier<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<div>
<div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0cm 0cm 0cm'>
<p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>De :</span></b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Stoves
[mailto:stoves-bounces@lists.bioenergylists.org] <b>De la part de</b> Crispin
Pemberton-Pigott<br>
<b>Envoyé :</b> jeudi 17 mai 2018 18:50<br>
<b>À :</b> Stoves<br>
<b>Objet :</b> Re: [Stoves] Air pollution kills<o:p></o:p></span></p>
</div>
</div>
<p class=MsoNormal><o:p> </o:p></p>
<div>
<p class=MsoNormal style='background:white'><span style='font-family:"Calibri","sans-serif";
color:#1F497D'>Dear Xavier<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-family:"Calibri","sans-serif";
color:#1F497D'>I agree with the thrust of your points: do something, and no
one was planning to do nothing. The problems arise when false or exaggerated
attributions substitute for knowledge. <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-family:"Calibri","sans-serif";
color:#1F497D'>"</span><span style='font-size:13.5pt;font-family:"Calibri","sans-serif";
color:#1F497D'>But force them to smoke 4 packs of cigarets a day, and many will
die or be severely sick."</span><span style='font-family:"Calibri","sans-serif";
color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>While is is <i>de rigeur</i> to
compare inhalation of bad air with 'smoking cigarettes' most people haven't a
clue what that means nor if what they are being told is a complete fantasy. As
you know, people just make stuff up a lot of the time. </span><span
style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>I have reported before that a
claim was made that 'living in Ulaanbaatar was like smoking two packs of
cigarettes per day'. That is ridiculous. Living in Ulaanbaatar all year is like
inhaling the smoke produced by 1/28th of a cigarette per day, or one per month.
Not 40 or 80 per day. </span><span style='font-family:"Calibri","sans-serif";
color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>But without context, the
number is not all that helpful. The WHO says (well, they say a lot of things so
let's pick one) that 10 microgrammes all the time all year, PM2.5, is
completely safe, in that no effect can be observed (which is not the same
thing, we agree).</span><span style='font-family:"Calibri","sans-serif";
color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>So they say inhaling 1/16th
of 1/28th of a cigarette per day all year has no meaning effect. </span><span
style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>Well, if you cook indoors,
boiling something, which is not that uncommon, the 1/16th of the 1/28th is
going to be exceeded. Same if you sweep the floor, shake out a rug or comb the
cat. It is such an extraordinarily small amount we can conclude that virtually
no one on the planet is 'safe'. </span><span style='font-family:"Calibri","sans-serif";
color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>It is unfortunate that there
is so much defective logic and bad math underlying the alarming statements.
Does no one fear exposure of the flaws? Apparently the risks are low enough
that you can say pretty much what you want. </span><span style='font-family:
"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>If you can claim anything,
any correlation no matter how tenuous, all is 'alarm' and nothing is alarming. </span><span
style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>Regards </span><span
style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'>Crispin </span><span
style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='background:white'><span style='font-size:13.5pt;
font-family:"Calibri","sans-serif";color:#1F497D'><br>
<br>
</span><span style='font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><br>
<br>
<o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><br>
<br>
<o:p></o:p></p>
</div>
<div>
<div>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Dear Nikhil,</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal>« You imagine "<span style='font-size:11.0pt;
font-family:"Calibri","sans-serif";color:#1F497D;background:white'>solutions
are relatively straight-forward". </span>Not so. Localized
air-quality management plans take an enormous amount of systematic work »<o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>I’m just trying not to fall into the state of mind of:
« oh, there are many factors anyways, it is very complex, so do not bother
doing anything. »</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>We were taking the example of Ulan-Bator. We think air pollution
kills? We replace inefficient stoves by « clean » stoves, we tar the
roads, we work with the construction sector so it limitates its emissions, we
work with the industry sector so it lowers its emissions.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Of course, this is complex and involves a lot of actors, and it
represents a lot of effort and investment, but this is feasible, there is no
magic involved. There aren’t 10 000 factors involved, there are a few big
steps to take.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>« </span>Read today's Washington Post opinion piece by
Robert Hahn about USEPA's debating of rules of scientific evidence »<o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Well, if Scott Pruitt’s proposal make EPA decision processes
more transparent, and make science more accessible, then I could not agree
more. I am a bit skeptical of Pruitt’s good intentions though.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>But transparency and clarity in science and policies? Yes of
course.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal>« Health is a property of an <u>individual</u>
body-mind. »<o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>OK, but what is your point? Sure individuals are all very
complex, they all have very different backgrounds. But force them to smoke 4
packs of cigarets a day, and many will die or be severely sick. Their
individualities and complexities can’t do much against that. Because they have
a common point : human health is vulnerable, sometimes very vulnerable, to
certain external factors.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>So focusing on exposure, why not, but when the source of
emission is clearly identified and there are hints it has an effect on health,
it’s understandable policy-makers focus on the source of emission.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal>« lumping random epidemiological studies with
"meta-analysis" pretense should be left to WHO »<o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>It should be left to anyone who wants to do epidemiological
studies. It should be left to the critics of WHO as well.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>« </span>in cohorts, contexts, confounding factors mean
most epidemiological studies for HAP and disease have no reliable
quantification. »<o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Then prove it.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>The thing you could do is to write a paper, a meta-analysis of
epidemiological studies and their methodology. If there are 200 studies
attributing diseases to air pollution, show how their methodology is flawed,
show how they prove nothing. It would be really, really useful. This would be
something we can work from.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Then, with this information, we’ll be able to say: « OK, we
have really no idea what causes respiratory diseases ».</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>We’ll be able to decide <i>en connaissance de cause</i></span>, <span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>knowing
fully our knowledge gaps.</span><o:p></o:p></p>
<p class=MsoNormal> <o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>And since we cannot let children die of respiratory diseases,
we’ll still have to do something, and put millions of dollars somewhere.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Best,</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Xavier</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0cm 0cm 0cm'>
<p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>De :</span></b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Nikhil Desai
[mailto:pienergy2008@gmail.com] <br>
<b>Envoyé :</b> samedi 12 mai 2018 04:41<br>
<b>À :</b> Xavier Brandao<br>
<b>Cc :</b> Andrew Heggie; Discussion of biomass cooking stoves; Crispin
Pemberton-Pigott<br>
<b>Objet :</b> Re: [Stoves] Air pollution kills</span><o:p></o:p></p>
</div>
<p class=MsoNormal> <o:p></o:p></p>
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<p class=MsoNormal>Xavier: <o:p></o:p></p>
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<p class=MsoNormal> <o:p></o:p></p>
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<p class=MsoNormal style='margin-bottom:12.0pt'>1. PM2.5 toxicity is a
theological monument, built with steel girders of assumptions, concrete of
arrogance, and glass of pretense. Read today's Washington Post opinion piece by
Robert Hahn about USEPA's debating of rules of scientific evidence; PM2.5 is
central to this debate. (Hahn was the White House anchor for the Acid Rain and
other Clean Air Act Amendments of 1990. I knew him briefly about a decade
later. An economist of sense and integrity, which is unfortunately rather
rare.) Without the PM2.5 toxicity assumptions -- for that is what they are,
estimates based on assumptions based on estimates based on assumptions - and
their questionable (and questioned) epidemiological basis, a lot of last 20
years of talk on "air pollution kills" would be rendered as rubble of
a monument. <br>
<br>
2. Whatever the received dogma - the fatwas we are familiar with - my Satanic
Verses are simple: <br>
<br>
Health is a property of an <u>individual</u> body-mind. <br>
Lifetime disease incidence and death are influenced by <u>individual</u>
genetics, nutrition, exposures to disease vectors and risk factors (in varying
intensities, durations, locations) according to age and sex, timely
identification of disease and availability of medical care. <br>
<br>
3. In simple terms, epidemiology is a tool for studying pathways taking into
account all such influences for different cohorts, so that pharmacology and
physician/nursing care can be geared to <u>individual</u> attention. <br>
<br>
Yes, mass propagation of medicines or technologies does transform the patterns
of disease incidence. Hence the search for marketable "better cooking
methods", tailored to specific contexts and cohorts. <br>
<br>
Quantification of the change in predicted disease incidence and death is,
however, subject to serious pitfalls, and lumping random epidemiological
studies with "meta-analysis" pretense should be left to WHO (as it
indeed did, in order to come up with utterly fictitious Guidelines for
Household Fuel Combustion). Differences in cohorts, contexts, confounding
factors mean most epidemiological studies for HAP and disease have no reliable
quantification. (Hence the ultra-heroic assumptions behind HAPIT and which is
also why WHO had to cook up the HAP GBD with no data on use quantities and
qualities, emission rates and concentrations, and disease incidence or their
variance by time, duration or space.)<br>
<br>
We need an anthropologist of this Environmental Health tribe, including Lancet
editor, who seems to have very little actual experience with experiments.
Curiouser and curiouser statements have been emerging from this tribe. <br>
<br>
Pick ANY context. Characterize health and air pollution (emission, exposures)
baseline. Make an action plan for air quality management in toto. It's no use
debating stoves cooking fuels alone, and criminal to do so without a
well-defined context. <br>
<br>
I just looked up NY Times website for news items from 1851 to 1988 - with
phrases "air pollution" and "cooking". The search failed to
show up anything about air pollution and cooking. <br>
<br>
I wonder why there are no studies of avoided premature deaths due to transition
from solid fuels to gaseous fuels and electricity in Western households from
1920s to 1980s. <br>
<br>
Nikhil<o:p></o:p></p>
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<p class=MsoNormal><span style='font-family:"Georgia","serif"'>------------------------------------------------------------------------<br>
Nikhil Desai</span><o:p></o:p></p>
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<div>
<p class=MsoNormal style='margin-bottom:12.0pt'><span style='font-family:"Georgia","serif"'>(US
+1) 202 568 5831<br>
<i>Skype: nikhildesai888</i></span><o:p></o:p></p>
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<p class=MsoNormal> <o:p></o:p></p>
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<p class=MsoNormal>On Fri, May 11, 2018 at 5:31 PM, Xavier Brandao <<a
href="mailto:xav.brandao@gmail.com" target="_blank">xav.brandao@gmail.com</a>>
wrote:<o:p></o:p></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Dear Crispin,</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>OK, but maybe not all studies are like the Korean one.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Then, for Ulan-Bator, for Mongolia, and as well for the world,
there is a need of a serious meta-analysis, which also reviews and criticizes
the methodology of the epidemiological studies on air pollution.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Then only, we might have a better view on the current landscape
of research, of the state-of-the-art on air pollution and health.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>« </span><span lang=EN-US style='font-size:11.0pt;
font-family:"Calibri","sans-serif"'>There is correlation between OAP and IAP
and infections, but they are associations, not causal relationships.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Sure, I understand the difference. But from what I understand
there are fields of research where this is the best you can get. That doesn’t
mean it doesn’t have grounds.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>I wouldn’t throw epidemiology with the bath water. It seems to
me that it is epidemiology which found the link between smoking and lung
cancer:</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><a
href="https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.theguardian.com%2Fsociety%2F2005%2Fapr%2F24%2Fsmoking.medicineandhealth&data=02%7C01%7C%7Ca08e1e157cf642f55b6108d5bc11de51%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636621707286994744&sdata=Uymy3lm%2BtkCjjV1X9YqCLWfFhhK%2BduR%2BIE5cCMx01MQ%3D&reserved=0"
target="_blank">https://www.theguardian.com/society/2005/apr/24/smoking.medicineandhealth</a>
</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“The
claim that 4.3m people ‘die from air pollution’ per annum is clearly false”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Indeed, but they might say instead: “Based on our data and
statistics and methodology, we have attributed the death of around 4.3 million
people to air pollution. It might be less, or more. We might be wrong, but this
is the best we have, sorry. The fact is that we highly suspect air pollution to
be dangerous for human health, so beware.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>That would be more correct. Would that change the outcome, which
is to take public policy measures to try to mitigate air pollution?</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>« </span><span lang=EN-US style='font-size:11.0pt;
font-family:"Calibri","sans-serif"'>Who simple is this statement? Did anyone
measure IAP in the rural areas where they burn dung for heating and cooking?
Many people in the rural areas are reasonably well fed and clothed. A lot of
people in Ulaanbaatar were driven there by absolute poverty and live in
desperate conditions, some depending on coal vouchers to obtain fuel. How did
the temperature of the home affect the incidence, and what is the socioeconomic
conditions of the families with high occurrence? Are there bronchitis epidemics
in town that do not occur in rural areas because the possibility of
transmission is so much lower? Yes the OAP is much lower in rural areas, but is
their exposure to smoke, for example, lower or higher?”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Sure, it raises a lot of questions. But let’s say we believe the
data the doctors have. I’d say this is a fact:</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>”Children in Ulaanbaatar, are taken bronchitis in 1.4-2.7 times
and bronchitis asthma in 5.5-7.9 times more than children who are living in
rural areas”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Mentioning this “less air pollution.” is already attributing a
cause. </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“Prof
Lodoysamba confirmed the ‘colder’ hypothesis this winter using a pretty
sophisticated monitoring station at his home in Nalaikh with thermometers at
different heights above the ground.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Maybe the cold is responsible of the bronchitis in Nalaikh, but
not in Ulan Bator. Maybe the cold is responsible everywhere and that is not
well measured or known.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Then, that “colder hypothesis” would infirm what was found in
this study, that air pollution from stoves was the main cause. Prof. Lodoysamba
was one of the co-writers of this study:</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'><a
href="https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.urbanemissions.info%2Fwp-content%2Fuploads%2Fdocs%2F2013-09-AQAH-Ulaanbaatar-PM-Pollution.pdf&data=02%7C01%7C%7Ca08e1e157cf642f55b6108d5bc11de51%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636621707286994744&sdata=4rvE4pX2qiWkTninU8f2xe%2BwWavVKCJdYRb0Sswfts0%3D&reserved=0"
target="_blank">http://www.urbanemissions.info/wp-content/uploads/docs/2013-09-AQAH-Ulaanbaatar-PM-Pollution.pdf</a>
</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“</span><span
lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Attributing
something as a cause does not mean that removing the attributed cause avoids
the problem. Suppose the attribution was in error by 80%?”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Sure, it could well be that: “oh, every household has an
electric stove now, but still the number of bronchitis cases are high.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Science is never definitive, always evolving.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“Regarding
proximity to highways: who lives next to noisy and polluted highways in
California: the well fed and exercised with good medical treatment? Or poor
people with poor health coverage, bad diets and no access to recreational
facilities? Correlation is not causation. “</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>We’d need to look at the study methodology to know if they took
this factor into account. Maybe they did. Maybe they compared poor people next
to highways, to poor people remote from highways.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“There
must be children for whom it is the worst environmental risk, and others for
whom it is now.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Sure, but if there are 10 000 children in the first group
and 2000 in the second group, then air pollution is the biggest environmental
risk for children in UB.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“The
major impediment to achieving this is the parade of baseless claims that coal
cannot be burned cleanly”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Sure, if coal stoves can burn cleanly like or almost like
electric stoves, that’s fine by me.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“That
is unbelievable. The “main source”? The cause? That is a clear claim that
second hand smoke causes bronchitis.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Well, cause, by association. Actually, it doesn’t necessarily
makes a hierarchy between causes, it also says: “Second, other potential risk
factors of LRTI-related hospital admissions might have been overlooked in our
investigation, such as the type of fuel used in household stoves, nutrition,
antenatal cigarette smoke exposure, and nursery attendance, where children might
contract an infection from others.Therefore, caution should be taken in
interpreting these study findings.“</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>”Think
about that. The record low for Ulaanbaatar is -54 C (2002). The annual average
is -2C. Is it possible that people earning $2500 per year live in a chronically
underheated home? Ya think??”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>If millions of dollars should go to preventing under-heating
rather than clean stoves, then that is worth a medical study, to attribute
deaths to cold. If there is no such study, it is understandable public deciders
well, decide, to focus on air pollution.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>It seems to me that the good news is that solving the issue of
cold in homes and IAP go hand-in-hand.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>”Some
say 45% depending on where you measure it. It was improved <i>uuugely</i>. Yet
people popped up to say nothing was achieved by the programme. Short memories.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>For sure, celebrating successes and giving credit where credit
is due is really important. Otherwise we tend to think we live in a bleak world
where nothing happens.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>”I
am sure asthma attacks decreased because air pollution aggravates asthma. I do
not have stats, however. It just seems likely.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>It seems to me also. And until you have a cohort of doctors,
statisticians, scientists to make more studies with a large number of
variables, and check, this is the best a public decider can get.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>”Now
we need to address the low pressure boilers which are more and more common and
burn 4 times as much fuel as the ger stoves, at least. They were not included
in the ger stove programme. We are working on the at the moment.”</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>That seems exciting! Good luck with that.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><br>
Best,</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><br>
Xavier</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'> </span><o:p></o:p></p>
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<div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0cm 0cm 0cm'>
<p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>De :</span></b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Stoves [mailto:<a
href="mailto:stoves-bounces@lists.bioenergylists.org" target="_blank">stoves-bounces@lists.bioenergylists.org</a>]
<b>De la part de</b> Crispin Pemberton-Pigott<br>
<b>Envoyé :</b> mercredi 9 mai 2018 00:20<br>
<b>À :</b> Discussion of biomass cooking stoves<br>
<b>Objet :</b> Re: [Stoves] Air pollution kills</span><o:p></o:p></p>
</div>
</div>
<p class=MsoNormal> <o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Dear
Xavier</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Thank
you for being skeptical. Science works on challenges, <i>nullis in verba</i>.</span><o:p></o:p></p>
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<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>On
the IAP matter in UB, there are generalisations one can make and specific
circumstances worth noting. There is a study of the effect on indoor air
pollution from the improved stoves (Korean study, available in English). The
concluded that the improved stoves which reduce PM2.5 output by 90-98% <i>increased
</i>indoor air pollution, which was so unbelievable that I bothered to
investigate the study quite carefully.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>What
I found was that they did indeed measure an increase, on average, in IAP but:
the difference was well inside their margin of error (a small fraction of the
variations measured, rendering the conclusion meaningless. Further, on
those days when they were measuring, the ambient (outdoor) air pollution
closely matched the claimed indoor air quality, save that in every case the IAP
was lower than the OAP. In short, all the Koreans measured was the effect
on IAP from outside air.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>The
worst aspect of the paper was that they claimed a statistically significant
difference: the new stoves provided worse IAP than the old stoves – which the
numbers did not support at all. There <i>was</i> a difference in the averages,
and the new stove measurements were higher, but the difference was a small
fraction of the Sigma 1 of their numbers, which is to say, the difference was <i>not</i>
statistically significant. </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Decent
chimney stoves with a correctly fitted chimney have very little effect on IAP.
We have ample recent evidence of this in Kyrgyzstan if there was any doubt.
Improper operation can lead to fugitive emissions from the stove – for example
leaving the ash drawer open a bit ‘to give more power’ breaks the draft from
the chimney and the top surfaces can leak smoke into the room as they are no
longer under negative pressure.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>There
is correlation between OAP and IAP and infections, but they are associations,
not causal relationships. We can ask Nikhil about which words to use exactly.
The claim that 4.3m people ‘die from air pollution’ per annum is clearly false
and a misrepresentation of the published evidence used to support the claims
that air pollution shortens lives – by attribution (not medical evidence).</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>« Children
in Ulaanbaatar, are taken bronchitis in 1.4-2.7 times and bronchitis asthma in
5.5-7.9 times more than children who are living in rural areas of less air
pollution. » says Social Health institute. </span><span lang=EN-US
style='font-family:"Calibri","sans-serif"'><a
href="https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.unoosa.org%2Fdocuments%2Fpdf%2Fpsa%2Factivities%2F2006%2Fgraz%2Fpresentations%2F0102.pdf&data=02%7C01%7C%7Ca08e1e157cf642f55b6108d5bc11de51%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636621707286994744&sdata=A3zvCFueHE5jElz4MN0gJm3AzECdrWHscM%2FGxB6WGck%3D&reserved=0"
target="_blank">http://www.unoosa.org/documents/pdf/psa/activities/2006/graz/presentations/0102.pdf</a></span><span
lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> p 12.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Who
simple is this statement? Did anyone measure IAP in the rural areas where they
burn dung for heating and cooking? Many people in the rural areas are
reasonably well fed and clothed. A lot of people in Ulaanbaatar were driven
there by absolute poverty and live in desperate conditions, some depending on
coal vouchers to obtain fuel. How did the temperature of the home affect the
incidence, and what is the socioeconomic conditions of the families with high
occurrence? Are there bronchitis epidemics in town that do not occur in rural
areas because the possibility of transmission is so much lower? Yes the OAP is
much lower in rural areas, but is their exposure to smoke, for example, lower
or higher?</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal style='margin-top:12.0pt'><span lang=EN-US style='font-size:
11.0pt;font-family:"Calibri","sans-serif"'>When the Kyrgyz villagers were
keeping their homes free of IAP (with chimneys and non-leaking stoves) <i>and 5
degrees warmer</i> the incidence of bronchitis dropped to zero (51 homes,
2016-17 season). I interviewed parents in February in the Naryn region and they
all said before they got the new stove the children were “sick all winter”
before and “much sicker than this winter” and so on. Chronic cold spreads
disease among children. Bronchitis is a bacterial infection. PM2.5 is sterilized.
So you are looking for pre-dispositions caused by PM2.5, not ‘causes’. </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>It
is dusty pretty much everywhere. The city is definitely smokier, and it can be
quite bad if the wind drops, because below -30 the city is colder than the
mountains around, or communities at higher elevation such as nearby Nalaikh
where the coal comes from. Prof Lodoysamba confirmed the ‘colder’
hypothesis this winter using a pretty sophisticated monitoring station at his
home in Nalaikh with thermometers at different heights above the ground. The
city, below -30, is colder, smokier, has a poorer diet and more fugitive dust
than rural areas. But a traditional stove burning dung can be pretty smoky, and
we have zero measurement of IAP in rural homes.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>«So we concluded that the level of urban air pollution in the
capital city is clearly having an adverse impact on the pulmonary health of
urban Mongolian children.»</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>They
can conclude that but that is no proof. That is an association. It is why
Nikhil keeps pointing out that you cannot make claims for causes and avoidances
without knowing a heck of a lot about the sub-population you are examining.
Attributing something as a cause does not mean that removing the
attributed cause avoids the problem. Suppose the attribution was in error by
80%?</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Regarding
proximity to highways: who lives next to noisy and polluted highways in
California: the well fed and exercised with good medical treatment? Or poor
people with poor health coverage, bad diets and no access to recreational facilities?
Correlation is not causation. </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“</span><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>UNICEF
says: « Outdoor air pollution is the most significant environmental risk
faced by children in Ulaanbaatar.</span><span lang=EN-CA style='font-size:11.0pt;
font-family:"Calibri","sans-serif"'>”</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Hmm…
Is alcohol an environmental risk? What about smoking? The air pollution
is awful on some days, and visible, and variable from place to place. There
must be children for whom it is the worst environmental risk, and others for
whom it is now. The point is that we can remove virtually all of it with
improved combustion of the very same fuels they now use. The major impediment
to achieving this is the parade of baseless claims that coal cannot be burned
cleanly, and therefore they must ban it – the only fuel available at a price
they can afford. The sheer stupidity of blaming the fuel for the performance of
the stove cannot have a greater effect on the people. Those advocates of fuel
bans based on the misbelief that the fuel is the problem, are partnering with
the advocates of ‘alternatives’ costing multiple times as much and which
provide no additional benefit save in some cases, convenience. Free electricity
is lovely – if the nation can afford it. No nation I know of can, so how can
Mongolia? Other countries are now depending on the great progress made in
coal stove designs from Mongolia. How is it possible that the Mongolians are
deprived of the benefits of this work? Advocates, that’s how. Advocators of
heat pumps, subsidised electricity, dimethyl ether, natural gas, LPG, wood
pellets, processed coal – every and anything that costs a lot, but not
ultra-clean-burning coal stoves developed right up the road <i>in a
university-owned, government-supported stove development centre</i>!</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“</span><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>For
bronchitis, this study points to indoor smoking from parents as the main source
of children’s bronchitis cases:</span><span lang=EN-CA style='font-size:11.0pt;
font-family:"Calibri","sans-serif"'>”</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>That
is unbelievable. The “main source”? The cause? That is a clear claim that
second hand smoke causes bronchitis.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>“</span><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>I
didn’t see anywhere that respiratory diseases were due to the cold in Mongolia.</span><span
lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>”</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Think
about that. The record low for Ulaanbaatar is -54 C (2002). The annual average
is -2C. Is it possible that people earning $2500 per year live in a chronically
underheated home? Ya think??</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>« With 50 % of the ambient PM pollution (and more in the
winter months) originating from household stoves for cooking and heating, this
sector tops the list of the most opportunistic of the interventions for better
air quality. »</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>That
is 2013. Times have changed. The stove programme was in full swing in 2013. The
% dropped from 88% (2010) in one district to an average of 45% in 2015 (in
winter). In summer the air is very clean (12 µg/m<sup>3</sup>, for
example).</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>So, if « 7 million deaths » from WHO may be far
fetched, it seems reasonable to me to call for cleaner stoves.</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>And, in the case of Ulan Bator, to sensitize people against
indoor smoking: is it actually being done?</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Preaching
against smoking is everywhere. The number f people smoking in developing
countries is increasing rapidly because they are targeted by vendors. The
advertising has been driven out of developed country media. It is <i>very</i>
reasonable to call for clean stoves. Very clean. Why not? The benefits are
huge, but it is not the entire problem. Without doubt the strangest country I
have worked in is Mongolia because the clean burning solutions were developed
there, tested there, supported financially yet are maligned for political
purposes. Everyone wants to blame others for “not solving the air pollution
problem”. After the stove replacement programme stopped at the end of 2015, air
pollution was down 65%. Some say 45% depending on where you measure it. It was
improved <i>uuugely</i>. Yet people popped up to say nothing was achieved by
the programme. Short memories. </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>I
am sure asthma attacks decreased because air pollution aggravates asthma. I do
not have stats, however. It just seems likely. Now we need to address the low
pressure boilers which are more and more common and burn 4 times as much fuel
as the ger stoves, at least. They were not included in the ger stove programme.
We are working on the at the moment. Products were tested last week –
efficiency was too high. I will reduce it.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>In
the meantime, Kyrgyzstan starts rolling out improved stoves (locally made) to
14,000 homes, slowly at first. The coal combustors are all based on the
Mongolian developments. South Africa localised the design and we have a model
ready for testing since last Monday. It is a beauty, and will incorporate
lessons learned from the use of the plastic refractory materials in Ulaanbaatar
last year. It is a game-changer.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Keep
pushing! Rocks don’t move by themselves.</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Crispin</span><o:p></o:p></p>
<p class=MsoNormal><span lang=EN-CA style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p>
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