To repair the world: Paul Farmer speaks to the next generation

To Repair the World: Paul Farmer Speaks to the Next Generation

Volumn , Issue , 2013, Pages

  Farmer, Paul ^a  

^a HARVARD MEDICAL SCHOOL   (United States)

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References (146)

1. Many of his academic writings are collected in Partner to the Poor: A Paul Farmer Reader (Berkeley: University of California Press, 2010).
2. The course is currently in its fifth year and continues to attract hundreds of students each term it is offered. An introductory global health textbook, which was modeled on this course, is forthcoming. Reimagining Global Health: An Introduction (Berkeley: University of California Press, in press).
3. For more on this topic, see Paul's book Infections and Inequalities: The Modern Plagues (University of California Press, 1999).
4. E. Marseille, P. Hofmann, and J. Kahn, "HIV Prevention before HAART in Sub-Saharan Africa," The Lancet 359, no. 9320 (May 25, 2002): 1851-1856.
5. Myron Cohen et al., "Prevention of HIV-1 Infection with Early Antiretroviral Therapy," The New England Journal of Medicine 11, no. 365 (August 2011): 493-505.
6. UNAIDS, "2012 World AIDS Day Report-Results," (2012), http://www.unaids.org/en/resources/documents/2012/.
7. Henry David Thoreau, Walden (New York: Thomas Y. Crowell and Co., 1910), 47.
8. Vaccination is an imperfect tool, and an expanded vaccine effort must not undermine the treatment of patients and the provision of clean water and modern sanitation. Strong public-sector water and sanitation systems would halt transmission of cholera and also that of other waterborne pathogens, such as typhoid fever and hepatitis A, which also claim many lives among the poor, especially among children. Paul and I wrote a longer piece exploring some of the claims of causality about cholera control in Haiti and elsewhere in Americas Quarterly, http://americasquarterly.org/cholera-and-the-road-to-modernity.
9. See also Arthur Kleinman's work on the moral dimensions of caregiving, for example: "Caregiving: The Odyssey of Becoming More Human," The Lancet 373, no. 9660 (2009): 292-293.
10. See, for example: J. W. Carlson et al., "Partners in Pathology: A Collaborative Model to Bring Pathology to Resource Poor Settings," American Journal of Surgery and Pathology 34, no.1 (2010): 118-123;
11. Carole Mitnick et al., "Community-based Therapy for Multidrug-resistant Tuberculosis in Lima, Peru," New England Journal of Medicine 348, no. 2 (2003): 119-122;
12. P. Farmer et al., "Community-based Approaches to HIV Treatment in Resource-poor Settings," The Lancet 358 (2001): 404-409;
13. Giuseppe Raviola et al., "Mental Health Response in Haiti in the Aftermath of the 2010 Earthquake: A Case Study for Building Longterm Solutions," Harvard Review of Psychiatry 20, no. 201 (2012): 68-77.
14. Paul Farmer, "Accompaniment as Policy," Kennedy School of Government Commencement Speech 2011, in this volume.
15. Paul Farmer, "Countering Failures of Imagination," Northwestern University Commencement Speech 2012, in this volume.
16. I have the late philosopher Richard Rorty's word on this. See Richard Rorty, "The Communitarian Impulse," speech given at Colorado College's 125th Anniversary Symposium, Cultures in the 21st Century: Conflicts and Convergences, Colorado Springs, CO (February 5, 1999).
17. Drew Faust, This Republic of Suffering: Death and the American Civil War (New York: Vintage Books, 2008).
18. This is the thesis, at any rate, of the forthcoming textbook that might be considered a sort of companion volume to this one. See Paul Farmer et al., Reimagining Global Health: An Introduction (Berkeley: University of California Press, in press).
19. Medline contains journal citations and abstracts for biomedical literature from around the world.
20. P.G. Wodehouse, Right Ho, Jeeves (Rockville, Maryland: Arc Manor Books), 145.
21. Plato, Republic, Book 1, 341-C.
22. Joseph Kahn, "Rich Nations Consider Fund of Billions to Fight AIDS," the New York Times: April 29, 2001, http://www.nytimes.com/2001/04/29/world/rich-nations-consider-fund-of-billions-to-fight-aids.html.
23. The Krebs' Cycle, also known as the citric acid cycle, is a sequence of chemical reactions that are a fundamental part of cellular metabolism.
24. D. V. Exner et al., "Lesser Response to Angiotensin-Converting-Enzyme Inhibitor Therapy in Black as Compared with White Patients with Left Ventricular Dysfunction," New England Journal of Medicine 344 (2001): 1351-1357;
25. R.S. Schwarz, "Racial Profiling in Medical Research," New England Journal of Medicine 344, no. 18 (2001): 1392-1393.
26. Peter Schworm, "For Sendoff, Grads Prefer Big Name," Boston Globe, May 12, 2005, http://www.boston.com/news/local/articles/2005/05/12/for_sendoff_grads_prefer_big_names?pg=full.
27. Father William P. Leahy, a historian of religion and education in the United States, has served as president of Boston College since 1996.
28. The "peculiar institution" was a euphemism for slavery in the United States. See, for example, John C Calhoun's "Speech on the Reception of Abolition Petitions," Feb 6, 1837, http://users.wfu.edu/zulick/340/calhoun2.html.
29. Adam Hochschild, Bury the Chains: Prophets and Rebels in the Fight to Free an Empire's Slaves (New York: Houghton Mifflin, 2005), 89.
30. Hochschild, 89.
31. Hochschild, 90.
32. Pedro Arrupe, S.J., "Men for Others," address given to the Tenth International Congress of Jesuit Alumni of Europe, Valencia, Spain ( July 31, 1973).
33. Roméo Dallaire, Shake Hands with the Devil: The Failure of Humanity in Rwanda (New York, Carroll & Graf Publishers, 2003).
34. Dallaire, 322.
35. Joseph Stiglitz and Linda Bilmes, The Three Trillion Dollar War: The True Cost of the Iraq Conflict (New York: W. W. Norton & Company, 2008).
36. This speech was given at the 2008 Skoll World Forum, an annual gathering of social entrepreneurs. The mission statement of the Skoll Foundation reads as follows: "to drive large scale change by investing in, connecting and celebrating social entrepreneurs and the innova tors who help them solve the world's most pressing problems," (http://www.skollfoundation.org/about).
37. The Skoll Foundation was launched by Jeff Skoll in 1999 and has been headed up by Sally Osberg since 2001.
38. International Campaign to Ban Landmines, Landmine Monitor Report 1999: Toward a Mine-Free World (1999); Human Rights Watch, "Exposing the Source: U.S. Companies and the Production of Antipersonnel Mines," Human Rights Watch Arms Project 9, no. 2 (1997); UNICEF, "Saving Children from the Tragedy of Landmines," Press Release, April 4, 2006.
39. For more on this story, see Paul Farmer, "'Landmine Boy' and the Tomorrow of Violence," in: B. Rylko-Bauer, L. Whiteford, and Paul Farmer, eds, Global Health in Times of Violence (Santa Fe, NM: SAR Press, 2009), 41-62.
40. See fig. 11 for photos of John before and after treatment.
41. Bertolt Brecht, "The World's One Hope," in Poems 1913-1956 (London: Eyre Methuen, 1976), 328.
42. Paul Hawken, Blessed Unrest: How the Largest Social Movement in History is Restoring Grace, Justice, and Beauty to the World (London, UK: Penguin, 2008), 190.
43. Father Michael McFarland, a computer scientist and engineer, served as Holy Cross's president from 2000 to 2012.
44. These are the two mottos of Holy Cross.
45. Nicholas Lemann, "Evening the Odds: Is There a Politics of Inequality?" New Yorker, April 23, 2012.
46. Credit Suisse Research Institute, Global Wealth Report (October 2010).
47. John Maynard Keynes, "The Economic Possibilities of Our Grandchildren," in Essays in Persuasion (New York: Norton, 1963), 358-373.
48. Northwestern's 2012 honorary degree recipients included Martha Minow, Dean of Harvard Law School and renowned scholar of human rights law; William D. Nix, emeritus professor of engineering at Stanford University and a pioneering researcher in the mechanical properties of materials; and Joan Ganz Cooney, founder of Chil dren's Television Workshop (best known for its flagship program Sesame Street).
49. Morton Schapiro, an economist of higher education, has served as president of Northwestern University since 2009.
50. "The Rock" is a Northwestern campus landmark. "Painting the rock" is a tradition in which students cover the rock with images and slogans to draw attention to various causes and events. "Dillo Day" is Northwestern's biggest party. In 1972, a group of students organized a small party in honor of the armadillo, which over time evolved into an annual all-day music festival on the campus's lake fill.
51. Practitioners and scholars trained in anthropology, sociology, history, and epidemiology echo this critique. But none of these fields individually captures the biosocial complexity of health and illness in the world today; nor do they capture what Arthur Kleinman calls "the local moral worlds" of the patients and their families. See Arthur Kleinman and Joan Kleinman, "The Appeal of Experience; The Dismay of Images: Cultural Appropriations of Suffering in Our Times," in Social Suffering, ed. Arthur Kleinman et al. (Berkeley: University of California Press, 1997), 1-24. See also Arthur Kleinman, What Really Matters: Living a Moral Life amidst Uncertainty and Danger (Oxford: Oxford University Press, 2006).
52. Kleinman is now completing a book on the subject, which has loomed for him as much as spouse-he nursed his wife through a long and painful progressive illness-as physician. See his two previously published essays: "Caregiving: The Odyssey of Becoming More Human," The Lancet 373, no. 9660 (2009): 292-293 and "Catastrophe and Caregiving: The Failure of Medicine as an Art," The Lancet 371, no. 9606 (2008): 22-23.
53. See, for example, Paul Farmer et al., eds., Women, Poverty, and AIDS: Sex, Drugs, and Structural Violence (Monroe, Maine: Common Courage Press, 1996).
54. Jim Yong Kim et al., "From a Declaration of Values to the Creation of Value in Global Health: A Report from Harvard University's Global Health Delivery Project," Global Public Health 5, no. 2 (2010): 181-188.
55. MVA is a medical acronym for a motor vehicle accident.
56. Countway Library is the principal library associated with Harvard Medical School.
57. OSHA is the Occupational Safety and Health Administration, a federal agency charged with implementing laws concerning health and safety. OSHA reports are not known for brevity.
58. Dr. Joseph Martin served as Dean of the Harvard Faculty of Medicine from 1997 to 2007.
59. HST refers to the Health Sciences and Technology program, a joint Harvard-MIT medical school track that is oriented toward students with an interest in biomedical research and a background in physical or biological sciences.
60. Jonas Salk was an American medical researcher best known for discovering and developing the first polio vaccine in 1955. Soon after, Albert Sabin developed an attenuated oral polio vaccine that was used to vaccinate millions of people. Louis Pasteur was a French microbiologist whose experiments helped establish the germ theory of disease. Pasteur also developed the first vaccine for rabies in 1885 and came up with the process of treating milk (pasteurization) to prevent the spread of disease.
61. Martin Luther King Jr., speech given at the Second National Convention of the Medical Committee for Human Rights, Chicago, IL (March 25, 1966).
62. "The Economics of Empire: Notes on the Washington Consensus," Harper's Magazine, May, 2003.
63. The "Second-year Show" is an annual comic play put on by second-year students at Harvard Medical School.
64. Carl Hiaasen, Skin Tight (New York: Berkley Books, 1989), 11.
65. Associated Press, "Calusas May Have Fled to Cuba," Miami Herald (March 15, 2004).
66. Eve Kerr et al., "Profiling the Quality of Care in Twelve Com munities: Results from the CQI Study," Health Affairs 23, no. 3 (May 2004).
67. Donna Shalala, a professor of political science and education and former Secretary of Health and Human Services under President Bill Clinton, has served as president of the University of Miami since 2001.
68. Brigham and Women's Hospital in Boston; Paul Farmer serves as Chief of the Division of Global Health Equity.
69. For more on Haiti's history, see Paul Farmer, The Uses of Haiti (Monroe, ME: Common Courage Press, 1994).
70. Boston Children's Hospital and Massachusetts General Hospital are Harvard-affiliated hospitals in Boston.
71. P. Lawrence et al., "The Water Poverty Index: An International Comparison," Keele Economic Research Papers (2002); see also the 2008 report by the Center for Human Rights and Global Justice and the Global Justice Clinic at New York University's School of Law, Partners In Health, Zanmi Lasante, and the Robert F. Kennedy Center for Justice and Human Rights "Wòch nan Soley: The Denial of the Right to Water in Haiti," www.pih.org/page/-/reports/Haiti_Report_FINAL.pdf.
72. Official estimates of the death toll of the 2010 earthquake range from 220,000 to 316,000. For more on the complexities associated with making such estimates, see Farmer, Haiti After the Earthquake, 119.
73. IRBs stands for institutional review boards, regulatory bodies charged with reviewing the ethical implications of proposed research involving human subjects.
74. Bascom-Palmer Eye Institute is the ophthalmic care center at the University of Miami Leonard M. Miller School of Medicine.
75. Quoted in Theodore M. Brown and Elizabeth Fee, "Rudolph Carl Virchow: Medical Scientist, Social Reformer, Role Model," American Journal of Public Health (December 2006) 96: 2104.
76. Barry Bloom, an expert in infectious disease research, served as dean of the Harvard School of Public Health from 1998 to 2008.
77. James K. Galbraith, "A Perfect Crime: Inequality in the Age of Globalization," Daedalus (Winter 2002), 22.
78. NICU is a medical acronym for neonatal intensive care unit.
79. Steven L. Gortmaker and Paul H. Wise, "The First Injustice: Socioeconomic Disparities, Health Services Technology, and Infant Mortality," Annual Review of Sociology 23 (1997): 147-170.
80. Peter Vinten-Johansen et al., Cholera, Chloroform, and the Science of Medicine: A Life of John Snow (New York: Oxford University Press, 2003), 7.
81. Vinten-Johansen et al., 7.
82. Ackerknecht, Erwin, Rudolph Virchow: Doctor, Statesman, Anthropologist (Madison: University of Wisconsin Press, 1953).
83. Bertolt Brecht, "A Worker's Speech to a Doctor" ("Rede eines Arbeiters an einen Arzt," Spätere Gedichte und Satiren aus Svendborg, 1936-38), in The Body in the Library: A Literary Anthology of Modern Medicine, ed. Iain Bamforth, (London: Verso, 2003), 167-168.
84. Howard Hiatt, Medical Lifeboat: Will There Be Room for You in the Health Care System? (New York: Harper & Row, 1987), ix.
85. Save the Children, State of the World's Mother 2006: Saving the Lives of Mothers and Newborns (Westport, CT: Save the Children, 2006).
86. Paul Krugman, "Our Sick Society," New York Times (May 5, 2006), A26.
87. R.D. Moore et al., "Racial Differences in the Use of Drug Therapy for HIV Disease in an Urban Community," New England Journal of Medicine 330 (1994): 763-768.
88. S.B. Lucas et al., "The Mortality and Pathology of HIV Infection in a West African City," AIDS 7 (1993): 1569-1579.
89. R.E. Chaisson, J.C. Keruly, and R.D. Moore, "Race, Sex, Drug Use, and Progression of Human Immunodeficiency Virus Disease," New England Journal of Medicine 333 (1995): 751-756.
90. Richard Rhodes, The Making of the Atomic Bomb (New York: Touchstone, 1986), 490.
91. Benjamin Sachs, an obstetrician and expert in reducing medical errors, has served as dean of the Tulane School of Medicine since 2007.
92. Hoya Saxa is the official cheer of Georgetown University. Hoya is an Ancient Greek word hoios, meaning "such a" or "what a," while saxa is Latin for "rocks." The complete phrase is often translated as "what rocks!" Over the last century and despite its ambiguous origins, Hoya has become the proud nickname for Georgetown's athletic teams and students. See http://alumni.georgetown.edu/ccg/ccg_17.html.
93. Steven Johnson, Where Good Ideas Come From: A Natural History of Innovation (New York: Riverhead, 2010), 31.
94. Adam Gopnik, "How the Internet Gets Inside Us," the New Yorker, February 14, 2011.
95. Martin Luther King Jr., "Beyond Vietnam," speech delivered April 4, 1967, at Riverside Church, New York.
96. See also "Accompaniment as Policy," Kennedy School of Government Commencement Speech 2011, in this volume.
97. Bill Clinton, Giving: How Each of Us Can Change the World (New York: Knopf, 2007), 207.
98. See Paul Farmer, "Countering Failures of Imagination," Northwestern University Commencement Speech 2012, in this volume.
99. The Union Medal was awarded jointly to Paul Farmer and Ophelia Dahl, two of the five cofounders of Partners In Health.
100. Interview on National Public Radio with Juan Williams, "Secretary Colin L. Powell," Washington, DC (March 8, 2004), http://2001-2009.state.gov/secretary/former/powell/remarks/30245.htm.
101. Bonhoeffer, 4.
102. See Paul Farmer, "Pestilence and Restraint: Guantánamo, AIDS, and the Logic of Quarantine," in Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley: University of California Press, 2003), 51-90.
103. A. Schoenholtz, "Aiding and Abetting Persecutors: The Seizure and Return of Haitian Refugees in Violation of the U.N. Refugee Convention and Protocol," Georgetown Immigration Law Journal 7, no. 1 (1993): 67-85.
104. Cited in G. J. Annas, "Detention of HIV-positive Haitians at Guantánamo: Human Rights and Medical Care," New England Journal of Medicine 329, no. 8 (1993): 589-592.
105. See Farmer, "Pestilence and Restraint."
106. Jim Michaels, "Behind Success in Ramadi: An Army Colonel's Gamble," USA Today (May 1, 2007), 1-2.
107. Jonathan Hansen, "Guantánamo: An American Story," lecture given at Harvard University (April 26, 2007). See also Hansen's recent book Guantánamo: An American History (New York: Hill and Wang, 2011).
108. Marcus Tullius Cicero, M. Tulli Ciceronis ad. M. Brutum Orator, translated by Sir John Edwin Sandys, (London: Cambridge University Press, 1885).
109. Susan Sontag, Regarding the Pain of Others (New York: Farrar, Strauss, and Giroux, 2003), 114.
110. "Harper's Index," Harper's Magazine, May 2007, 13.
111. Cited in Richard Dawkins, The God Delusion (London: Bantam Press, 2006), 15.
112. Jim Wallis, The Great Awakening: Reviving Faith and Politics in a Post-Religious Right America (New York: HarperOne, 2008), 25.
113. Wallis, 12.
114. Each year, some 20,000 alumni and their families attend Reunion and Commencement weekend activities at Princeton University. Fireworks follow the annual, public, and well-loved University Orchestra evening lawn concert. See "Nassau Notes," Princeton Weekly Bulletin, May 19, 2008, 27, http://www.princeton.edu/pr/pwb/08/0519/nn/.
115. Seamus Heaney, The Cure at Troy: A Version of Sophocles' Philoctetes (New York: Farrar, Straus and Giroux, 1991), 77.
116. "Nixon's Nose" is the affectionate nickname for Henry Moore's iconic sculpture, Oval with Points, positioned by West College on the Princeton campus. See the Daily Princetonian, October 6, 1999, 8. Princeton is also home to 11 historic private eating clubs, which are an important part of social and nutritional life on campus. See http://www.princeton.edu/main/campuslife/housingdining/eatingclubs/.
117. Martin Luther King Jr., Where Do We Go from Here: Chaos or Community? (New York: Harper & Row, 1967).
118. Martin Luther King Jr., Presentation at the Second National Convention of the Medical Committee for Human Rights, Chicago, IL (March 25, 1966).
119. Martin Luther King Jr., "The Casualties of the War in Vietnam," The Nation Institute, Los Angeles, CA (February 25, 1967).
120. Martin Luther King Jr., Where Do We Go from Here?
121. Martin Luther King Jr., "Beyond Vietnam: A Time to Break Silence," speech delivered at a meeting of Clergy and Laity Concerned About Vietnam at Riverside Church in New York City (April 4, 1967).
122. Editorial, Life, April 21, 1967.
123. "A Tragedy," the Washington Post, April 1967, A20.
124. Martin Luther King Jr., "Remaining Awake Through a Great Revolution," Oberlin College Commencement Speech ( June 14, 1965).
125. Martin Luther King Jr., "Beyond Vietnam," speech delivered April 4, 1967, at Riverside Church, New York.
126. Martin Luther King Jr., Where Do We Go from Here?
127. Martin Luther King Jr., "The Drum Major Instinct," sermon delivered at Ebenezer Baptist Church, Atlanta, GA (February 4, 1968).
128. Rudolf Virchow, "Der Armenartzt," cited in Erwin Heinz Ackerknecht, Rudolf Virchow: Doctor, Statesman, Anthropologist (Madison: University of Wisconsin Press, 1953), 46.
129. Paul Farmer et al., "Tuberculosis, Poverty, and 'Compliance': Lessons from Rural Haiti," Seminars in Respiratory Infections 6, no. 4 (1991): 254-260.
130. Carole Mitnick et al., "Community-based Therapy for Multidrug-resistant Tuberculosis in Lima, Peru," New England Journal of Medicine 348, no. 2 (2003).
131. Suppl 5 (2004): S429-s436.
132. Eric Larsen and Daniel Pederson, "Too Poor to Treat," Newsweek, July 27, 2007.
133. Paul Farmer et al., "Community-based Approaches to HIV Treatment in Resource-poor Settings," Lancet 358, no. 9279 (2001): 404-409.
134. For more on the etymology of accompaniment, see Roberto Goizueta, Caminemos con Jesus: Toward a Hispanic/Latino Theology of Accompaniment (Maryknoll, NY: Orbis Books, 2003).
135. See, e.g., Gustavo Guitiérrez, The Power of the Poor in History: Selected Writings (Maryknoll, NY: Orbis Books, 1973).
136. Goizueta, Caminemos, 192.
137. United Nations Office of the Special Envoy for Haiti, "Has Aid Changed? Channelling Assistance to Haiti before and after the Earthquake," June 2011, http://www.haitispecialenvoy.org/download/Report_Center/has_aid_changed_en.pdf.
138. These numbers are, of course, contested. For an overview of both contradictory numbers and their origins, see Paul Farmer, Haiti After the Earthquake (New York: PublicAffairs Books, 2011), 118-120.
139. Martha Mendoza, "Would-be Haitian Contractors Miss Out on Aid," Associated Press (December 12, 2010), http://news.yahoo.com/s/ap/20101212/ap_on_re_us/cb_haiti_outsourcing_aid_1.
140. Isabelle Defourny et al., "Management of Moderate Acute Malnutrition with RUTF in Niger," MSF Report (2007), http://www.msf.org.au/uploads/media/mod_acc_mal_Niger.pdf.
141. Of course there have been sharp disagreements about this matter, including the question of whether or not RUTF, this miraculous treatment for malnutrition, should be subject to international patent law. See, for example, Andrew Rice's exposé "The Peanut Solution" in the New York Times Magazine, September 2, 2010, http://www.nytimes.com/2010/09/05/magazine/05plumpy-t.html?pagewanted=all. We're confident that the accompaniment approach will lead many partners away from ready acquiescence to intellectual property regimes that make sense for some therapeutics but not others.
142. This example is discussed at length in Farmer, Haiti After the Earthquake.
143. Malcolm Gladwell, "Creation Myth," the New Yorker, May 16, 2011, 50.
144. Atul Gawande, The Checklist Manifesto: How to Get Things Right (New York: Metropolitan Books, 2009).
145. Mercedes Becerra et al., "Using Treatment Failure under Effective Directly Observed Short-Course Chemotherapy Programs to Identify Patients with Multidrug-resistant Tuberculosis," International Journal of Tuberculosis and Lung Disease 4, no. 2 (2000): 108-114.
146. The historian Michael Roth has observed: "The privileging of irony is often the result of the inability to sustain belief in the possibilities of significant political change" (p. 148). His book about memory, trauma, and the construction of history is titled, with a nod to Weber, The Ironist's Cage.