Square One

I thought I’d have you listen in on this IM conversation I had with a friend from medical school, Simon Adebola, about science, science illiteracy and biomedical science in Nigeria/Africa. Simon blogs at iInitiative.

Simon Adebola: So tell me, what is new in the nebulous world of cells transmitters and neurobiology?

Seye Abimbola: Nebulous world?

Simon Adebola: Just teasing. But wait, let’s see how well you can guard your territory. Imagine I thought it was nebulous and even went a bit further to say that science could be tricky and the analysis dodgy.

Seye Abimbola: …and you’d be perfectly right. That is indeed the true nature of science and the bravado and hubris of science in its more modern history is a loss and the way science has fed public imagination with promises of its powers is also unfortunate… That said, it is still the only way we know by which we can grasp the mysteries of  the natural world, hence the need for constant doubt and skepticism, from the makers and the consumers of science alike.

Simon Adebola: Wait a minute, you remind me of this Oxford Prof Jerome Ravetz. He wrote on post normal science, citing much of what you just stated above. It could be that much of what we call hard facts, especially in modern science is not as factual as we tend to want to make our journal editors, peers and larger public believe.

Seye Abimbola: Journal editors and peers are often conniving partners in the business… and unfortunately, the scientifically illiterate public and newspaper editors just take it in, and spread it… and it backfires some times, with the recent example of Climate Science. Climate science had an agenda and I am suspicious of any science with an agenda and unfortunately that is what much of science is today.

Simon Adebola: Well, all writing, I was taught, has an agenda, and that virtually spoilt films and entertainment for me because I then acquired a magnifying lens and sometimes it descends much lowers to an agenda for money. Science like religion has proven not to sit comfortably with the kind of scrutiny it has gotten. They both would rather prefer to be seen as being infallible and yet no enterprise with humans at the helm should be seen as such

Seye Abimbola: It is troubling how money and agenda drives a lot of research, including medical research and how unfortunately no one beyond the club is even able to really scrutinize. When I was at the BMJ (British Medical Journal) I had a different impression of how science worked. There was the image of science in its most perfect, ideal sense, and although it showed that there was a lot of crap science and studies going on, it didn’t quite ring home that it was a given in “the holy of holies of intellectual objectivity” (Wole Soyinka).

Simon Adebola: Being a strong believer in objectivity and experimentation (I find it truly fascinating) I wonder what the scientific community can do to regain its credibility.

Seye Abimbola: I don’t think it will happen unless we redefine our index of academic credit and the way science is funded – number of papers in peer reviewed journals is a bad idea and funding according to result – often number of papers or positive result – is killing science. It forces scientists to want to say something, when there isn’t anything to say, creates publication bias, unnecessary data analysis et cetera.

Simon Adebola: Sometimes it is like the case of a serially abused individual. Concurrently ignored and used by those they hoped would care about them – politicians and to a lesser extent industry. Over at Cuba (Forum 2009, Global Forum for Health Research) there was this palpable inferiority complex in the research community, a complex not devoid of pride, seemingly crying to be heard by policy makers. As they say in Yoruba, it is a thief who knows how to trace the footprints of another thief on a rock. Once the politicians/policy people see through the credibility flaws, they just would rather use, rather than trust the research community. What would you recommend to improve the assimilation of science into policy?

Seye Abimbola: There’s a lot that is wrong about how science is presently done and how it feeds into policy. I’ve been thinking a lot about policy these days…Ultimately what we need to do is improve scientific literacy. I wouldn’t mind suggesting a model that has scientists, not necessarily practicing, as policy makers in science/medicine…

Simon Adebola: …building a bridge sort of.

Seye Abimbola: Yes, because it’s so easy for scientists to stand on the other end of the divide and send in dumbed down, over-edited, information that lack the nuances, and the element of doubt that comes with science…I’m not happy about the example of Al Gore who has been the most public face for climate change for a long time…It would be a different scenario entirely if he is re-echoing what scientists in the field are saying to the public. However, scientists in the field are the ones trying to re-echo what he is saying by making their data agree.

Simon Adebola: No one is comfortable with the ‘everything is caused by climate change’ line. It gets rancid after a while, with science making the claim on both sides. Ten years ago, science predicted that due to climate change some parts of the world experience drops in snow, for example I heard they said British children would not know what snow was. Now science is proving to us that due to climate change, there would be fiercer snow storms. That breeds the reaction you get when you discover the movie you are watching does not have a plot you want to turn it off, but again you want to see if its plotlessness, is the ingenuity of the director in display, so you hang on watching, hoping it would eventually make sense, somehow.

Seye Abimbola: Again, this is because scientists are not committed to saying the truth the way it is…

Simon Adebola: …and that is the context in which post normal science explores its stance. “Post-Normal Science is a concept developed by Silvio Funtowicz and Jerome Ravetz, attempting to characterise a methodology of inquiry that is appropriate for cases where “facts are uncertain, values in dispute, stakes high and decisions urgent”. It is primarily seen in the context of the debate over global warming and other similar, long-term issues where we possess less information than we would like.” (Wikipedia)

Seye Abimbola: …and again it boils down to scientists feeling a need for that sort of misplaced recognition…

Simon Adebola: …true, opening them up to near destructive abuse. I guess each side just has to make peace with its roles. Oxford would never be Hollywood, or Washington DC, or the Super bowl. Hollywood with its fortune, sports with its fame, and Washington with its power wielding capabilities. The strength of science like you have said would continue to lie in its innovativeness and simplicity once other interests start driving it, that inferiority complex bites in, and self destruction could result. For now we observe the movie, hoping there is a plot. Those profiting off this, increase the hype, the noise, silence the naysayers and hope to bank as much as they can, such that win or lose, at least they have made enough to reward their efforts.

Seye Abimbola: I’m wondering what is there for science in Nigeria… There’s a lot that never happened, despite enormous early promise in Nigeria.

Simon Adebola: There is hope. New minds, fresh minds, need to be trained. We need a reorientation. Science as you know has flourished even when repressed. Galileo, Einstein. It is the commitment that we should hope does not dwindle. The value is in service that would drive a pursuit of excellence, creativity, and better ways of doing things…

Seye Abimbola: In medicine, if we look back to the days of Osuntokun et cetera, they somehow did not, and I suspect due to a lot happening on the political front in Nigeria, manage to build that critical mass that could help sustain scientific productivity. Those guys did and published a lot of great work, good, world class studies and it just didn’t trickle down the generations…and I’m wondering, what can we do? How do we ensure that fresh minds are trained?

Simon Adebola: I hope there can be mega research institutes that will represent a focus on excellent research, openness to innovation, and economically sustainable models where research and innovation lead to productivity and development. I also think scholarships and studentships focused on solving the actual needs in the continent are a crucial need – these should come first. It is just that the selfishness can be acute and sometimes crippling, but we can’t deny the need to keep building capacity.

Seye Abimbola: We are presently finishing up the Build AfReCa! (African Research Capacity) paper for the journal Science. Build AfReCa! Is a very young network of young scientists, mostly Africans in the Diaspora, mostly students trying to work towards improving research capacity in Africa…

Simon Adebola: We need more and more of that, aggressively driving knowledge growth.

Seye Abimbola: We put out a survey in the last quarter of last year to assess the needs of young scientists from Africa and why they might not work in Africa and what might make them want to work in Africa, and their general geographical spread. At this stage, it’s essentially advocacy, creating a voice, an image, some advocacy for the need for funding, coordinated funding for young scientists in sub-Saharan Africa, funded to do great work on the ground in Africa.

Simon Adebola: I think that is crucial and greater seriousness with African journals. We need the equivalent of The Lancet, BMJ and NEJM (New England Journal of Medicine) on the continent…In fact one could talk to some of these journals to help grow stronger journals with greater visibility on the continent.

Seye Abimbola: We will need to work with the model like PLoS (Public Library of Science). It would be nice to have a PLoS Africa…. PLoS is absolutely open access, and online with a good Impact Factor…The tricky bit is that it will be online, but again, internet access in Africa is getting better by the day…so, that can be done.

Simon Adebola: …and daily digests can be sent by email or even SMS gateways alerting of papers of interest…

Seye Abimbola: …the first place to go when looking for good studies from Africa.

Simon Adebola: I am sure we can get funding for that…The Library is online, you register and select your interest. Each time a paper of interest to you appears, based on your selection, you get an SMS with basic info on the paper.

Seye Abimbola: The journal will need an editorial team, a peer reviewer bank, et cereta.

Simon Adebola: This is the kind of aid they should be interested in giving Africa, not more money for corrupt leaders…

Seye Abimbola: Good. Maybe we should put a proposal together…

Simon Adebola: I think we should…once we have the back end defined well, and teams in place… and even though it costs, we can start with donor funding and once we have a critical base of users, we can work on different models to make it work. This would make research awareness go up greatly…

Seye Abimbola:  Thanks. It’s been a great conversation, and I’m tempted to blog excerpts from the conversation on NT.org (Nigerians Talking Science – An IM Conversation).

Simon Adebola: Thanks. Please feel free to do that. It’s been a huge pleasure on my part.

Richard Smith reviews Nigel Crisp‘s  Turning the World Upside Down: The Search for Global Health in the 21st Century in this week’s BMJ. The striking comment in the review was an explanation for health workforce brain drain in Africa:

His case for “turning the world upside down” might begin with the stark facts that Africa has 25% of the world’s burden of disease but only 3% of its healthcare resources and 1% of health workers. North America, in contrast, has 3% of the disease burden but 25% of healthcare resources and 30% of health workers.

Rich countries are plundering health workers from poor countries, and one reason that’s happening is that rich countries have exported their outdated health systems and ways of thinking—meaning that health workers in poor countries are trained inappropriately and feel more comfortable in rich settings.

It has just occurred to me that developing countries might indeed be in the best position to redefine the health worker for the 21st century in the light of America’s super-expensive over-doctored system, and the sheer effect of grappling with chronic illnesses on health systems globally.

The full review is here.

Muza Gondwe from Malawi is presently on a six-month fellowship at the Centre of African Studies on the Public Understanding of Science in Africa in Cambridge. She writes on BMJ Blogs about her project which seeks to develop ways of engaging science through communication in Malawi and to identify and celebrate distinguished black African pioneers of science. She was motivated to do this after reading these:

“It will be seen that when we classify mankind by colour, the only one of the primary races, given by this classification, which has not made a creative contribution to any one of our twenty-one civilizations is the Black Race.” – Dr. Arnold Toynbee, The Study of History, Vol. I, page 233. (Vol I: Introduction; The Geneses of Civilizations (Oxford University Press 1934).

“[I am] inherently gloomy about the prospect of Africa” because “all our social policies are based on the fact that their intelligence is the same as ours – whereas all the testing says not really.” James Watson, in 2007 in an interview with the Sunday Times.

And what does she find?

In my investigation I have learnt some startling facts: no black African has won any of the Nobel prizes in science; the UK has six times as many researchers as Sub-Saharan Africa; and, according to the Mathematicians of the African Diaspora (MAD), 0.1% of the total number of mathematicians in the world are of black African heritage.

The full post is here.

Muza Gondwe’s personal blog, “Communicating science, the African way” is here.

I still remember the shock when I realised that the practice of homeopathy was funded within the National Health Service (NHS) in England. I was taking a lunchtime stroll when I came across the Royal London Homeopathic Hospital, which as it turned out was one of the hospitals within the UCL Hospitals NHS trust, which also included the hospital to which the Institute of Neurology where I was studying at the time was affiliated. I almost felt ashamed.

It was particularly shocking because the United Kingdom does have a reputation for science and rationality that is hardly equalled elsewhere in the world. The experience however made it less shocking for me when I got to Sydney, Australia and found lots and lots of alternative practices, with all sorts of interesting and grand names, structured to deceive and confuse with legitimate science. However, I doubt that like in the UK, any is funded from the public purse of Australians.

Two weeks ago, I met a black woman from Jamaica (although born in London and raised in Auckland). She was the first black person I walked up to and spoke with in Sydney, and the first and only person ever to have referred to me as ‘brother’ in the restricted black folk sense of the word. It was rather strange. I had never been a ‘brother’. There are not many in Australia.

We got on the bus together. She had studied ‘alternative/complimentary medicine’ in her youth and had also received training in homeopathy. Much of the rest of the trip was spent discussing the claims of homeopathy, during which she argued that homeopathy was much like vaccination. I was so mad, but out of courtesy I had to change the topic immediately. It reminded me of Raymond Tallis‘ 2007 Sense about Science annual lecture where he said:

…and this is how it is with junk science that borrows the terminology of science, without any sense of its true meaning, and of the massive interconnected hinterland of facts and concepts and even uncertainties behind them.

…and so we have treatments such as ‘reflexology’ which expropriates a well-established, indeed central, concept in biological science, and uses it to label treatments that have no biological foundation whatsoever.

…and ‘homoeopathy’ which, being in Greek, one of the languages of science, sounds very scientific but is based on magic thinking that would shame a six year old child.

…they domesticate terms by uprooting them from a complicated nexus of hard-won concepts.

Whenever I see those Sydney shops or offices, what comes to mind is how successful alternative medicine practice/movement is in Nigeria as well, and how they feed on pretty much the same sentiments. I reckon it must indeed be a universal phenomenon. Thankfully, we are not yet at the stage where the Nigerian government will fund an alternative medical practice, but I bet we are not that far either. I am almost certain of it that the movement will soon have a ‘scientific’ arm made up of people trained as much as to be able to throw terminologies around but not quite as much as to have any deep, nuanced understanding of them.

Here is an excerpt from an advertorial on the popular Doctor Akintunde Ayeni of Yem-Kem International Nigeria Limited:

…he [has] invested resources – time and money to visit renowned herbal homes in India, China, Australia, Japan and Pakistan. In similar vein, [practitioners] of alternative therapy in those countries visit him, here in Nigeria, to exchange notes. The result of these research efforts is manifested in the emergence of our three products namely (1) Blood Cure, which a blood purifier and immune boosting herbal medicine (2) M & T Capsule which is an effective herbal medicine for all chronic fever and (3) Energy 2000 which is a powerful herbal medicine for sex ability deficient patients.

The words again: ‘research’, ‘immune’, ‘capsule’, ‘doctor’, ‘discover’, et cetera. It is also interesting that Australia has its place among the visibly oriental countries that Akintunde Ayeni has visited.

John Diamond, who before his eventual death had his hopes of cure from cancer falsely raised by several alternative medicine practitioners did put what would be my summation very beautifully: “There is in reality no such thing as alternative medicine, just medicine that works and medicine that doesn’t…There isn’t an ‘alternative’ physiology or anatomy or nervous system any more than there’s an alternative map of London which lets you get to Battersea from Chelsea without crossing the Thames.”

So how do you define medicine that works? Well, the same way that Artemisinin made its way from the fields of central China to clinics everywhere chloroquine resistant Malaria is treated.

This is an article from Nature about how the recession has dampened donor enthusiasm for scientific research in Africa and here is an excerpt about Nigeria:

Countries that don’t depend on aid are also struggling. In Nigeria, the drop in demand for oil and gas, exacerbated by a stricken banking sector, means that private donations — a major source of funding for Nigerian universities — are slowing. “In the past, a conference like this would have a lot of Nigerians coming, supported by industry grants. We don’t find many today,” says Oye Ibidapo-Obe, president of the Nigerian Academy of Science in Lagos. Nigeria’s government won’t pick up the slack left by the drop in private investments, Ibidapo-Obe adds. “Research is not seen as the major driver of the economy.”

I am not sure where Nature got these assertions from, or why Oye Ibidapo-Obe said what he is quoted to have said, but this certainly reeks of falsehood. Someone is either making up stories to mislead Nature, or Nature itself is doing the  embellishment. Nigerian banking sector, and industry grants being a major source of funding for Nigerian universities? This is just so false.

There are many reasons for me to blog about David Morley (1923-2009), who perhaps more than any other western scientist has done more towards the development of paediatrics and child health in Nigeria, Africa and possibly the whole developing world. His work started at the hospital where I was born many years after he worked there, where I later studied, and afterwards stayed back to work: Wesley Guild Hospital, (WGH) Ilesha.

His former colleague and fellow professor of International Child Health at UCL, Andrew Tomkins reflects on his life in the Guardian UK:

When David qualified in medicine in 1947, one in four children in developing countries died before their fifth birthday. As a young doctor in a mission hospital in Nigeria, he established that effective treatment for such children should not revolve around hospitals but community-based healthcare and technologies, some of which he developed himself. His findings had a great impact on governments and agencies worldwide, and many have subsequently adopted that approach. He also set up training courses for medical staff and a charity, Teaching Aids at Low Cost (TALC).

These included a robust scale for weighing infants in the community, parent-owned Road to Health Charts and a simple mid-upper arm circumference (MUAC) tape for detecting severe malnutrition. He set up the Tropical Child Health Unit (TCHU) at the Institute of Child Health (ICH), London, which formed the basis for the present Centre for International Health and Development

Three missionary doctors working in the Wesley Guild Hospital in Ilesha, Nigeria, obtained research funding from the West African Medical Research Council and the Methodist Missionary Society to help tackle the limitations of traditional (western) clinical services when applied in the developing world. Andrew Pearson, David Cannon and John Wright recruited David to do the work and, in 1953, he set up an extensive health and nutrition study of 413 children in Ilesha. It was the first of its kind and produced very influential publications.

Earlier this year, a month after his death on 2 July 2009, bloggers at the Nigeria Health Watch invited Bryan Pearson, publisher of Africa Health to write an obituary of David Morley. He wrote about how the missionary doctors at WGH Ilesha had brought the problem they strove to solve upon themselves by increasing patient population “having negotiated a deal with their new regional governor, Obafemi Awolowo, to provide free health services for under 18s.” The full obituary is here. This is an excerpt:

A full longitudinal study was initiated and over the next 18 months all children born into the community were registered and then followed with monthly checks for a full five years. Growth charts were introduced (now utilised universally) and a special ‘Under Fives Clinic’ was initiated back at WGH. High protein weaning food was introduced. Mothers kept the children’s records (less loss than for hospital based records); Grade II midwives were taught to deal with 90% of clinical need and to refer the other 10%.

By 1960 outpatient attendance had reached 200 000 at WGH, 80% of whom were under 18 year olds. The first measles vaccine was trialled at Ilesha and Imesi-Ile in 1960.

 And thus the community-based health revolution was born. Quickly the Imesi-Ile population started growing at more than 9% per annum, and the first family planning programme (as it was known then) had to be initiated.

It is no accident that Olikoye Ransome-Kuti was closely involved and inspired by David Morley. Just a shame, that despite all Olikoye’s efforts, so little of what was learned from this landmark work of community-based prevention was adopted throughout the Federation. Many other countries did take heed, and probably millions of children have benefitted.

There are other obituaries from the Telegraph and the Independent both in the UK. I doubt that any Nigerian daily has reported his death or published an obituary. We are often far too caught up in our politics of misrule to have time for that.

It is well worth mentioning though that the special ‘Under Fives Clinic’ still runs as Wesley Guild Hospital under Oyeku Oyelami, (professor of Paediatrics and Child Health at OAU Ile-Ife) without regard for Nigeria’s numerous public holidays or strike actions, continuing to benefit thousands of children and their families in Ilesha and its environs.

Build AfReCa! (Build African Research Capacity), an international network of young scientists supporting the advancement of biomedical research in Africa and its diaspora is conducting a survey to help identify the needs of biomedical research training (BSc, MSc, or PhD) in Africa from the perspective of young scientists and graduate students throughout Africa and around the world.

The survey results will be published for academic institutions, nonprofit organizations, policy makers, and other stakeholders to assess and strengthen capacity building for health service and biomedical research in Africa.

We hope you will find 20 to 30 minutes to participate in this important endeavour no later than October 30th, 2009. All your identifying information will be kept confidential.

We are eager to get as many people as possible to complete the questionnaire, so please send out the link to everyone within your network of friends,  your colleagues in the office or laboratory, your classmate or old schoolmate, anyone that would satisfy the description “young scientists and graduate students throughout Africa and its diaspora.”

The survey is here.

If you have any questions or need assistance in French please contact Denis Zofou at zofden@yahoo.com, and if in English, contact Seye Abimbola at seyeabimbola@hotmail.com or simply leave a message as comment on this blog post.

Thanks.