My friend Nathan (!) visited me in Aden this past week and we climbed the highest peak on the Aden peninsula, Shamsan. Shamsan means 'Two suns' in Arabic. It was a fun climb and a beautiful view from the top. We learned from one of our climbing buddies, a British fellow who has lived in Aden for the better part of the last 20 years that the record time to the top of the peak is 31 minutes. One side of the peak has a path that leads from the quarry at the bottom all the way to the top that, according to the story, a Yemeni serving with the British soldiers in Aden, ran up to set the record.
It's not an easy goal or a short peak but I have two years here and I think I can beat that. I'll keep you updated.
Sunday, September 26, 2010
Sunday, September 19, 2010
Clinical Trials
NY Times article on the ethics of clinical trials here
The article raises the issue of randomized assignment to treatment and control to prove a drug's efficacy when the drug seems to be working and people's lives are at stake. Doctors, however, need to know which treatments are truly effective and this is only possible through a rigorous randomized trial. Also, drug companies need to prove to the FDA their drug works. This sadly pits millions of dollars in patent rights against the cost of the lives of those in the control group.
Another issue in this trial is its 'no-blind' design. It was obvious to the doctors and patients who was receiving the treatment and who was not due to the different delivery methods, confronting the doctors and patients with the ethical reality of the trial. As a patient I don't think I could handle knowing I was receiving what appeared to be an inferior treatment.
To argue the other side, randomized trials are necessary because they have the power to confirm what you suspect (the drug is working), dispel what you hope for (you think the drug is working when it's actually not) or save you from worse consequences (you think the treatment is helpful but it actually harms the patients).
The article raises the issue of randomized assignment to treatment and control to prove a drug's efficacy when the drug seems to be working and people's lives are at stake. Doctors, however, need to know which treatments are truly effective and this is only possible through a rigorous randomized trial. Also, drug companies need to prove to the FDA their drug works. This sadly pits millions of dollars in patent rights against the cost of the lives of those in the control group.
Another issue in this trial is its 'no-blind' design. It was obvious to the doctors and patients who was receiving the treatment and who was not due to the different delivery methods, confronting the doctors and patients with the ethical reality of the trial. As a patient I don't think I could handle knowing I was receiving what appeared to be an inferior treatment.
To argue the other side, randomized trials are necessary because they have the power to confirm what you suspect (the drug is working), dispel what you hope for (you think the drug is working when it's actually not) or save you from worse consequences (you think the treatment is helpful but it actually harms the patients).
Sunday, September 12, 2010
Chicken and the Egg Part II
A Times article on security in Afghanistan here
And another article on political institution building, security and corruption here
A couple notes:
1. Instability and Elections - as the articles discuss, if NATO forces can not provide sufficient security, the Afghan election committee will have close some rural polling stations for next Saturday's Parliamentary election. With a large portion of Afghanistan's population living in those rural areas, this exposes the election to claims of fraud and coercion. The investment-security argument may be complex but there is a direct cost politically for contested state rule in Afghanistan. Legitimate elections could improve the government's image among it citizens but that is currently in jeopardy.
2. The cost of corruption -Again, a goal on par with providing security in Afghanistan is creating a government that Afghans actually want. The current one is plagued by corruption which either makes citizens indifferent between the state and the Taliban or drives them to the Taliban.
3. Winning and Losing - What does winning look like for NATO forces? The eradication of the Taliban and delivering a secure and stable Afghan state. What does winning look like for the Taliban? Not losing. To accomplish its goals (whatever they may be), the Taliban simply has to survive. It does not have to build a comprehensive infrastructure or eject NATO forces from the country, it just has to stay around long enough to erode NATO's will to be in Afghanistan. This is true of almost insurgencies that pressure of military victory only falls on the state. Time is on the side of the Taliban.
And another article on political institution building, security and corruption here
A couple notes:
1. Instability and Elections - as the articles discuss, if NATO forces can not provide sufficient security, the Afghan election committee will have close some rural polling stations for next Saturday's Parliamentary election. With a large portion of Afghanistan's population living in those rural areas, this exposes the election to claims of fraud and coercion. The investment-security argument may be complex but there is a direct cost politically for contested state rule in Afghanistan. Legitimate elections could improve the government's image among it citizens but that is currently in jeopardy.
2. The cost of corruption -Again, a goal on par with providing security in Afghanistan is creating a government that Afghans actually want. The current one is plagued by corruption which either makes citizens indifferent between the state and the Taliban or drives them to the Taliban.
3. Winning and Losing - What does winning look like for NATO forces? The eradication of the Taliban and delivering a secure and stable Afghan state. What does winning look like for the Taliban? Not losing. To accomplish its goals (whatever they may be), the Taliban simply has to survive. It does not have to build a comprehensive infrastructure or eject NATO forces from the country, it just has to stay around long enough to erode NATO's will to be in Afghanistan. This is true of almost insurgencies that pressure of military victory only falls on the state. Time is on the side of the Taliban.
Wednesday, September 8, 2010
Paper and Plastic
Yemen has been a welcome change from Egypt where sometimes it seemed impossible to find, well, change. During my time in Egypt, almost every monetary exchange turned into a battle of wills, pitting me against the cab driver or shop owner to see who would surrender their small bills in the transaction. While it created opportunities to talk, it also made life a wee bit stressful.
But Yemen. Oh Yemen. Such ills as the total absence of change are not to be found in this exchange paradise. Pay for a 50 Yr (Yemen riyal or less than 25 cents) bus ride with 1000 YR? No problem. The only misgiving I have so far is that 1000 YR is the largest bill in circulation meaning when it comes time to pay the rent, I feel like I stepped into a mobster movie where Uncle Donnie and Cousin Lou carry around the briefcase full of bills.
Turning to plastic, everything in Yemen is given to you in a plastic bag. If you buy eggs, you get two (for reinforcement). These bags cause a huge mess. Rogue plastic bags get hooked on tree branches, litter street curbs or can be seen taking a scenic flight on the breeze. A couple years ago, Kigali, the capital of Rwanda, placed a ban on plastic bags in an effort to clean up the city. Its citizens complained but the ban is still in place and Kigali is considered one of the cleanest African capitals. It has also paid dividends for the Rwandan environment.
Somehow, I don't think plastic bag use or the environment is on the top of any Adenese or Yemeni politician's list (or on the list for that matter) but at least on a superficial level, addressing plastic bag use would make the city prettier. I am interested to see if steps will be taken to clean the city in advance of Aden hosting the Gulf 20 Soccer Tournament in November.
But Yemen. Oh Yemen. Such ills as the total absence of change are not to be found in this exchange paradise. Pay for a 50 Yr (Yemen riyal or less than 25 cents) bus ride with 1000 YR? No problem. The only misgiving I have so far is that 1000 YR is the largest bill in circulation meaning when it comes time to pay the rent, I feel like I stepped into a mobster movie where Uncle Donnie and Cousin Lou carry around the briefcase full of bills.
Turning to plastic, everything in Yemen is given to you in a plastic bag. If you buy eggs, you get two (for reinforcement). These bags cause a huge mess. Rogue plastic bags get hooked on tree branches, litter street curbs or can be seen taking a scenic flight on the breeze. A couple years ago, Kigali, the capital of Rwanda, placed a ban on plastic bags in an effort to clean up the city. Its citizens complained but the ban is still in place and Kigali is considered one of the cleanest African capitals. It has also paid dividends for the Rwandan environment.
Somehow, I don't think plastic bag use or the environment is on the top of any Adenese or Yemeni politician's list (or on the list for that matter) but at least on a superficial level, addressing plastic bag use would make the city prettier. I am interested to see if steps will be taken to clean the city in advance of Aden hosting the Gulf 20 Soccer Tournament in November.
Sunday, September 5, 2010
The Chicken and the Egg of Stability
Check out these articles, one from the WSJ here:
And the other from the NYT here:
The WSJ article reports on new US aid to the Yemen military in an effort to combat Al-Qaeda's presence and influence in the Arabian Peninsula. It highlights a critical imbalance between military action and civilian development in Yemen and asks what must come first to prevent terrorism, investment or security. In Yemen, the US chooses to fund the Yemeni military although every military is historically a blunt public policy tool. Unfortunately, civilian development projects in Yemen have also been largely ineffective. Policy makers seem to be making the choice between guns and goods and are choosing guns. What if it is this policy choice of guns that makes Al-Qaeda attractive?
On a related note, the NYT article discusses waning faith and support among Afghan citizens for the Afghan government due to the blatant and rampant corruption. NATO, US and Afghan forces are struggling to establish security on behalf of a government that more and more people do not want. Foreign military forces may succeed in establishing security stability but the government will remain unappealing and the Taliban an attractive alternative. Security without an incentive does not create stability. Half of the equation is missing.
It is not clear what has to come first, development or security. The case of Afghanistan demonstrates, however, that it can be costly to try to find out.
And the other from the NYT here:
The WSJ article reports on new US aid to the Yemen military in an effort to combat Al-Qaeda's presence and influence in the Arabian Peninsula. It highlights a critical imbalance between military action and civilian development in Yemen and asks what must come first to prevent terrorism, investment or security. In Yemen, the US chooses to fund the Yemeni military although every military is historically a blunt public policy tool. Unfortunately, civilian development projects in Yemen have also been largely ineffective. Policy makers seem to be making the choice between guns and goods and are choosing guns. What if it is this policy choice of guns that makes Al-Qaeda attractive?
On a related note, the NYT article discusses waning faith and support among Afghan citizens for the Afghan government due to the blatant and rampant corruption. NATO, US and Afghan forces are struggling to establish security on behalf of a government that more and more people do not want. Foreign military forces may succeed in establishing security stability but the government will remain unappealing and the Taliban an attractive alternative. Security without an incentive does not create stability. Half of the equation is missing.
It is not clear what has to come first, development or security. The case of Afghanistan demonstrates, however, that it can be costly to try to find out.
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