Explainer: Where were you in the #wormwars?
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Version 0 of 1. What’s it all about? It was supposed to be a magic bullet that would get under-privileged children in full health and into school. But in the last few weeks a row has broken out over just how useful mass ‘de-worming’ really is. Two weeks ago newspapers reported that accepted wisdom about mass deworming had been “debunked” by research which re-examined an influential study in Kenya in the 1990s. The London School of Hygiene & Tropical Medicine looked at the original raw data and found several errors, holes and inconsistencies, throwing doubt on the conclusion that deworming led to more children going to school. “The belief that deworming will impact substantially on economic development seems delusional,” commented Liverpool School of Tropical Medicine’s Professor Paul Garner. The news prompted furious ping-ponging of blogs and tweets, initiating the #wormwars. Why does it matter? Approximately 2 billion people worldwide suffer from intestinal parasitic worms, according to the WHO. This causes internal bleeding, loss of iron and anaemia, malabsorption of nutrients, diarrhoea and loss of appetite. Related: Every dollar spent on childhood nutrition can save up to $166 The negative effects of worms on child nutrition, health and development are well established. What has become less clear in the last couple of weeks is whether mass school deworming programmes are the “magic bullet” low-cost high-impact intervention that they have been heralded as by the development establishment: the World Bank, Cherie Booth Blair and the Copenhagen Consensus. What did global development bloggers say? Most bloggers called for a calm response to the news (ironically contributing to the furore). Some posts blame the media for exaggerating the significance of the new research. On the Centre for Global Development blog Michael Clemens and Justin Sandefur said the Guardian was wrong to use “debunk” in the headline. “New information about the original deworming study qualifies its findings, but certainly does not ‘debunk,’ ‘overturn,’ or negate its findings,” they wrote. “Donors should remain open to and encourage new evidence but should not shift their priorities on deworming in response to this episode.” Paul Gertler, professor at Haas School of Business and School of Public Health, described the “media frenzy” as “a major step backward in global health”. Columbia University political scientist Chris Blattman provided a helpful summary in his blogpost entitled The 10 things I learned in the trenches of the Worm Wars. He wrote that the “hive mind” of scientist and development professionals had concluded the original “Kenya deworming results are relatively robust”. Blattman finds the intersection between media and science “problematic” and for him the “real tragedy” is that there hasn’t been more large-scale studies on the impacts of deworming. “This is not some schmuck cause,” he wrote. “This is touted as one of the most promising development interventions in human history.” What does it mean for development programmes? Charity research non-profit Give Well gave a rapid and detailed response that stated: “Our current view is that these new papers do not change our overall assessment of the evidence on deworming.” This was concurred by Clemens and Sandefur who wrote: “We feel the policy case for mass deworming is largely unchanged after the latest kerfuffle.” What does it mean for science? The impact appears more significant for researchers than development policymakers, at least in the short term. Science writer Ben Goldacre wrote a comprehensive piece on the controversy in which he calls it a “pivotal point in history”. Goldacre is clear that the new research has found serious errors in the original study, and that this is not likely to be a blip. “There is only one thing different about this deworming trial and the rest of social science and medicine,” he wrote. “Miguel and Kremer had the decency, generosity, strength of character, and intellectual confidence to let someone else peer under the bonnet.” If, as Goldacre recommends, more studies are re-analysed in the same way, there could be wider repercussions for global development programmes. “This is the beginning of a massive, and long overdue, culture shift,” Goldacre concludes. Join our community of development professionals and humanitarians. Follow@GuardianGDP on Twitter. |