Global impact

Sorry for the absence. Frankly, I've felt that writing about quotidian subjects is somehow futile or beside the point. Truth and logic no longer matter in the making of policy. But, I suppose life must go on.

We Americans are often too self-obsessed and don't bother to know or understand much about the rest of the world. On the other hand, the U.S. does matter, a lot. Reading the new BMJ (British Medical Journal) illustrates the point. It's as much about the U.S. as it is about Britain.

For example, there's Travel ban threatens medical research and access to care in the US, medical groups warn. This tells the story of a resident physician at the Cleveland Clinic who was refused re-entry because she holds a Sudanese passport.

Nitin S Damle, president of the American College of Physicians, said that foreign physicians and medical students working in the US have to be “thoroughly vetted” to obtain their visas. The order was “discrimination based on religion” and should be rescinded, he said. “If the executive order is not permanently rescinded, blocked by the courts, or reversed by Congress, it will hinder the free exchange of information and travel among doctors around the world,” he said.

The president and chief executive of the Association of American Medical Colleges, Darrel C Kirch, said that international graduates played an essential role in US healthcare, accounting for 25% of the workforce, and that the ability of the US to attract top talent to its medical centers had helped make it a global leader in medical research. “Because disease knows no geographic boundaries, it is essential to ensure that we continue to foster, rather than impede, scientific cooperation with physicians and researchers of all nationalities, as we strive to keep our country healthy,” he said.

Then there's this, on the proposed of a bilateral trade deal between the U.S. and Britain which the "president' is pushing to facilitate the breakup of the E.U. Doesn't sound like a bad thing, right? Well, it's a bit complicated, but it could be very bad for Britain, given the highly unequal negotiating power between two economies of such disparate size. Read if you want to get a little more sophisticated about trade.

Then there's the global gag rule. Republican presidents always forbid U.S. funding of agencies abroad that make referrals for abortion or even discuss it with patients. But the "president" has gone beyond George W. Bush's version to extend it to all U.S. departments and agencies, not just AID, including the CDC, NIH and FDA.

The administrative burdens of implementing this rule, on both US agencies and aid recipients, could be very large. Such rules are likely to prevent the US from effectively tackling a problem like the Zika virus.

The consequences of this action can be expected to be widespread and contrary to the stated intent of the rule. If the goal of this policy is to reduce the number of abortions worldwide, then it will fail. Countries exposed to the gag rule show a rise in abortion rates when the rule is in effect and a reduction when it is not.2 Policies that curtail investments into comprehensive family planning programmes reduce the outreach of these programmes to the rural areas where the majority of people in sub-Saharan Africa live.

By limiting women’s access to modern contraception, the rate of unwanted pregnancies rises. In this situation women will often turn to abortion.

Reducing access to abortion and contraception results in shorter birth intervals, which negatively impact the health of women and their children and result in higher levels of child malnutrition.3 Rather than improving the health of women and children in the world’s poorest countries, the global gag order increases maternal and child morbidity and mortality.

In short, making policy based on ignorance and prejudice is usually not a good idea.