Apr 17 2020

Mixed Feelings About the WHO

The World Health Organization (WHO) is one of those entities that are so essential if it didn’t exist it would need to be invented. But at the same time, it is a frustratingly flawed institution.  Some of those flaws are being highlighted during the Covid-19 pandemic. But the WHO is not alone in this – Covid-19 is an extreme stress on the system, and it is revealing multiple weaknesses. The big lesson I hope at least a majority of people take from this entire episode is that we actually need continuity of competent government.

The WHO is essential for establishing international standards of medical care, and helping deliver modern medicine to the developing world. They are a critical source of information on epidemiology, and often the first source I go to when researching a medical topic. They have become a critical trust of medical, public health, and epidemiological expertise. They are also critical in dealing with things like pandemics. Here is their list of their primary goals, but in short:

Our goal is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and well-being.

The WHO is a creature of the UN and came into existence in 1948 (just three years after the UN itself). They have 7,000 employees in offices in 150 countries. Ideally, an organization dedicated to health would be apolitical, nonpartisan, and heavily science-based. In a way the WHO represents the highest ideals of the UN – many nations getting together to cooperate for mutual benefit. But predictably it’s difficult to get so many different cultures and perspectives to collaborate seamlessly, and this has lead to what I consider some major problems with the WHO.

The WHO, in short, has let politics trump science. In the name of appeasing various countries it has kowtowed to their cultural beliefs, and put respect for “traditional” medicine above high standards of science-based medicine. In my opinion, this is an affront to their core mission and their very reason for existing. Perhaps most outrageous was then they straight-up endorsed traditional Chinese quackery. They wrote:

The goal of this policy “is to promote the safe and effective use of traditional medicine by regulating, researching and integrating traditional medicine products, practitioners and practice into health systems, where appropriate”.

But we have heard this defense before – you cannot regulate nonsense. You cannot mix quackery with real medicine without destroying the scientific standards of medicine. This move only served to validate unscientific medicine. I cannot tell you how many times people have used the WHO position to justify their own use or endorsement of quackery, both personally and institutionally. It has had the exact effect that we warned about.

And yes, the WHO has in particular a “China problem.” As an otherwise gullible Nature article notes:

The WHO’s support applies to all traditional medicines, but its relationship with Chinese medicine, and with China, has grown especially close, in particular during the tenure of Margaret Chan, who ran the organization from 2006 to 2017.

If you doubt that TCM is harmful nonsense, here is a brief example from that same Nature article.

For example, ‘wasting thirst syndrome’ is characterized by excessive hunger and increased urination and explained by “factors which deplete yin fluids in the lung, spleen or kidney systems and generate fire and heat in the body”. On the basis of those observations, physicians can work out how to treat them. The patient, who would probably be diagnosed as diabetic by a Western doctor, would probably be prescribed acupuncture, various tonics and moxibustion — in which practitioners burn herbs near the skin of the patient. Spinach tea, celery, soya beans and other ‘cooling’ foods would also be recommended.

If you have out-of-control diabetes, with blood sugar so high the glucose is spilling into your urine, drawing out more water through osmosis, causing excessive thirst and urination, the WHO thinks it’s OK that you are diagnosed with “wasting thirst syndrome” and treated with acupuncture and tonics. That is not health care justice. That is dangerous malpractice by any reasonable standard. So what the WHO is saying is that, for some people, it’s OK to be grossly mismanaged, even during an acute severe and potentially life-threatening illness, as long as it is in line with local traditions (and promoting Chinese cultural hegemony doesn’t hurt).

Isn’t this exactly what the WHO is supposed to be fighting – a double standard where those from industrialized nations have access to science-based effective medicine and those from developing nations are exploited by quacks (even though many in developed nations choose to be exploited by quacks – at least they have a choice)?

I acknowledge this can be a tricky area. There is a way to respect local culture, incorporate local healers and practitioners, while still maintaining a high standard of effective and ethical medicine. But I don’t care if it’s tricky – that is exactly what the WHO should be expert in. That is exactly in the bulls eye of their mandate – they should be cultivating expertise in exactly that goal.

I don’t know if this problem, and particularly their obsequiousness with China, impaired their response to the Covid-19 outbreak staring in Wuhan. When the dust settles there will need to be an investigation and a reckoning. This is also a standard part of medical practice – reviewing what happened, brutally outlining what went wrong, but all for the purpose of doing things better going forward. Science and medicine require criticism, but constructive criticism. The WHO needs to seriously review its policies and stance toward the primacy of the scientific basis for medicine and get much better at dealing with the political background in which it operates.

But even with all its flaws, the WHO is an essential organization that needs to exist, and even thrive. Defunding the WHO in the middle of a pandemic is reckless and dangerous. What we need to do is make the WHO better, not make it harder for it to do its job. If the pandemic teaches us one thing, disease is global. Our response to it must also be global, and that requires an organization like the WHO.

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