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Balancing risks on the backs of the poor

Malaria kills over one million people, mainly children, in the tropics each year, and DDT remains one of the few affordable, effective tools against the mosquitoes that transmit the disease. Attaran et al. explain that the scientific literature on the need to withdraw DDT is unpersuasive, and the benefits of DDT in saving lives from malaria are well worth the risks.

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Figure 1: Cumulative malaria cases derived from Pan-American Health Organization data for Brazil, Colombia, Peru, Ecuador and Venezuela.

References

  1. World Health Organization. Document SDE/PHE/DP/02 (1999).

  2. United Nations Environment Programme Governing Council. Decision 19/13C (7 February 1997).

  3. http://www.malaria.org/DDTpage.html

  4. Metcalf, C.L. & Flint, W.P. Destructive and Useful Insects: Their Habits and Control 4th edn. (McGraw-Hill, New York, 1962).

    Google Scholar 

  5. Roberts, D. R. et al. DDT, global strategies and a malaria control crisis in South America. Emerg. Infect. Dis. 3, 295– 302 (1997).

    CAS  Article  Google Scholar 

  6. International POPs Elimination Network platform. http://www.ipen.org/pops_platform.htm.

  7. World Health Organization and United Nations Environment Programme. Environmental Criteria No. 9. (World Health Organization, Geneva, 1979).

  8. Kouznetsov, R. L. Malaria control by application of indoor spraying of residual insecticides in Tropical Africa and its impact on community health. Trop. Doct. 7, 81–91 (1977 ).

    CAS  Article  Google Scholar 

  9. Chareonviriyaphap, T. et al. Pesticide avoidance behavior in Anopheles albimanus, a malaria vector in the Americas. J. Amer. Mosquito Control Assoc. 13, 171–183 (1997).

    CAS  Google Scholar 

  10. Grieco, J.P. et al. A comparison of house entering and exiting behavior of Anopheles vestitipennis using experimental huts sprayed with DDT or deltamethrin in the southern district of Toledo, Belize. J. Vector Ecol. 25, 62–73 (2000)

    CAS  PubMed  Google Scholar 

  11. De Zuleta, J. et al. Deterrent effect of insecticides on malaria vectors. Nature 200, 860–861 ( 1963).

    Article  Google Scholar 

  12. World Health Organization Expert Committee on Malaria. Seventeenth Report. World Health Organ. Tech Rep. Ser. 640 (1979).

  13. Macdonald, G. The Epidemiology and Control of Malaria (Oxford University Press, Oxford, 1957)

    Google Scholar 

  14. Roberts, D. R. et al. A probability model of vector behavior: effects of DDT repellency, irritancy, and toxicity in malaria control. J. Vect. Ecol. 25, 48–61 (2000).

    CAS  Google Scholar 

  15. Physicians for Social Responsibility. The Modern Malaria Control Handbook (Physicians for Social Responsibility, Washington, 1999).

  16. World Wildlife Fund. Resolving the DDT Dilemma (World Wildlife Fund, Toronto, 1998).

  17. Wolff, M.S. et al. Blood levels of organochlorine residues and risk of breast cancer. J. Natl. Cancer Inst. 85, 648– 652 (1993)

    CAS  Article  Google Scholar 

  18. Krieger, N. et al. Breast cancer and serum organochlorines: a prospective study among white, black, and Asian women. J. Natl. Cancer Inst. 86, 589–599 (1994)

    CAS  Article  Google Scholar 

  19. Schecter A. et al. Blood levels of DDT and breast cancer risk among women living in the north of Vietnam. Arch. Environ. Contam. Toxicol. 33, 453–456 (1997)

    CAS  Article  Google Scholar 

  20. Hunter D.J. et al. Plasma organochlorine levels and the risk of breast cancer N. Engl. J. Med. 337, 1253– 1258 (1997).

    CAS  Article  Google Scholar 

  21. Lopez-Carillo L. et al. Dichlorodiphenyltrichloroethane serum levels and breast cancer risk: a case control study from Mexico. Caner Res. 57, 3728–3732 (1997)

    Google Scholar 

  22. Moysich K.B. et al. Environmental organochlorine exposure and postmenopausal breast cancer risk. Cancer Epidemiol. Biomarkers Prev. 7, 181–188. (1998)

    CAS  PubMed  Google Scholar 

  23. Zheng T. et al. DDE and DDT in breast adipose tissue and risk of female breast cancer. Am. J. Epidemiol. 150, 453– 458 (1999)

    CAS  Article  Google Scholar 

  24. van't Veer P. et al. DDE and DDT (dicophane) and postmenopausal breast cancer in Europe: case-control study. Brit Med. J. 315, 81–85 (1997)

    CAS  Article  Google Scholar 

  25. Helzlsouer K.J. et al. Serum concentrations of organochlorine compounds and the subsequent development of breast cancer. Cancer Epidemiol. Biomarkers Prev. 8, 525–532 ( 1999).

    CAS  PubMed  Google Scholar 

  26. Longnecker M. P. et al. The human health effects of DDT and PCBs and an overview of organochlorines in public health. Annu. Rev. Pub. Health 18, 211–244 (1997)

    CAS  Article  Google Scholar 

  27. Baris, D. et al. Agricultural use of DDT and risk of non-Hodgkin's lymphoma: pooled analysis of three case-control studies in the United States. Occup. Environ. Med. 55, 522–527 (1998).

    CAS  Article  Google Scholar 

  28. Gladen, B. C. et al. DDE and shortened duration of lactation in a northern Mexican town. Am. J. Pub. Health 85, 504– 508 (1995).

    CAS  Article  Google Scholar 

  29. World Health Organization. Document SDE/PHE/DP/04 (1999).

  30. Goodman, C.A. et al. Cost-effectiveness of malaria control in sub-Saharan Africa . Lancet 354, 378–385 (1999).

    CAS  Article  Google Scholar 

  31. Goodman, C.A. et al. The evidence base on the cost-effectiveness of malaria control measures in Africa. Health Policy Planning 14, 301–312 (1999)

    CAS  Article  Google Scholar 

  32. Gallup, J. L., Sachs J. D. The Economic Burden of Malaria (Harvard Center for International Development, 1998), http://www.hiid.harvard.edu/pub/other/mal_wb.pdf

    Google Scholar 

  33. Mouchet, J. et al. Evolution of malaria in Africa for the past 40 years: impact of climatic and human factors. J. Am. Mosq. Control Assoc. 14, 121–130 (1998).

    CAS  PubMed  Google Scholar 

  34. The Abuja Declaration on Roll Back Malaria in Africa. http://www.rbm.who.int (25 April 2000).

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Acknowledgements

The views expressed are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense or the United States Government.

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Attaran, A., Roberts, D., Curtis, C. et al. Balancing risks on the backs of the poor. Nat Med 6, 729–731 (2000). https://doi.org/10.1038/77438

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