I Give In: I Finally Bought Malaria Medicine

Today, I moved. I am much happier in my new residence, a student hostel next the La Universidad de Los Andes. It's the best hostel I have ever seen. In a place like Colombia the people who come and stay in hostels are very intersting, but it is also very well run. Free coffe, Hammocks, patios, and balconies in a very old colonial building. I can see the kitchen below me through the spaces betwen the old planks of wood on the floor. It's also directly downtown in the colonial district, much better than the boring but safe suburb I was in. I think this was a good decision. In other news, I still have a headache that is the result of staying at various salsa clubs until 7 am. Colombians can dance. Well. And for a long time. When I woke up this morning (afternoon?) I tried to calculate how many beers I must have hade in the 10 hours I was out last night. For a variety of reasons I could not even estimate. I still don't have an apartment in New York. If anyone is reading this and has an apartment that they don't want, LET ME KNOW. I was reading The Short Happy Life of Francis Macomber--decidedly my favorite Ernest Hemmingway short story and the only reading in English I have with me--and found a quote I rather like that I think about a lot in Colombia. In general it's a good world view, to realize that the worst thing that can happen to you is death. It's Shakespeare, I think from King Henry IV: "By my troth, I care not; a man can die but once; we owe God a death and let it go which way it will, he that dies this year is quit for the next." It's a helpful way to think about a world where you need to have firm opinions on taking risks.

Speaking of which, I am going to the Amazonian town of Letcia soon. I don't know when. But it's a tiny town on the borders with Brazil and Peru. I'm going to go to the Brazilian embassy first to present FINGER PRINTS to get a visa to visit Brazil. Americans have to do this. Brazil made this law after America required the same of Brazillians. I think it's pretty funny, but I'm sort of upset that it's so hard to get a visa. If I do get one in time, I am going to rent a hammock on a boat that runs down and through the Amazon from Leticia to Manaus. I think it will be sweet. I´m actually going to buy malaria pills.

As you may know, I think malaria pills are a scam. Doctors and, mostly, pharmasutical companies, advise you take them everyday if you leave the euro-american bubble. In the states, due to the monopoly rights that patents grant, you pay an ENORMOUS amount for them. When we went to India last summer my friends paid upwards of $200 (After the Insurance contribution) for drugs that they were told to take the entire time we were in India. First, the same drugs in India cost no less than ten dollars for a months supply.

More importantly, there are a billion people living in India, almost none of whom take malaria medication regularly. Most are fine--or at least malaria is the least of their problems. They are not somehow imune to the illness, they have the same suceptability that anyone else does. It's just, in most places, exceedingly unlikely you will get malaria. You have to be bitten by a female member of a very specific and uncommon species of misquito that is only active for an hour a day (sundown) and lives in swamps. Yet almost all doctors, the AMA, and the US Department of Health advise good idea to take anti-malarials in Bombay, Bogotá, or other enormous, poor city.

In my mind, there are two reasons for this, both are incentives problems. The first is that, you Doctor, the AMA, and the Department of Health only care about your health, not about you more generally. That means, they have nothing to gain from saving you two hundred dollars and taking a very minor risk. But they would be in a bad place if they advised you not to take an anti-malarial and you got malaria. In many places, people would be better of spending the same $200 taking other safety measures (like flying instead of taking a bus through Colombia). Gurillas are a much greater threat than Malaria in the country at large.

The second reason is that drug companies are a very organized group with clear incentives. They want you to take drugs, and they can easily target your doctor or the health department trying to get them to advocate your case. There is no organized group of people in whose interest it is that you not take malaria drugs when they are not necessary. By saving some $200 and spending it somewhere else, you certainly help people. But you help commerce in general and no single industry can expect to see a big difference in their profits if they save you $200 every time you go on vacation. It's not worth any one persons time to tell doctors and the health department when anti-malarials are not worthwile investments.

I don't want to make it sound like Malaria is not a problem in the world. It's a big problem for a lot of people. Most of these people live in impoverished, rural places where a misquito net is an absolute necesity that many cannot afford. For these people, unlike tourists with the means to travel to the third-world, Malaria is fatal. For wealthy tourists it is certainly unplesant and inconvenient and can be fatal if not treated, but because they have access to superior medical care, the disease is almost never deadly.

But tourists are seldom infected even in the absence of anti-malarials because they tend to travel to cities, and it has never been a very good idea to build large cities in places with serious malaria problems. The better way to think about this is that malaria investations have always prevented towns from becoming large cities.

And on top of tourists having a small risk of contracting a disease that is, to them, not very dangerous, malaria medicine doesn't work very well at all. To give you an idea, the most popular anti-malarial in Latin America, Chloroquine, is as effective as a heavy regemine of gin and tonic as quinine is the active ingredient in both. (though modern tonic water does not contain nearly enough quinine. But you can, evidently, put Cinchona bark in brandy for a few hours to make a drink that has about two grams of quinine, the same a Chloroquine. says this website: http://www.thetraveldoctor.com.au/gin_tonic.html)

But for the first time, I am going somewhere (the rural Amazon) where malaria medicine is a good idea and people should take it. I give in.

Oh, but the line about 'you should never trust drugs from other countries' that my doctor read to me from a script that I presume Pfizer provides is complete nonesense. The United States is a net importer of pharmaceuticals where as India is a next exporter. http://www.piribo.com/publications/country/usa_canada/usa/usa_intell.html