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Brain drain is a hidden tax on the countries left behind

India, Nigeria, Pakistan and South Africa lose thousands of trained doctors each year, lured away to work in richer countries – at great cost to their nation’s healthcare systems.

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Many doctors and healthcare staff feel the need to practice in richer countries that offer a more stable politics, better education and opportunities for their families. Julien Harneis, CC BY-SA

Dr John Baptist Mukasa, or JB Neuro, as his colleagues called him, “was always at the beck and call of everyone who needed neurosurgical care”, according to his colleague Dr Sabrina Kitaka. Mukasa’s death from COVID on June 29, in the middle of Uganda’s most lethal wave so far, robbed the country’s medical fellowship of a friend and a mentor.

It also cut the total number of neurosurgeons in Uganda by 25%.

Only three neurosurgeons remain in Uganda, a country of 44 million people (although some estimates put the workforce as high as ten). By comparison, Canada, with a population of 35 million, has over 150 neurosurgeons. New York City’s Columbia Presbyterian Hospital, where I did my residency, has 17 neurosurgeons in one department alone – several times larger than the entire neurosurgical workforce of Uganda.

There are many reasons for this disparity, including a lack of training facilities and hospitals capable of supporting complex surgical care. And then there’s the brain drain – the migration of trained professionals out of a country to other, often wealthier, locations.

Brain drain is taxation

There are many reasons doctors leave. A higher salary, access to education, stable political conditions, improved standards of living, increased perceived quality of life, and greater personal safety all draw doctors away from their homes and often to countries that previously colonised theirs.

It’s a multi-billion–dollar industry. Recently, my colleagues and I published an estimate of the economic effect of the migration of doctors (we didn’t have enough information to look at the migration of nurses or other health professionals). We found that countries lose somewhere between US$3.5 billion and US$38 billion a year as a result of the excess deaths that brain drain causes. The countries exporting the greatest number of doctors incur the largest costs: India, Nigeria, Pakistan and South Africa.

In other words, not only do the countries to which doctors migrate benefit from an influx of trained, experienced professionals, they also inflict what is essentially a tax on the economies of source countries — all for the privilege of attracting away their clinical staff.

Map showing main routes of migration by doctors from the developing to the developed world.
Migration of doctors from source (orange) countries to destination (green) countries. Saluja, Rudolfson, Massenburg, Meara, Shrime/BMJ Global Health, CC BY-NC

Brain drain and COVID

In 2010, the World Health Organization agreed the Global Code of Practice on the International Recruitment of Health Personnel. This agreement encouraged source countries to hold onto their healthcare workforce by improving education, living standards and working conditions (it didn’t address how this could be achieved in the face of limited resources). The agreement also required destination countries to stop recruiting from countries with a shortage of healthcare workers.

But that never happened. In fact, at the beginning of the COVID pandemic, active recruitment of doctors from these source countries stepped up as the scale of the crisis became clear.

COVID initially hit developed countries hard, pummelling Italy, Spain and New York City, and leaving countries in Africa relatively unscathed. It seemed pretty miraculous, prompting commentators to offer reasons for Africa’s relative success.

Calls rose for medical professionals from resource-constrained regions to help shoulder the burden of the pandemic in developed countries — flying in the face of the WHO agreement. These calls went beyond simple recruitment. Some offered additional incentives to entice doctors to stay: for example, the UK fast tracked registration of doctors trained outside the country.

Now that the pandemic has swung back to ravage Africa, India and other parts of the developing world, this is a favour that developing countries have not returned.

Since I began writing this piece, Uganda also lost a 36-year-old ENT surgeon, Dr Ian Bwete Apuuli. During the pandemic, he performed tracheotomies on COVID patients, allowing them the chance to breathe without ventilation. But tracheotomies generate aerosols, and aerosols carry infection. Apuuli succumbed to the disease, leaving Uganda with only one surgeon trained to remove tumours from the head and neck.

The brain drain of healthcare workers from countries that can scarcely afford to lose them is not an emotionless, economic discussion. When we actively entice doctors not just to come and help, but to and come and stay, the effect is more than temporary. It is more than monetary. It undermines the entire health systems of the countries these doctors leave behind.

Mark Shrime receives funding from the Iris O'Brien Foundation and is on the board of Pharos Global Health Advisors.

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Fauci Net Worth Soared 66% During Pandemic

Fauci Net Worth Soared 66% During Pandemic

The net worth of Dr. Anthony Fauci’s household soared a whopping 66% over the course of the pandemic,…

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Fauci Net Worth Soared 66% During Pandemic

The net worth of Dr. Anthony Fauci's household soared a whopping 66% over the course of the pandemic, according to new financial disclosures obtained by OpenTheBooks.com. Fauci reported a Jan 1, 2019 net worth of $7,523,634. By Jan 1, 2022, it had grown to $12,677,513.  

Values are as of Jan 1 each year. Chart via OpenTheBooks.com

As director of the National Institute of Allergy and Infectious Diseases, Fauci was paid a 2021 salary of $456,028, making him the highest-paid employee in the entire federal government. His wife, Christine Grady, is chief bio-ethicist for the National Institutes of Health, does very well too, raking in a $238,970 salary last year.

Fauci is famously paid more than the president, and his wife collects more than the vice president. However, those hefty federal salaries aren't the only driver of the Fauci household's pandemic-era enrichment.

In 2021, Fauci was awarded the Tel Aviv University-affiliated Dan David Prize, which came with a $1 million check. The prize committee said Fauci "has been widely praised for his courage in speaking truth to power" during the Covid-19 pandemic.

The committee was apparently oblivious that Fauci was the power and routinely spoke falsehoods about everything from the usefulness of masking to herd immunity, the efficacy of vaccines, and NIH funding of gain of function research at the Wuhan Institute. 

As is customary, Fauci donated some of his prize money back to be awarded as student scholarships, but still pocketed $901,400, according to the financial statements reviewed by OpenTheBooks.com. 

Though it's chump change compared to the Dan David Prize, Fauci also scored $12,500 from both the Elliot Richardson Prize in Public Service and the Abelson Prize from the American Association for the Advancement of Science, and got $5,198 when he was named Federal Employee of the Year at the 2020 Samuel J. Heyman Service to America Medals ceremony.  

Fauci even did some moonlighting as an editor for McGraw Hill, taking home $100,000 for his work in 2021. 

There's no indication Fauci made any "shrewd" investments a la Nancy and Paul Pelosi. According to the financial disclosures, Fauci's portfolio comprises broad mutual funds with no individual stocks: 

"These funds were held in a mix of trust, retirement, and college education accounts. Fauci has an IRA worth $706,219 (up $67,700); a defined benefit brokerage account totaling $2,551,210 (up $147,688); and a revocable trust worth $7,014,197 (up $1,718,299). His wife’s revocable trust is worth $2,269,225 (up $306,406) and an IRA totaling $136,662 (up $16,385)," reports OpenTheBooks.com. 

OpenTheBooks.com has filed four federal lawsuits against NIH to pry loose additional details not only about Fauci but also about royalties received by other NIH employees.  

Though Fauci has announced he'll retire by the end of the year, the wheelbarrows full of taxpayer money will keep on rolling his way. When you're the highest-paid employee in federal government history and you've been on the federal payroll for more than 55 years, that'll make for an astounding pension of some $375,000 a year. 

It's emblematic of the whole miserable Covid-19 spectacle: Bureaucrats wallow in government money while ordinary people suffer the ever-mushrooming destruction caused by public health's catastrophic lockdown and mandate regime.  

Tyler Durden Thu, 09/29/2022 - 23:20

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This Thanksgiving, Supplies Of Turkey, Eggs, & Butter Will Be Extremely Tight In The US

This Thanksgiving, Supplies Of Turkey, Eggs, & Butter Will Be Extremely Tight In The US

Authored by Michael Snyder via The Economic Collapse…

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This Thanksgiving, Supplies Of Turkey, Eggs, & Butter Will Be Extremely Tight In The US

Authored by Michael Snyder via The Economic Collapse blog,

If you love to cook, this upcoming Thanksgiving may be a real challenge for you.  Thanks to a resurgence of the bird flu, supplies of turkey are getting tighter and tighter.  Sadly, the same thing is true for eggs.  And as you will see below, reduced milk production is sending the price of butter into the stratosphere.  Thanks to soaring prices, a traditional Thanksgiving dinner will be out of reach for millions of American families this year, and that is extremely unfortunate.  Of course all of this is happening in the context of a horrific global food crisis that is getting worse with each passing day.  Yes, things are bad now, but they will be significantly worse this time next year.

The bird flu pandemic that has killed tens of millions of our chickens and turkeys was supposed to go away during the hot summer months, but that didn’t happen.  And now that the weather is starting to get colder again, there has been a resurgence of the bird flu and this is “devastating egg and turkey operations in the heartland of the country”

Turkeys are selling for record high prices ahead of the Thanksgiving holiday as a resurgence of bird flu wipes out supplies across the US.

Avian influenza is devastating egg and turkey operations in the heartland of the country. If just one bird gets it, the entire flock is culled in order to stop the spread. Millions of hens and turkeys have been killed in recent weeks. As a result, prices for turkey hens are nearly 30% higher than a year ago and 80% above pre-pandemic costs. Just as concerning are inventories of whole turkeys, which are the lowest going into the US winter holiday season since 2006. That means there will be little relief from inflation for Thanksgiving dinner.

In the months ahead, we could see tens of millions more chickens and turkeys get wiped out.

Egg prices have already tripled in 2022 and the price of turkey meat is up 60 percent.  Unfortunately, this is likely just the beginning

Turkey hens are $1.82 a pound this week, according to Urner Barry, compared to $1.42 last year and $1.01 before the pandemic. Meanwhile, wholesale egg prices are at $3.62 a dozen as of Wednesday, the highest ever, up from a previous record of $3.45 a dozen set earlier this year, said John Brunnquell, chief executive officer of Egg Innovations, one of the biggest US producers of free-range eggs. Consumers have seen prices for eggs at grocery stores triple this year, while turkey meat rose a record-setting 60%, according to a Cobank report.

Meanwhile, supplies of butter are steadily getting tighter as well

Lower milk production on U.S. dairy farms and labor shortages for processing plants have weighed on butter output for months, leaving the amount of butter in U.S. cold storage facilities at the end of July the lowest since 2017, according to the Agriculture Department.

Tight supplies have sent butter prices soaring at U.S. supermarkets, surpassing most other foods in the past year. U.S. grocery prices in August rose 13.5% during the past 12 months, the largest annual increase since 1979, according to the Labor Department. Butter outstripped those gains, rising 24.6% over the same period.

The trends that are driving up the price of butter aren’t going away any time soon, and so we are being warned to brace ourselves for “elevated” prices for the foreseeable future…

The forces at work in butter highlight the challenge of curtailing inflation. Economic pressures fueling high prices for livestock feed, labor shortages and other factors could persist, keeping prices for the kitchen staple elevated longer term.

To me, slathering a piece of warm bread with a huge chunk of butter is one of the best things about Thanksgiving.

And most of us will continue to buy butter no matter how high it goes.

But the truth is that rapidly rising food prices are forcing vast numbers of Americans to adjust their shopping habits.  Here is one example

For Carol Ehrman, cooking is a joyful experience.

“I love to cook, it’s my favorite thing to do,” she said. She especially likes to cook Indian and Thai food, but stocking the spices and ingredients she needs for those dishes is no longer feasible. “When every ingredient has gone up, that adds up on the total bill,” she said.

“What used to cost us $250 to $300 … is now $400.” Ehrman, 60, and her husband, 65, rely on his social security income, and the increase was stretching their budget. “We just couldn’t do that.”

The global food crisis is starting to hit home for many ordinary Americans, and we need to understand that this crisis is still only in the very early chapters.

David Beasley is the head of the UN World Food Program, and he is actually using the word “hell” to describe what is potentially coming in 2023

“It’s a perfect storm on top of a perfect storm,” Beasley said. “And with the fertilizer crisis we’re facing right now, with droughts, we’re facing a food pricing problem in 2022. This created havoc around the world.”

“If we don’t get on top of this quickly — and I don’t mean next year, I mean this year — you will have a food availability problem in 2023,” he said. “And that’s gonna be hell.”

The World Food Program keeps sounding the alarm, but very few of us in the western world seem to be taking those warnings very seriously.

People are literally dropping dead from starvation in some areas of the globe right now, and a new report that the WFP just released says that there are 19 “hotspots” where we could see a “huge loss of life” between October and January…

World Food Programme (WFP) and the Food and Agriculture Organization of the United Nations (FAO) are out with a new report outlining countries that “are either already starving or on the brink of disaster.”

WFP and FAO found 19 hunger hotspots worldwide, with most countries in Africa, the Middle East, and even some in Central America. They call for urgent humanitarian action between October 2022 and January 2023 to avoid “huge loss of life.”

Afghanistan, Ethiopia, South Sudan, Somalia, Nigeria, Yemen, and Haiti are labeled “hotspots of highest concern,” facing catastrophic hunger levels.

The sort of famines that we were warned about are already starting to happen right in front of our eyes, but most people simply will not care as long as they are not going hungry themselves.

What those people do not realize is that this global food crisis is going to continue to spread.

As supplies of food get tighter and tighter, prices will continue to soar and shortages will become more common.

We truly are in unprecedented territory, and the pain that is ahead will greatly shock all of the lemmings that just kept assuming that everything would work out just fine somehow.

*  *  *

It is finally here! Michael’s new book entitled “7 Year Apocalypse” is now available in paperback and for the Kindle on Amazon.

Tyler Durden Thu, 09/29/2022 - 21:40

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Computers calling time on isolation

Kyoto–Across the world, many people infected with Covid-19 have been made to completely isolate from others in order to avoid passing on the infection….

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Kyoto–Across the world, many people infected with Covid-19 have been made to completely isolate from others in order to avoid passing on the infection. Some countries still recommend minimum isolation periods for as long as 10 days from when patients start to develop Covid-19 symptoms.

Credit: LAIMAN

Kyoto–Across the world, many people infected with Covid-19 have been made to completely isolate from others in order to avoid passing on the infection. Some countries still recommend minimum isolation periods for as long as 10 days from when patients start to develop Covid-19 symptoms.

Professor Shingo Iwami, affiliated with Kyoto University’s Mathematical Biology Laboratory at the Institute Advanced Study of Human Biology (WPI-ASHBi) says, “Although a long time for isolation reduces the overall risk of patients passing on the infection, there will always be patients who recover early and have to accept several days of redundant isolation while no longer posing an infection risk. We would like to calculate a way to reduce this unnecessary disruption in people’s lives as well as the broader losses for the economy.”

Writing in the journal Nature Communications, an international team of scientists, led by Iwami, has reported a simulation of the potential risks and benefits of ending an individual’s isolation early using antigen tests instead of isolating patients for a fixed time. They call for more sensitive and regular antigen testing to help reduce isolation periods for patients recovering from Covid-19.

The team decided to base their model on antigen rather than PCR testing, trading sensitivity for short turn-around time, low cost, and practicality. Iwami explains that although antigen tests do have a risk of generating “false-negatives” and fail to detect individuals who could still be infectious, there are clear benefits to getting results within an hour rather than waiting a day.

Their model accounts for the sensitivity of antigen tests as well as factors like the amount of virus in a patient that makes them infectious. These are then balanced against the acceptable risk of missing unrecovered and potentially infectious patients, by letting them out of isolation early.

Using their model, the team compared different scenarios to identify the best strategy. For example, the model projects that letting a recovering patient leave isolation after 2 consecutive negative results on 2 days in a row would spend 3.9 days of redundant isolation after their recovery. But under these conditions 1 in 40 patients would continue to pose an infection risk.

More conservative approaches might increase the burden on patients by requiring more than 2 consecutive negative test results of antigen tests.

Iwami says, “The epidemic has still not completely subsided, and we are living with a lot of uncertainty with regard to new variants of the virus. Antigen tests could help, but there is also a real need for worldwide systematic guidelines that simultaneously reduce risks and burdens. We hope this simulator will help doctors and policy makers meet those demands.”

******************
About WPI-ASHBi https://ashbi.kyoto-u.ac.jp/
Institute for the Advanced Study of Human Biology (ASHBi) was launched in October 2018 with funding from the World Premier International Research Center Initiative (WPI) Program of the Ministry of Education, Culture, Sports, Science and Technology (MEXT). The Institute inaugurated with 18 principal investigators (PIs) to create and promote human biology to elucidate key principles of human traits, including disease states. The Institute will perform interdisciplinary research between biology and mathematics (machine learning and topological data analysis) and between biology and humanities/social sciences (bioethics and philosophy on life), respectively. The Institute implements three research development cores for cutting-edge single-cell genome information analysis, primate genome editing, and non-human primate phenotype analysis, respectively. The Institute establishes a link with international institutions such as the EMBL, University of Cambridge, and Karolinska Institutet, creating a stratified organization for research promotion and strengthening its international profile.


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