Policy Memo for Masters in Public Health

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MemoExample2Arsenic.pdf

BRIEFING MEMO BANGLADESH VITAMIN E AND SELENIUM TRIAL

New York, NY May 5th, 2008

FROM: Tariqul Islam Superfund-Bangladesh Project Director TO: Faruque Parvez and Joseph Graziano Bangladesh Vitamin E and Selenium Trail Researchers RE: Arsenic Mitigation in Bangladesh

BACKGROUND In 2005, the arsenic mitigation project known as Bangladesh Vitamin E and Selenium Trial (BEST) received $10 million dollars to fund the first five-years of an anticipated 10-year long research. Branching from satisfactory results provided by the Health Effects of Arsenic Longitudinal Study (HEALS), BEST aimed to implement an intervention where participants would receive treatment for arsenic exposure - which has been known to cause a painful and fatal medical condition known as arsenicosis. Can you give us a quick sense of the epidemiology of this problem? Under BEST, study participants were randomized into different groups. Those receiving the intervention have been treated with either vitamin E or selenium. Since safe drinking water was necessary for participants to properly take their medication [I don't think this is quite accurate—I think, rather, that it was for reasons of both ethics and scientific integrity that they provided the fresh water—they had to do their best to ensure that they were no longer exposed], the BEST project worked with the UNICEF to provide free water filters through the regions targeted in the research. Despite the underlying good intentions with the BEST research aim, unfortunately program issue in Laksam and its associated negative publicity have led to a significant issue which must be immediately addressed. Therefore, I have requested an urgent press conference for May 8th, 2008. I need key representatives to speak on behalf of the BEST research mission, address the negative misrepresentation of this project, and most importantly mitigate the trust and credibility which were lost in the Bangladesh region as well as our research institutions. I’d say that most of this is really background material. But we also need a little more. What was the nature of the bad publicity? Why did it arise? <<In looking at your options, it seems that what you are trying to do is develop an issue that revolves around access to information, so let’s find a way to build up to that. So, then, think about wrapping up the background along these lines: We are facing a media crisis that stemmed from inadequate integration into one of the study sites and a lack of adequate information about how a key staff member there fit into the local economy. To be sure, that

Moved (insertion) [1]

is an issue that you and your team will have to address. More pressing is addressing the press allegations. As ridiculous as the allegations might seem, someone involved in your study actually did sabotage filters, which might end up having had the same effect (depending on the source of the water).>> ISSUE. As we move to a press conference, we must consider how much information to give regarding miscalculations on the part of the study team and how much information to give regarding the actual harm the fired staff member may have caused. OPTIONS Option 1: Transparent or Censored Panel Discussion—I’d then reframe this option to weigh whether to simply describe the study and assure participants that the medication is believed to be beneficial and address a serious condition that is caused by arsenic in the water supply (this also includes your plan to showcase prior research mentioned below) OR explain the ways that the study was compromised, how people may have been hard, and what BEST will do to ameliorate OR some combination of both. From this point, you’ll have to rethink what you have below, but as you do that be sure to weigh the pros and cons of each decision, something I think is missing from the first draft (in large measure because you really hadn’t given yourself enough of a problem to grapple with). …. Option 2: Panel Participation from Solely Research Team or with Local Officials Another main question delves into whom should speak and explain the study. << I think that this isn’t really an alternative to option 1. I also think that you have enough to grapple with without it. This, rather, is like a separate decision and your choice here is either to go it alone at the press conference or try to include the local community, understanding that you really don’t have strong ties with them at this point. A third option under this decision-point, then, might be to delay a press conference. Again, if you decide to keep this in here, then I need to see the positives and negatives of different choices. Also consider that if you keep this decision point in, you’ll need to slightly reframe the issue to grapple with two problems: what’s the nature of the information you should give people? Should you go it alone at a press conference or find some strong community partners given the nature of what you choose to convey at the press conference.>>

• It is imperative for members of the BEST research team to address the media. This would ensure institutional credibility as the current issue has already been alerted to presidents of the University of Chicago and Columbia and the dean of the Mailman School of Public Health at Columbia University.

• The question remains as to whether we should incorporate participation from local officials in order to improve relations with members in Bangladesh. Since prior project in the region known as HEALS was successfully implemented, I believe it is imperative for us to utilize our local contacts who assisted with the HEALS project. By showcasing our prior research success, we can attempt to mitigate the current public relations issue.

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Moved up [1]: Despite the underlying good intentions with the BEST research aim, unfortunately program issue in Laksam and its associated negative publicity have led to a significant issue which must be immediately addressed. Therefore, I have requested an urgent press conference for May 8th, 2008. I need key representatives to speak on behalf of the BEST research mission, address the negative misrepresentation of this project, and most importantly mitigate the trust and credibility which were lost in the Bangladesh region as well as our research institutions. ¶

Deleted: ↵ The question remains as to how much information representatives from the BEST research team should delve into.

Deleted: <#>On the one hand, it is imperative for us to strengthen our credibility and trust with members residing in this region, as well as, continue a working relationship for future studies. Therefore, we should reveal as much information in order to counteract the negative portrayal of the BEST study in the media. ¶ <#>On the other hand, the purpose of the BEST study was to conduct a randomized, double-blind study to evaluate the effectiveness of vitamin E and selenium to counter the side effects associated with arsenic exposure. If too much information is revealed during the panel discussion, the credibility of this research - which aims to improve population health - could be compromised. The intent behind a randomized study would falter as media coverage would have the potential to reveal too much information to current study participants. ¶

Based on the current situation, I believe it is imperative to move forward with the scheduled press conference on May 8th, 2008 by (1) holding a transparent discussion which does not compromise the legitimacy of the BEST study which has been conducted in the three regions because there is a long-term population health improvement linked to the research and (2) inviting key members of the BEST research team as well as local officials who have previously worked with us in order to address the current issue as well as strengthen our research as well as our respected institutions' credibility and trust. ____________________________________________ Tariqul Islam Superfund-Bangladesh Project Director