[OPINION] Sidewalks and dengvaxia

Sylvia Estrada Claudio

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[OPINION] Sidewalks and dengvaxia
In the use of any technology, whether that be sidewalks or an anti-dengue vaccine, it is crucial to do a cost-benefit analysis

When I took my morning walk the other day, I realized that we now have an ingrained inability to appreciate sidewalks.

We are not a walking city despite our over-the-top traffic situation. Given what I understand of how cities should look in the future, this is yet another cause for concern that we are being left behind. Walking would reduce traffic and pollution. Making walking pleasurable and safe would be a great way to increase the general health of our population.

There are many reasons why people do not walk, even short distances, in Metro Manila. And one of them is that we have lousy sidewalks even if they exist.

I say “if they exist”, because I have seen some roads where sidewalks are non-existent. There are places where people’s front doors actually let out into the street. Scandalous, really. And I do not know who to blame but it is likely that there is a large amount of stupidity and a larger amount of corruption on the part of the government officials concerned and the private contractor.

Many sidewalks though are non-existent because they have been taken over by cars, stores, stalls, funeral wakes, public toilets, jeepney and tricycle depots, and nuclear bomb silos. Well, maybe not nuclear bomb silos. But I wouldn’t be surprised given what one finds on our sidewalks other than pedestrians. In fact, pedestrians are the least likely of the many animate and inanimate things we can find on our sidewalks.

Our subdivision has sidewalks. But when I take my morning walks, I notice no one uses our sidewalks anyway. Everyone still walks on the road. This includes me until the other day.

I know why I walk on the road. Because I am not used to walk on sidewalks in Metro Manila. In the first place why bother if you have to step off the curb for the fish vendor, vegetable vendor, illegal arms trader or whoever has taken over the sidewalk for reasons not related to walking? So even in our subdivision where there are sidewalks, I automatically walk on the road.

Our subdivision sidewalks aren’t very helpful either in terms of teaching the habit of walking on the sidewalk. Cars are parked on both sides of the street, the pavement is broken up here and there, dog and cat shit is left by irresponsible pet owners and some people have put all sorts of tacky landscaping on the sidewalk. (Obviously there are noveau riche people where I live who think they own the sidewalk in front of their house just because they bought the house.)

Contrast this with our roads, which are smooth, because tires are more important than feet – and it is inevitable that pedestrians must swallow their pride and sneak into spaces provided for cars.

Cost-benefit analysis of sidewalks

Yet I now walk on the sidewalks in our subdivision. I did a cost-benefit analysis and decided the benefits outweigh the inconvenience.

1) There are parts of my route that are busy with cars. Staying on the sidewalk is still safer than risking getting run over.

2) Because there are many potential dangers like tripping on uneven pavement or a tree root, getting hit in the eye by a tree branch because some of my neighbors like their plants growing wild, stepping on dog and cat shit – I have to concentrate on where I am going. This concentration takes my mind off the aches and pains this old body feels whenever it is made to exercise. It also allows me to be mentally challenged and not just physically challenged when I walk.

3) Walking on the sidewalk also allows me to see the gardens of my neighbors who do get it right. Some stretches are clean, and their frontages display orchids, and mums and forget-me-nots and so many interesting things.

4) There is a bird that lives in the bush up the road. If I walk slowly and quietly it comes and gives me a cynical look.

5) I do my patriotic duty by giving people a mental image of what should be the norm: a pedestrian walking on the sidewalk.

Dengvaxia

In the use of any technology, whether that be sidewalks or an anti-dengue vaccine, it is crucial to do a cost-benefit analysis such as what I have done with the sidewalks.

Even the question of safety is best approached this way. Thus, whether it is safe to walk in the sidewalk depends on many things. A cost-benefit analysis requires that we  have knowledge of the technology itself, the conditions in which the technology will be used, who will benefit if it is used, and to whom it would pose a danger.

This is where the role of experts can come in. Experts can do the cost-benefit analysis correctly or they can be unethical and skew their cost-benefit analysis to make political points. Some may have not be experts, claim they are, and do it badly.

In the continuing saga regarding the anti-dengue vaccine, I have heard everyone from a former congressmen to sitting senator, to media people make statements about aspects of the vaccine for which they have no expertise.

What is worse is that medical doctors who should be more ethical have made statements that go against the assessment of the majority experts who say the vaccine is safe and effective if used properly. Forensic experts release results about possible patterns of suspected deaths without telling us that so many deaths that are unrelated in terms of cause, have similar patterns. Some “experts” tend to go hog-wild about safety concerns (costs) without being honest with the public about the benefits. They won’t tell the public that a cost-benefit analysis for every technology is the proper approach. Without a cost-benefit analysis, we wouldn’t be using most of the drugs and medical procedures we are using now.

Other experts spread lies about the way the FDA monitors adverse reactions, how it is properly done and what it means. Post market monitoring, in one sense, is a continuing way of ensuring that the cost-benefit analysis that shows the drug can be used by the general public was essentially correct. Those who lie about what the process entails know that their political agenda would not be validated if people understood that it is being done properly.

I hope this issue dies down soon. The lies have scared people, wasted resources, and put the public’s health at risk. Studies have shown that when people are scared over one vaccine, they not only refuse that vaccine even if they shouldn’t, they also refuse other vaccines.

Someday, someone should write about how the introduction of this vaccine was handled in the Philippines. They need to know why, of the many countries where the vaccine has been approved and used, only the Philippines is having such an uproar. When things finally are less politicized we will know who are the true experts who kept faith with their mandate to give people the real information they need to make the proper health decisions. – Rappler.com

Sylvia Estrada Claudio is a doctor of medicine who is also a doctor of philosophy in psychology. She has been an advocate of monitoring the ethical and unethical practices of physicians and drug companies.

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