This is extremely disturbing: 

U.S. government medical researchers intentionally infected hundreds of people in Guatemala, including institutionalized mental patients, with gonorrhea and syphilis without their knowledge or permission more than 60 years ago.

Many of those infected were encouraged to pass the infection onto others as part of the study.

About one third of those who were infected never got adequate treatment.

Secretary of State Hillary Clinton and Health and Human Services Secretary Kathleen Sebelius offered apologies for the experiments today. 

The experiments, which took place from 1946-1948, were discovered by Wellesley Women's Studies professor Susan Reverby in the course of her study on another infamous STD study, the Tuskeegee Syphillis Experiment. You can read her findings here. 

Imagine for a moment that you're a government minister in a poor or fairly poor country. You've got a limited budget and you've also got a lot of work to do -- children are undernourished, you need to increase the numbers of them that go to school, and maternal mortality is leaving behind ranks of young orphans. Let's also say that, like most countries in the world, yours is a bit unequal. So here's the question: If you want to cut poverty rates, who should you target? The lower middle class -- the "low-hanging fruit" that doesn't have far to go? Or the most destitute of the population?

For years, the answer has been the former. It seems logical: If you can only spend so much, why not help the category that is closest to overcoming poverty? Surely, the most destitute have too far to go to benefit from the limited aid available. This is the approach that countries such as Nigeria, Ghana, Pakistan, and Vietnam have taken in recent years. And they have made some progress.

But you'd be wrong, according to a new study released today by UNICEF. Based on rigorous data tests from 15 countries, the researchers found that the best way to reduce poverty is to start at the bottom, not in the middle. And the difference is a lot. For every $1 million spent on anti-poverty measures, you would "avert 60 percent more deaths" if you help the poorest first, according to the study. The reason for this is simple: if you're destitute, and you recieve a bit of aid, say a cash transfer of $100 a month, that will boost your income by a massively larger percentage than if you are middle-income. Put in another context, if you are a women with no access to healthcare during childbirth, a trained midwife will mean much more to you than it would to a woman with basic care already.

This isn't wonky. It's big -- really big -- not least because it is something of a rethink of the way that governments, including the United States, have been doing development. One of the biggest focuses of the Obama administration's $63 billion Global Health Initiative, for example, is to build up health "systems" -- training healthcare workers, improving facilities, etc. This study says, that kind of thing is great -- but it's also not the most efficient solution. Health systems are usually not accessible to the poorest of the poor because of cultural barriers, poor transportation, or a pure and simple lack of information. Healthcare has to come directly to the communities.

This is, by the way, useful for another another global problem that has arisen in recent years: massive inequality. The world has lifted millions out of poverty (thanks to China and India mostly, but they weren't alone.) But those who remained poor have gotten poorer, and those who were rich have gotten richer. How great would it be if the way to tackle absolute poverty (the numbers of poor) and relative poverty (the inequality factor) was actually the same? Pretty great. As UNICEF Exectuive Director Anthony Lake put it today, "We have an extraordinary opportunity to do not only the right thing but the most practical thing."

Now, to convince the politicians...

Editors note: I am in New York this week on a generous fellowship from the United Nations Foundation, covering the lead-up to the Millennium Development Goals Summit at the U.N. General Assembly starting on Sept. 20.

For those of you who don't subscribe to the bimonthly print edition of Foreign Policy, you're missing a great feature: the FP Quiz. It has eight intriguing questions about how the world works.

The question I'd like to highlight this week is:

After Mexico, which OECD country has the highest rate of teen births?

a) Czech Republic      b) Turkey       c) United States 

Answer after the jump …

Read on

Ireland is cautious when it comes to defending its stance against abortion. Voters approved the Lisbon treaty on EU integration earlier this year only after stringent guarantees from other EU countries that EU law would not force Ireland to relinquish its ban on the procedure, which was backed by a 1983 referendum.

So, after all that, it's ironic that the challenge to its constitutionally enshrined "right to life of the unborn" is instead coming in the form of a human rights case before a different European body: the 47-member Council of Europe. The case could have continent-wide implications, if the European Court of Human Rights rules in favor of the three women bringing the case, establishing some protection of abortions sought on medical grounds.

As a signatory of the European Human Rights Convention, Ireland would have to change its laws if the court finds in favor of the women -- identified as A, B and C in the court documents. Abortion is currently permitted only in cases of significant risk to the mother, but the women's lawyer argued today that even in those cases abortion is effectively out of reach due to doctor's fear or unwillingness to risk falling afoul the narrow parameters allowed.

The court's ruling, expected in a few months, might have implications for other EU countries, such as Poland and Malta, which have very restrictive abortion laws. Two years ago, the same court found in favor of a Polish woman denied an abortion despite medical recognition that the pregnancy endangered her eyesight, forcing the government to pay her compensation and provide a legal framework for access to lawful, medical need abortions.

Where is the worst place for children to be born in 2009, especially girls? Surprise! Afghanistan. Today, UNICEF published a special report titled State of the World's Children; Daniel Toole, UNICEF regional director for South Asia, told a news briefing in Geneva earlier today: 

Afghanistan today is without a doubt the most dangerous place to be born.

After eight years since the U.S. invasion, this is just one more incentive to encouarge the Obama administration to make a decision on its role in the region.

More optimistically, the reports highlights signatory countries of the UN's Convention on the Rights of the Child who have shown marked improvement, including India, Serbia and Sierra Leone.

Paula Bronstein/Getty Images

Combating alchohol abuse has always been something of a non-starter in Russian politics. This is, after all, a country whose former president was once found by the Secret Servce thoroughly sauced outside the White House, wearing nothing but his underwear trying to hail a cab so he could get a pizza.

But current President Dmitry Medvedev is trying to change things with a proposal to ban outdoor beer sales in his country, a first step in getting Muscovites to lay off alcohol. He also wants to limit the hours of the day alcohol can be sold.

This week, a bill was submitted to lawmakers that would triple the tax on beer from 3 rubles per liter to 10 rubles per liter by 2012. Wine and spirits would also see a sharp increase.

State prosecutors are also moving to ban liquor sales in airports. Under Russian law, no beverage with alcohol content above 15 percent can be sold in crowded or dangerous places, and prosecutors say this means airports.

Russians drink five gallons of pure ethanol a year, double what is considered dangerous by the WHO. And on average, 30,000 people a year die from alcohol poisoning in the country. Over half of the deaths of the 15 to 54-year-old demographic between 1990 and 2001 are attributed to alcohol.

"I have been astonished to find out that we now drink more than we did in the 1990s, although those were very tough times," Medvedev said.

He is a fan of Soviet Premier Mikhail Gorbachev's anti-alcohol reforms in the 1980s aimed at curbing consumption, even though he acknowledges that the plan had major flaws. Gorbachev destroyed the majority of vineyards and wineries in Georgia, probably the birthplace of wine (This didn't help the growing anti-Russia sentiment in the Southern Caucasus at the time). He also shut down distilleries and breweries. Most notably, the Soviet Union suffered tremendous sugar shortages, because people turned to moon shining. (The Russian word for ‘shine is Samogon) Stores also ran out of window cleaner and aftershave. It is estimated that 13,000-25,000 people died from drinking ill-made moonshine.

Medvedev's plan is much more cautious but many Russians are still wary.

"It's impossible. He doesn't stand a chance," a Russian construction worker told The Los Angeles Times."The Russian man will always be drinking. Russians don't surrender."

ALEXANDER NEMENOV/AFP/Getty Images 

China's food and drug administration has approved the world's first vaccine for the H1N1 virus and the government has announced plans to 5 percent of the Chinese population by the end of this year. Not everyone's so sure about it though:

Skeptics, however, have a hard time believing that a one-dose vaccine lacking a special substance called an adjuvant -- which primes the body to react to the dead virus and produce antigens against it more efficiently and effectively -- can work as well as a two-dose one.

"It would be hard for me to imagine a single-shot vaccine without an adjuvant," says Barry R. Bloom, the former dean of Harvard's School of Public Health. "My understanding in trials here is that you need more than one shot with just the straight virus to get a good enough immune response."

The study that preceded the vaccine's approval tested it on 1,614 participants from age three to over 60, according to Sinovac's head of investor relations, Helen Yang.

Stanford researcher David B. Lewis, who is involved in studies that test how adjuvants can improve seasonal flu vaccines, says it could be misleading to lump the results of all age groups together.

 The WHO has also expressed some reservations about the size of China's vaccination plan, noting that "adverse effects that are too rare to show up in a large clinical trial could become apparent when much larger numbers of people receive the vaccine."

Given the speed at which China rushed this vaccine into production and the past record of the country's pharmaceutical industry, I think I would take my chances with the swine flu. 

No, this is not a Mel Brooks movie:

On Monday morning an Arkia airlines plane took off from Ben Gurion Airport carrying rabbis and kabbalists and flew over the country in a flight aimed at preventing the swine flu virus from spreading in Israel through prayers.

"The purpose of the flight was to stop the epidemic, thus preventing further deaths," explained Rabbi Yitzhak Batzri whose father, Rabbi David Batzri had initiated the flight. "We are certain that because of our prayers danger is already behind us," he added.

During the flight the passengers blew the shofar seven times and said prayers intended for abolishing illnesses.

There have been over 2,000 recorded cases of swine flu in Israel.

Hat tip: On Deadline 

Time reports that for tobacco companies, Africa is the next great unsold frontier.

Driven in no small part by commodity booms, Africa has seen rapid economic growth in the last decade, and tobacco companies are betting on a pattern of rising incomes leading to higher smoking rates. With few smokers and increasing disposable income, the market logic makes sense:

In Ghana, the male smoking rate (which in most places in the world is higher than the female rate) is only 8%; in the Democratic Republic of Congo, it's 14%; in Nigeria, it's 12%. Compare that with 31% in India, 56% in Malaysia and a whopping 61% in China.

Along with increasing marketing and production within the continent, cigarette companies are also preemptively aiming for good publicity. 

Tobacco companies have jumped into the corporate-social-responsibility game, doing all manner of benevolent work across Africa and Asia. In 2005, Philip Morris paid $5 billion to buy Indonesian cigarette-maker Sampoerna, a company that was already pouring money into scholarships for local students. British American does similar work in Malaysia, and in Nigeria has devoted 1% of its local profits to improving access to drinking water, health care and vaccines. That kind of largesse buys the companies a measure of indebtedness.

"It's hard to tell a village, 'You shouldn't accept these new wells or bicycles because it's from industry,' " says Stella Bialous, an adviser to the World Health Organization. "[But] when it comes time to pass regulatory things the company doesn't think reasonable, they can call in their chips. They have all these little groups dependent on their money."

Despite these efforts, in 2007, Nigeria filed a $45 billion lawsuit against three tobacco companies for marketing to children, and a number of countries have launched anti-smoking campaigns.

Though the Sudanese children pictured above seem to have gotten the message that cigarettes are dangerous (and have bloody fangs), it will be hard to prevent smoking from taking off in the conditions of poor regulation, low healthcare, and low life expectency common to many African countries. 

Isam Al-Haj/AFP/Getty Images

File this under "d'oh!" British doctors have begun to advise against having "swine-flu parties" meant to develop immunity to the illness, the BBC reports:

Reports have emerged of people intentionally mixing with friends who have flu.

Their reasoning is that it is best to be infected before the winter when the virus could become more deadly.

Does this qualify for a Darwin Award?

This has to qualify as the most dangerously stupid swine-flu overreaction yet:

Haitian officials rejected a Mexican aid ship carrying 77 tons of much-needed food aid because of ''unfounded'' swine flu fears, Mexico's ambassador said Wednesday.

The Mexican navy ship El Huasteco was to arrive May 2 in Port-au-Prince carrying rice, fertilizer and emergency food kits to help the impoverished country respond to chronic hunger and devastating tropical storms.

But Mexican Ambassador Zadalinda Gonzalez y Reynero said Haitian officials told her April 29 they would not accept the ship, which was still in Mexican waters near the Yucatan peninsula at the time.

''The crew was in perfect health and there was no risk at all,'' Gonzalez y Reynero told The Associated Press, adding that the cargo and 64 sailors aboard the ship had all been screened in Mexico.

24 percent of children in Haiti suffer from chronic undernutrition. Glad the country has its priorities in order.

Bill Easterly flags this article from Kenya's Daily Nation:

Mosquito net manufactures are teaming up with the provincial administration and village elders in several parts of Kenya in an effort to apprehend and prosecute people who use the products for purposes other than covering beds.

According to Dr Elizabeth Juma, who is the head of malaria control under the Ministry of Public Health and Sanitation, there has been evidence of people turning the nets into fishing gear especially in Nyanza Province. Now a different group has discovered another lucrative business venture, and are using the nets to make wedding dresses.

Easterly notes: "Net promoters seem to consistently underestimate the challenge of spreading the scientific knowledge about the risks of getting malaria from mosquito bites."

The vaccine works like that of yellow fever or smallpox -- injecting a small quantity of diseased parasite into the patient's bloodstream, such that the body can develop antibodies ready to strike back if and when a real infection occurs. Sanaria have focused their vaccine efforts on Plasmodium falciparum, the most fatal and also most resilient species of the parasite. 

There are a number of candidate vaccines at the moment -- most of which have an efficacy rate of around 50 percent. That's enough to bring down mortality rates if even at-risk patients are given the vaccines. But as public health experts will no doubt point out, the hard part is getting that kind of comprehensive coverage. The rural health systems that are most burdened by malaria will find it difficult to support the kind of coordination that a vaccine scheme would require. 

Still, a vaccine would do wonders. Falcipurum in particular has built up confounding resistance to conventional treatments in recent years. Certainly, it will continue to do so as long as we have to keep treating -- rather than preventing -- infection. 

TONY KARUMBA/AFP/Getty Images

Depending on where you stand, President Barack Obama's Friday decision to lift the Mexico City Policy, better known as the global gag rule, was either wonderful or appalling. For the last seven years, the gag rule stipulated that charities promoting and supporting abortion services could not recieve funding from the U.S. Government. Now, they can. I say: it's about time.

My position is not drawn from either side of the abortion debate. It's drawn from what I saw as a reporter and as a person living in Nigeria. HIV/AIDS is the open secret there -- a growing problem with a whispered name.

To put it politely, the gag rule created a rift -- at times gaping -- between U.S. government-funded projects and those of private NGOs trying to prevent HIV infection. The U.S. government brought the buck -- President Bush's PEPFAR program boasted $39 billion for HIV/AIDS work -- but it also brought rules about how to get the work done. The foundations brought less money and a sometimes different approach. Both sides fought to win the support of the local government for their strategies. From what I saw, that debate could get ugly. Friends working in the field were frustrated and saddened by the result: inertia and politics, instead of posters and condoms.

There was one particular problem that brought it home for me. In 2006, a Nigerian lawmaker announced that 55,000 women die in the country each year from unsafe illegal abortions. The evidence was everywhere -- from women that my colleagues and I met to Nigerian films on exactly that topic.

What was the best way to get that statistic down? Some will say abstinence. But sex is not always a choice. It's in those situations where women seek -- or are forced by their partners to seek -- unsafe abortions. Some counseling and a sterile doctor's office would go a long way.

That's just one example. The real "gag" was that you didn't hear a lot of stories about birth control or HIV prevention in Nigeria. So my few are only the beginning. Maybe now we'll start to hear a few more.

Photo: TIM SLOAN/AFP/Getty Images