Open Letter to the Lancet Review of the film 3 Billion and Counting

Firstly, let me say that throughout this whole film making process, I have not felt compelled to respond to a film review thus far.   However, this review is in a medical journal – my field of expertise.  So, I do feel compelled to respond to this “film review”.  I sincerely appreciate and would like to thank the editor of the Lancet, Joanna Palmer and the reviewer Amir Attaran for giving their time to review this important film.  It really is an honor to have a film reviewed in the Lancet.  I wonder how many documentaries have been reviewed by the Lancet?  I suspect not too many.

That said, I really found this “film review” simultaneously amusing and sad.  Why?  Because it was supposed to be a scientific film review of what I consider to be very important subject matter.  But instead, it was primarily a personal attack, often employed when one is at a loss in rebuttal of the science, or the facts at hand.  They are either inept and do not have the capacity to objectively stay with the scientific facts or are so enthralled by their own ego that they cannot perform what they set out to do.  Having interviewed Attaran for the documentary in 2006, I suspect, in this case, it was more of the latter.

Also, I have a question.  Why did the Lancet not ask someone of my same level of expertise to review the film?  Why a lawyer?

Obviously the answer to that question is in your hands.  Now, on to the review.   You will find the review below in its entirety.  Then below it, I will address all the points line by line. My responses will be in bold and italics.

A distorting take on DDT

Amir Attaran

Knowing a good story, and telling a good story, are two substantially different things. The cineasts behind 3 Billion and Counting certainly know a good story: their film explores the medically incorrect, damaging campaign against dichlorodiphenyltrichloroethane (DDT), when the scientific evidence is overwhelming that DDT has saved millions of lives from malaria and continues to do so. Their telling of that story, however, is anything but good, so what could have been an educational and entertaining documentary is instead woefully narcissistic, hectoring, and often inaccurate.

The film’s auteur is an osteopath, D Rutledge Taylor, who practises anti-ageing medicine in Los Angeles and is also the film’s funder, director, and music composer. Dressed in scrubs for effect, he cuts a goofy, nerdish, but sometimes endearing figure, as he jets across continents to learn about malaria and how DDT came to be so stigmatised. The narrative style annoys with tales of boyish adventure, as when Taylor brags his way through a border crossing, but there are several important interviews. Some African malaria control managers candidly admit to Taylor that they are afraid to talk about DDT, much less to use it, lest western donors cut off their funding.

For this, Taylor blames the foreign aid industrial complex, in particular contractors with secure jobs selling anti-malaria bednets to the very poor. But his fiercest, most over-the-top invective is laid at the feet of the environmental movement. While environmentalists from Rachel Carson onward often exaggerate DDT’s risks and belittle its benefits—as seen in this film’s interview with a Ugandan environmentalist, who calls DDT use “primitivity”, and urges armed resistance and to “let one die” instead—Taylor is similarly guilty of losing factual moorings. He claims DDT is suitable for many other diseases, some of which are not even insect-borne, and equates its rejection with genocide—overblown statements that are scientifically and legally untrue. Although cinematic exaggeration can make a point when done comically or ironically à la Michael Moore, here the assertions are merely aggressive and wrong.

Thus at best, this film has flashes of interest, amid cringe-inducing stretches. At worst, it is an example of how ideology turns otherwise valid arguments into unethical posturing. One may rightly fault environmentalists’ ideological loathing of DDT, but what exactly, if not ideology, leads the filmmakers to record what seems to be an Indian woman’s death of malaria, apparently without Taylor, a doctor, or his crew stepping in to offer treatment? The middle-ground lesson, in this film lacking middle-ground, seems to be that if factual and ethical laxity led to banishing DDT as a medical intervention in the first place, resort to neither should be had in bringing it back.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62017-X/fulltext?rss=yes

AA was interviewed for 3 Billion and Counting, although that interview does not appear in the film by mutual agreement with the filmmakers.

____________________________________________________________________________________________________________________

A distorting take on DDT

Amir Attaran

Knowing a good story, and telling a good story, are two substantially different things.

Ok, film review 101.  This film is a cinema ve’rite’ (no script) style FEATURE DOCUMENTARY. Documentaries of this style do not “tell stories”.  One “tells stories” when one has a pre-written script such as in FEATURE NARRATIVE films.  Today, some documentaries do have a pre-written script but are not considered the purest art form – ie “quasi-documentaries”.  There was no script in this film.  That should be evident in the shooting style.   “3 Billion and Counting” was a fact finding mission of documented events.  However, this reviewer was not expected to know the difference, so no fault.  To review a film for the Lancet, the reviewer is expected to know science and to critique the science.   Again, why a lawyer and not a medical doctor reviewing this documentary?

The cineasts behind 3 Billion and Counting certainly know a good story: their film explores the medically incorrect, damaging campaign against dichlorodiphenyltrichloroethane (DDT), when the scientific evidence is overwhelming that DDT has saved millions of lives from malaria and continues to do so. Their telling of that story, however, is anything but good, so what could have been an educational and entertaining documentary is instead woefully narcissistic, hectoring, and often inaccurate.

Yes, some that view the film may not find it entertaining, especially those who have been steeped in the Rachael Carson School of environmentalism.  However, I know for a fact that the film IS educational.  Try and find one person on this planet that knew all these facts that were dug up over an intense five long years.  You will not find one.  I have been thanked by many modern scientists for that which was revealed in the documentary.  As far as the line “woefully narcissistic, hectoring, and often inaccurate”, this is a matter of opinion to which one is entitled.  However, if one cannot and does not support one’s opinion with specifics, such a diatribe is primarily a useless waste of print space and the reader’s time.  Please do point out the inaccuracies.  I sincerely would like to know every scientific inaccuracy or any other inaccuracy for that matter.

The film’s auteur is an osteopath, D Rutledge Taylor, who practises anti-ageing medicine

Yes, I am an Osteopathic medical doctor who obtained MD board certification, therefore medically trained in both traditional and functional medicine. However, it was not mentioned that I practice preventive medicine and nutrition, which is Anti-Aging and thus my drive to get to the bottom of why malaria was not being PREVENTED.

in Los Angeles and is also the film’s funder, director, and music composer.

An inaccuracy.  I am not the music composer.  See opening title card 5 – composers Debbie Gibson and Rudy Haeusermann.

Dressed in scrubs for effect, he cuts a goofy, nerdish, but sometimes endearing figure, as he jets across continents to learn about malaria and how DDT came to be so stigmatised.

Yes, I do dress in scrubs for “effect” much as lawyers generally dress in a tie for “effect”.  I dress in scrubs every day.  It is my office attire.  Ask any patient I have – they will affirm it.

The narrative style annoys with tales of boyish adventure, as when Taylor brags his way through a border crossing,

This may be perceived by some as “bragging”.  However the line “money talks and men mumble” is a FACT when crossing African borders with cameras and equipment.  Give it a try.  Unfortunately, money talks at borders.  Had I not paid off each and every one of them, we would not be reading this “film review” because they would have taken my vital footage.  That is fact.

but there are several important interviews. Some African malaria control managers candidly admit to Taylor that they are afraid to talk about DDT, much less to use it, lest western donors cut off their funding.

For this, Taylor blames the foreign aid industrial complex, in particular contractors with secure jobs selling anti-malaria bednets to the very poor. But his fiercest, most over-the-top invective is laid at the feet of the environmental movement. While environmentalists from Rachel Carson onward often exaggerate DDT’s risks and belittle its benefits—as seen in this film’s interview with a Ugandan environmentalist, who calls DDT use “primitivity”, and urges armed resistance and to “let one die” instead—Taylor is similarly guilty of losing factual moorings. He claims DDT is suitable for many other diseases, some of which are not even insect-borne.

Truth is never concerned with job security, but job security is indelibly linked to Truth no matter how ugly it may first appear.  Every disease listed in the film is transmitted by insects with the part exception of Cholera – flies indirectly transmit it. However, this is really beside the point.  Strict attention to the film rather than invoking what seems a personal vendetta would reveal the inaccuracy of the “insect-borne” comment.  It was not said that all those cases were insect-borne diseases.  The actual statement said “diseases”.   There are other diseases such as cholera and dysentery that are indirectly reduced by the reduction of flies with the use of DDT.  To quote the late Dr. J Gordon Edwards “when DDT was sprayed in the WWII camps the dysentery wards all closed.”  The very credible Dr. J Gordon Edwards was in that war and was one of the first soldiers to be gratefully dusted with DDT. He had first hand experience with DDT and diseases.

and equates its rejection with genocide—overblown statements that are scientifically and legally untrue.

Having addressed the claimed “scientifically untrue” part, now on to the “legal” part.  I do not claim to be a lawyer.  It really does not matter to me as a doctor what the legal definition of genocide is… If you asked most of the people on the street if withholding a lifesaving technology (DDT) from a destitute population which results in millions of deaths, I think you will find, LEGAL or not, intentional or not, they consider it genocide.  Or, some perhaps prefer the new and improved, more sanitized term, “crimes against humanity.”

Dr. Art Robinson, a world renowned scientist, who is in the film, did call it genocide.  So, is equating what is happening in Africa by the withholding of DDT to genocide LEGALLY inaccurate?  Perhaps so.  However, we are talking about people dying.  Legal or not, they are still dying.  That is a fact.  To me, and many others, save perhaps lawyers, it is seen as genocide.

Although cinematic exaggeration can make a point when done comically or ironically à la Michael Moore, here the assertions are merely aggressive and wrong.

Already addressed – see above on the difference in a narrative feature, cinema ve’rite’ feature documentary, and “quasi-documentary”.  And again, Attaran utterly fails to address exactly which assertions he found” merely aggressive and wrong.” Therefore, I have no comment.

Thus at best, this film has flashes of interest, amid cringe-inducing stretches. At worst, it is an example of how ideology turns otherwise valid arguments into unethical posturing. One may rightly fault environmentalists’ ideological loathing of DDT, but what exactly, if not ideology, leads the filmmakers to record what seems to be an Indian woman’s death of malaria, apparently without Taylor, a doctor, or his crew stepping in to offer treatment?

I will address the unethical comment.  We did not film our giving the girl’s family money to pay for treatment and hospital transport.  We did not feel this personal and spontaneous act was important to the film.

The middle-ground lesson, in this film lacking middle ground, seems to be that if factual and ethical laxity led to banishing DDT as a medical intervention in the first place, resort to neither should be had in bringing it back.

I will address the “factual and ethical laxity”  comment.  I find this comment quite ironic since Attaran’s “review” is so woefully vague, lacking in substance, and absent of scientific critique.  I have no further comment.

AA was interviewed for 3 Billion and Counting, although that interview does not appear in the film by mutual agreement with the filmmakers.

Actually, it was NOT mutually agreed that we not use his interview.  What actually happened?  Attaran line item struck the word irrevocable in the interview release form before signing it.  And, if I recall correctly, he looked up at me and said “I would not give that to my own mother”.  I knew at that moment, I would not be using Attaran’s interview.  It would not have passed the film’s legal review anyway.