Elizabeth Pisani

Elizabeth Pisani (born 1964) is a British-American epidemiologist, public health consultant, author and journalist. She is an academic researcher and the director of Ternyata Ltd., a public health consultancy based in London, UK.[1] Her research investigates the ways in which politics, economics and culture influence public health. This has included markets for substandard and falsified medicines and HIV. Before this, Pisani was a journalist who worked as a correspondent for Reuters in several Asian countries.

Elizabeth Pisani
Pisani at the 2014 QED Conference
Born1964 (age 58–59)
United States
NationalityAmerican, British
Alma materOxford University, London School of Hygiene and Tropical Medicine,
Occupation(s)Epidemiologist, analyst, author
Notable workThe Wisdom of Whores, Indonesia, etc.
Websitewww.wisdomofwhores.com, indonesiaetc.com

Her first book The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS,[2] which examines factors influencing decision-making for HIV prevention, was longlisted for the Samuel Johnson Prize in 2009.[3] Pisani is also known for her 2014 travel book Indonesia Etc.: Exploring the Improbable Nation, in addition to other writings on the society and politics of Indonesia.

Pisani holds (or has held) visiting or honorary posts at  Universitas Pancasila Jakarta (Professor); the George Institute for Global Health (Professorial Fellow);  London School of Hygiene and Tropical Medicine (Honorary Associate Professor);  the Policy Institute, King's College London (Senior Research Fellow); Imperial College London (Reader); and the School of Health Policy and Management at Erasmus University Rotterdam (Associate Professor).

Education

She was born in the United States and educated in several European countries. She graduated from Oxford University with an MA in classical Chinese in 1986.[4] After working as a journalist for many years, Pisani changed professional course, taking an MSc in Medical Demography and later a PhD in Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine.[5]

Journalism career

After her first degree, Pisani joined Reuters as a foreign correspondent,[6] working in Hong Kong, India and Indonesia. She also reported at various times for The Economist and the Asia Times from Jakarta, Hanoi, Phnom Penh, Brussels and Nairobi. During her times as a journalist she covered major political events such as the Tiananmen Square demonstrations[7] and the insurgency in Aceh as well as a wide range of business stories.

Epidemiology and public health career

After retraining as an epidemiologist, Pisani focused on HIV for over a decade, conducting research and working as an advisor for the Ministries of Health of China, Indonesia, East Timor and the Philippines, and for organisations such as the UNAIDS, US Centers for Disease Control and Prevention, World Bank, and the World Health Organization. Her work has focused on HIV, sexually transmitted infections and sexual and drug-taking behaviour, and on building disease surveillance systems.

In the late 2000s, she began working with the Wellcome Trust and other major funders of public health research to increase the sharing of data between scientists so that more knowledge can be squeezed out of expensive field research.[8] She also worked with Wellcome to explore ways of increasing engagement between scientists and society in the countries where they sponsor major research programmes. One outcome of this was the "Foreign Bodies, Common Ground" exhibition,[9] bringing together art from residencies in research centres in Thailand, Vietnam, Malawi, Kenya, South Africa and the UK. In 2016, Pisani initiated a collaboration with an East London based orchestra, the Grand Union Orchestra, which led to "Song of Contagion", a jazz show which tried to explore the reasons for bad decision-making in global health through music.[10][11]

Pisani wrote the first two editions of the biennial global report on AIDS for UNAIDS in 1998.[12]

In 2008, she published her first book The Wisdom of Whores,[2] which argues that a substantial portion of the funding devoted to HIV and AIDS is wasted on ineffective programming, the result of science and good public health policy being trumped by politics and ideology.[13] It was long-listed for the Samuel Johnson Prize for Non-fiction in 2009.[3] The following year, she gave a TED talk arguing that the "rational" health belief model that underpins many public health campaigns are irrational from the point of view of those they target.[14]

In the mid-2010s, Pisani's interest turned to the quality of medicines. With research grant support from the Wellcome Trust and Erasmus University Rotterdam, she led a four-country study into the political and economic factors driving the market for substandard and falsified medicines, especially in middle income countries,[15] and continues to work in this area.

Medicine procurement, pricing and quality

While working in an HIV prevention programme in Indonesia in 2004, Pisani and her colleagues discovered that the medicines they were giving female sex workers to cure sexually transmitted infections were not working.[16] There were three possible reasons for this: the women were not taking their medicines correctly; the pathogens were resistant to the medicines; or, the medicines were of poor quality. It turned out to be the second of these, but it took fully four years to change national guidelines and to start treating women with medicines that did work, largely because of the economic interests of government-owned pharmaceutical companies. At the Conference on Medicine Quality and Public Health in Oxford in September 2018, Pisani explained that this incident suggested a link between medicine quality and antimicrobial resistance, as well as in the political drivers of pharmaceutical policy.[17]

In 2016, the UK government's Review on Antimicrobial Resistance[18] asked Pisani to review evidence for the links between poor quality medicine and the development and spread of drug resistant infections. The full report[19] was summarised in an interim paper published by the AMR Review.[20]

With funding from Wellcome Trust, Pisani led a study looking at the political and economic factors that incentivise pharmaceutical companies to produce substandard medicines, and the factors that create market opportunities for criminals to make and sell falsified drugs. The research team looked closely at medicine markets in Indonesia, Romania and Turkey, as well as at producers of active ingredients in China. They concluded that substandard medicines are most common where oversight of production standards is lax and procurement systems push prices so low that companies are incentivised to cut corners. Falsified medicines, on the other hand, appear where there is an unmet demand from patients (sometimes because of aggressive marketing), and where patients or health care providers are incentivised to step outside of the regular supply chain, to cut costs or to maximise profits.[15]

Pisani has initiated and overseen several studies of medicine quality in Indonesia, using different sampling and research methods. These include case finding,[21] exposure-based sampling[22] and random sampling.[23] (Funding for these studies comes from UK National Institutes for Health Research; Australia's National Health and Medical Research Council, and United States Pharmacopeia.) She has also investigated medicine procurement and pricing, with a special interest in the incentives embedded in the supply chain.[24][25][26]

AIDS prevention

Pisani has been a vocal advocate of the harm reduction approach to addressing HIV/AIDS, supporting needle exchange programmes, making condoms widely available, and giving aid to countries that have policies of legalized prostitution. She outlined these views in her book, subsequent articles, interviews, and her 2010 TED Talk.[14] She strongly criticized the regulations imposed by USAID ambassador Randall Tobias, in particular, those forbidding aid recipients from accepting, tolerating, or legalizing prostitution, or promoting anything but abstinence, arguing that organizations of prostitutes are effective at educating those most at risk, and that abstinence-only sex education has been demonstrated to fail in rigorous scientific studies. In addition, she criticized the Catholic Church's prohibition on condom use as a means to prevent the spread of HIV.

In an interview with The Guardian, she said "I don't think it's evil to have anal sex with 16 people in a weekend without condoms. I just think if you do that there's a high likelihood you're going to get infected. That's all. It's cause and effect. And I think if we can prevent a fatal disease, we should. I don't get how it's OK to keep someone alive once they're sick - but not OK to stop them getting sick. I just don't get that."[27] In an article for The Guardian the following year, she criticised the Catholic Church's attitude to HIV/AIDS, asking "[w]hy can't we extend our compassion to those who are not yet infected, and provide them with all the information and tools they need to stay uninfected? Whether the pope likes it or not, those tools include condoms.[28] In her TED Talk, she called the position "clearly irrational."[14]

Writing on Indonesia

In late 2011, Pisani took a sabbatical from her day job to explore Indonesia, where she had worked from 1988 – 1991 as a foreign correspondent, and from 2001 to 2005 in her capacity as an epidemiologist and public health advocate. She blogged about her travels at Portrait Indonesia from late 2011-2013.[29] At the end of 2013, she moved her blog to a new site, Indonesia, Etc.[30] Her travels there form the basis of a book, Indonesia, Etc.: Exploring the Improbable Nation,[31] which was published to critical acclaim in June 2014. The book was listed among the best non-fiction books of 2014 by The Economist[32] and by The Wall Street Journal.[33]

Since working on Indonesia, Etc., Pisani has contributed articles on Indonesian politics, particularly the 2014 presidential election, to Foreign Affairs,[34] The New York Times[35][36] and Nikkei Asia Review.[37][38] Pisani has also provided commentary on corruption in Indonesia.[39][40]

Personal life

In The Wisdom of Whores, Pisani wrote, "I went to Sunday School as a child, and I still go to church every now and then. But I am unable to understand religious convictions or religious ideologies that stand in the way of saving hundreds of thousands of lives."[13]

In addition to English, she is fluent in French and Spanish, and has learned Chinese and Indonesian.

References
  1. "Ternyata – Public Health Consultancy". www.ternyata.org. Retrieved 2016-07-20.
  2. Pisani, Elizabeth (2009-09-21). The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS. W. W. Norton. ISBN 9780393337655.
  3. "Samuel Johnson Prize for Non-fiction Longlist | Book awards | LibraryThing". www.librarything.com. Retrieved 2015-09-25.
  4. Pisani, Elizabeth (28 October 2014). "Can corruption reduce conflict? Lessons from Indonesia". SOAS. Archived from the original on 2019-01-21. Retrieved 2019-01-22.
  5. Pisani, Elizabeth. Back to basics: putting the epidemiology back into planning and monitoring HIV prevention programmes. Case studies in Indonesia (Thesis).
  6. "Events". King's College London. 25 May 2016. Archived from the original on 23 September 2016. Retrieved 4 August 2016.
  7. Pisani, Elizabeth (16 April 2009). "A Summer's Evening in Beijing". Granta. Retrieved 25 September 2015.
  8. "Ternyata - Data Sharing". Ternyata.org. Retrieved 2019-01-22.
  9. "'Foreign Bodies, Common Ground' at Wellcome Collection". wellcome.ac.uk. 14 November 2013. Retrieved 2019-01-22.
  10. "Song of Contagion - Elizabeth Pisani". Retrieved 2019-01-22.
  11. "BBC World Service - Sounds". June 3, 2017. Retrieved 2019-01-22.
  12. Pisani, Elizabeth; et al. (June 1998). "Report on the Global HIV/AIDS Epidemic" (PDF). data.unaids.org. Archived from the original (PDF) on 26 September 2015. Retrieved 25 September 2015.
  13. Pisani, Elizabeth (2009-09-21). The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS. W. W. Norton. ISBN 9780393337655.
  14. Pisani, Elizabeth (April 2010). "Sex, drugs and HIV — let's get rational". TED. Retrieved 25 September 2015.
  15. Pisani, Elizabeth; Adina-Loredana Nistor; Hasnida, Amalia; Parmaksiz, Koray; Jingying Xu; Kok, Maarten (2018). "The political economy of substandard and falsified medicines: an evidence-informed risk-assessment framework based on a multi-country study". ResearchGate. doi:10.13140/rg.2.2.30137.62563. Retrieved 2019-01-21.
  16. Sutrisna, A.; Soebjakto, O.; Wignall, FS; Kaul, S.; Limnios, EA; Ray, S.; Nguyen, N-L; Tapsall, J. W. (2006). "SAGE Journals: Your gateway to world-class journal research". International Journal of STD & AIDS. 17 (12): 810–812. doi:10.1258/095646206779307595. PMID 17212856. S2CID 6526259.
  17. "Medicine Quality and Public Health 2018". Centre for Tropical Medicine and Global Health - Nuffield Department of Clinical Medicine - University of Oxford. Retrieved 2019-01-22.
  18. "Home | AMR Review". amr-review.org. Retrieved 2019-01-21.
  19. "Antimicrobial Resistance: What Does Medicine Quality Have to Do with It?". apps.who.int. Archived from the original on July 25, 2017. Retrieved 2019-01-21.
  20. "Safe, Secure and Controlled: Managing the Supply Chain of Antimicrobials" (PDF). AMR Review. Retrieved 2019-01-22.
  21. Pisani, Elizabeth; Hasnida, Amalia; Rahmi, Mawaddati; Kok, Maarten Olivier; Harsono, Steven; Anggriani, Yusi (2021-08-16). "Substandard and Falsified Medicines: Proposed Methods for Case Finding and Sentinel Surveillance". JMIR Public Health and Surveillance. 7 (8): e29309. doi:10.2196/29309. PMC 8406122. PMID 34181563.
  22. Dewi, Aksari; Patel, Anushka; Palagyi, Anna; Praveen, Devarsetty; Ihsan, Bachtiar Rifai Pratita; Hariadini, Ayuk Lawuningtyas; Lyrawati, Diana; Sujarwoto, Sujarwoto; Maharani, Asri; Tampubolon, Gindo; Jan, Stephen; Pisani, Elizabeth (2022-11-01). "A study of the quality of cardiovascular and diabetes medicines in Malang District, Indonesia, using exposure-based sampling". BMJ Global Health. 7 (11): e009762. doi:10.1136/bmjgh-2022-009762. ISSN 2059-7908. PMC 9703323. PMID 36427901.
  23. Team, STARmeds Field (2023-01-11), Conducting randomised field surveys of medicine quality using mystery shoppers: A practical guide and toolkit., Harvard Dataverse, doi:10.7910/dvn/obidhj, retrieved 2023-02-17
  24. Pisani, Elizabeth; Dewi, Aksari; Palagyi, Anna; Praveen, Devarsety; Ihsan, Bachtiar Rifai Pratita; Hariadini, Ayuk Lawuningtyas; Lyrawati, Diana; Sujarwoto; Maharani, Asri; Tampubolon, Gindo; Patel, Anushka (2022-11-27). "Variation in price of cardiovascular and diabetes medicine in Indonesia, and relationship with quality: a mixed methods study in East Java". medRxiv 10.1101/2022.11.24.22282722v1.
  25. "In Sickness and In Health: Diagnosing Indonesia | ISEAS Publishing". bookshop.iseas.edu.sg. Retrieved 2023-02-17.
  26. https://kebijakankesehatanindonesia.net/images/2021/Taking-a-cut-investigating-incentives-in-Indonesia_Medicine_Supply_Chain.pdf.
  27. Aitkenhead, Decca (2008-05-13). "'People do stupid things - that's what spreads HIV'". the Guardian. Retrieved 2015-09-25.
  28. Pisani, Elizabeth (2009-10-08). "The Catholic church's Lazarus complex over HIV-AIDS | Elizabeth Pisani". the Guardian. Retrieved 2015-09-25.
  29. "About Portrait Indonesia « Portrait Indonesia". portraitindonesia.com. Retrieved 2015-09-25.
  30. "Indonesia Etc - Exploring the Improbable Nation -By Elizabeth Pisani - A book and blog". indonesiaetc.com. Retrieved 2015-09-25.
  31. "Buy the Book | Indonesia etc". indonesiaetc.com. Retrieved 2015-09-25.
  32. "Page turners". The Economist. ISSN 0013-0613. Retrieved 2015-09-25.
  33. Graphics, WSJ.com News. "Best Books of 2014: A Compilation". Retrieved 2015-09-25.
  34. Pisani, Elizabeth (2014-06-16). "Indonesia in Pieces". Foreign Affairs (July/August 2014). Retrieved 2015-09-25.
  35. Pisani, Elizabeth (2014-07-15). "Indonesia's Democracy Test". The New York Times. ISSN 0362-4331. Retrieved 2015-09-25.
  36. Pisani, Elizabeth (2014-10-07). "Sore Losers Spite Indonesia's Democracy". The New York Times. ISSN 0362-4331. Retrieved 2015-09-25.
  37. Pisani, Elizabeth (18 July 2014). "Whoever the winner, Indonesia's new leader must let districts rule". Nikkei Asian Review. Retrieved 25 September 2015.
  38. Pisani, Elizabeth (19 October 2014). "For Indonesia's new president, it's time to get dirty". Nikkei Asian Review. Archived from the original on 26 September 2015. Retrieved 25 September 2015.
  39. Pisani, Elizabeth (28 October 2014). "Can corruption reduce conflict? Lessons from Indonesia". Archived from the original on 2019-01-21. Retrieved 2019-01-22.
  40. "Elizabeth Pisani: Corruption isn't always a bad thing". NewsComAu. 2014-08-28. Retrieved 2021-05-27.
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