Lessons along the path of most resistance (pdf)

Lessons Along the Path of Most Resistance
WHAT FUNDERS SHOULD KNOW ABOUT THE KEEP ANTIBIOTICS WORKING COALITION
In less than four years, an unusual mix of foundations and nonprofits has placed a little-known issue on the map, convinced a giant industry to begin changing its practices, and taken great strides towards protecting public health. The coalition’s story is still being written, but its success so far offers insights into how philanthropy may evolve in the years to come. By Andy Goodman
Global Business Network and Monitor Institute, members of the Monitor Group Symptoms
A Short Course in Antibiotic Resistance
Throughout America, more bacteria are becoming resis- Put yourself inside this story, one that starts routinely enough with tant to antibiotics, and unnecessary farming practices a baby’s cry in the middle of the night. Earlier in the day, your 3- are a major cause. To understand how factory farms can month-old daughter was having trouble keeping food down, but lessen the effectiveness of medicine we count on, take a now her forehead is almost hot to the touch. Th quick journey along the path of most resistance: wailing tells you this is more than a “tummy ache,” and you hur- It starts during feeding time at the “pharm.”
riedly dress her for the car ride to the nearest emergency room. To make chickens, hogs, and beef cattle grow slightly faster, factory farm operators routinely include antibiot- Aft er what seems like an eternity, the nurse mumbles your daugh- ics in their feed. These drugs also help prevent diseases that can spread quickly in the overcrowded and unsani- ter’s name through an intercom and the doctor on call arrives. As tary conditions that often prevail in such large opera- he glances at her chart and takes the baby from your arms, you re- tions. The Union of Concerned Scientists has estimated fl exively give him the Protective Parent Once-Over and conclude, that as much as 70 percent of all antibiotics used in the “Too young,” but his questions skillfully elicit a likely culprit: un- U.S. each year are fed to animals that are not sick, and this cooked chicken, or to be more precise, a few drops of the meat’s juice that probably contaminated the baby’s food while you were Now imagine an episode of “Survivor,” except for bacteria.
preparing dinner. He diagnoses a bacterial infection and prescribes Whenever antibiotics are used, some bacteria will even- tually be able to withstand their effects. This is a natural a cure with a reassuring brand name: Bactrim, an antibiotic your process, but it is artificially accelerated by factory farms that unnecessarily serve antibiotics to thousands of ani- mals on a daily basis. Under these heightened conditions, But this is where the story takes a turn that is anything but routine. each animal becomes, in effect, an incubator for newly re- Aft er a few days on her medicine, your daughter is not improving. sistant strains of bacteria. Over time, some bacteria—the If anything, the child is getting worse, and for the fi rst time you so-called “superbugs”—become resistant to several dif- ferent types of antibiotics, including those used in medi- are genuinely worried. An appointment with your family pediatri- cian—known, trusted, older—does not bring the expected relief. You can’t keep a superbug down on the farm.
Instead, she informs you that the bacteria causing your daughter’s Resistant bacteria living in animals’ intestinal tracts can suff ering is apparently resistant to certain antibiotics. Th contaminate meat during slaughter. If this meat is under- be alternative drugs worth trying, she adds, but they will be more cooked, or if its juices contaminate other food, the bacte- expensive and the side eff ects may be worse.
ria can now complete their journey from farm to fork—and into a human stomach. Water and soil can also be con- And there are no guarantees they will work.
taminated by resistant bacteria that escape from animal manure-storage lagoons, a common feature on factory is troubling scenario, now better known as “antibiotic resis- farms. People who drink untreated water or swim in con- taminated lakes or rivers offer another escape route for tance,” is on the rise in the United States. According to the Cen- the resistant bacteria. Finally, farm workers may become ter for Disease Control, reported cases in which salmonella was infected while caring for animals that are fed antibiotics, resistant to antibiotic treatment rose from zero to nearly 36 per- and can then pass resistant bacteria to others in their fam- cent between 1980 and 1997. Experts now estimate that antibiotic resistance in the U.S. is costing at least $4 billion to $5 billion in From “wonder drugs” to “I wonder why they’re not working.”
increased medical expenses each year, and they place the number A visit to the doctor’s office may take an unexpected turn as the patient discovers that the prescribed antibiotics are ineffective against what would normally have been a mi- overuse of antibiotics in human medicine and the extraordinarily nor bacterial infection. In this increasingly common sce- massive feeding of antibiotics to healthy animals on factory farms nario, the doctor would be forced to try other drugs (often (see sidebar, A Short Course in Antibiotic Resistance). more expensive or with more severe side effects), while the patient’s illness progresses. In some cases, there are Lessons Along the Path of Most Resistance 2 of the “miracle drugs” Americans have without the contribution of the Keep relied on for years, and yet antibiotic re- sistance received very little attention un- til recently. Until the late 1990s, the press virtually ignored it, which meant the mental Defense (ED), the Institute for issue was also absent from the average Agriculture and Trade Policy (IATP), person’s radar. Without public pressure and the Union of Concerned Scientists or a bright media spotlight, the practic- well before the coalition came into exis- crease in antibiotic resistance continued unabated. And even though concern Nathan Cummings, and Jennifer Alt- within the scientifi c community was man subsidized much of this early work. But it was not until all these parties and cut through this apathy. Little wonder, several others joined forces that a genu- then, that federal regulators who could ine breakthrough was achieved. Today, the picture looks very diff erent. simply another story of a whole that ex- Stories about antibiotic resistance have ceeds the sum of its parts. By taking a KAW Hits the Big Time
appeared on the front pages of major closer look at how this particular coali- On February 10, 2002, an article entitled newspapers around the country and in tion coalesced, identifi ed its priorities, “Poultry Industry Quietly Cuts Back on page of The New York Times. “Above the vision (see sidebar, KAW Hits the Big to-day basis, funders may be catching a Time). Two of the country’s largest bulk glimpse of an important new trend in purchasers of meat—the fast-food giant American philanthropy.
committee, proudly pointed out. For her, McDonald’s and Bon Appetit, the nation’s fourth-largest institutional food-service tion’s battle for public awareness. That Rx: Widen the Lens…
would come two months later when The ing their chicken suppliers to reduce an- Onion, the satirical online newspaper, ran a story entitled, “U.S. Children Get- tibiotic use and creating a purchase pref- erence for beef and pork suppliers who Rebecca Goldburg found themselves in follow suit. And in both the U.S. Senate a taxi together, crawling through New and House of Representatives, bipartisan really hit the big-time,” said Florini, legislation is pending that will broaden director of the Food & Environment and institutionalize the changes already Program at UCS, and Goldburg, a senior begun among food animal producers scientist with Environmental Defense, and meat buyers. In sum, agricultural had met with an editorial board mem- overuse of antibiotics is fi nally being ad- dressed, and ongoing public scrutiny is genetic engineering of food. Sitting in cause for optimism that the tide may be the cab with plenty of time to talk, the turning on this important contributor to other food-related issue that was equally Lessons Along the Path of Most Resistance 3 Both women were familiar with the problem: alarmingly large amounts of antibiotics were being fed to healthy chickens, hogs, and beef cattle on factory farms. Th is widespread agricultural practice was intended to accel- erate the growth process and serve as a preventative against the outbreak of disease despite poor animal hus- bandry practices, but Mellon and Goldburg believed it was also undermining the effi “I made the case that we should take on antibiotic use in ani- mal production,” Goldburg recalled, and she off ered three rea- sons. First, antibiotic resistance had the potential to become a major threat to public health. Second, there was solid science to connect the rise in resistance to activities on factory farms. And third, Goldburg believed that changes in the agricultural industry could, in fact, be achieved. Mellon concurred, and saw an additional reason for moving forward: challenging the excessive use of antibiotics in agriculture would require the attention of both the environmental and health commu- nities, two huge sectors representing hundreds of nonprofi ts and foundations. Perhaps, Mellon speculated, this issue could open new lines of communication, connecting two worlds that tended to think and act independently.
e two women agreed to work on antibiotic resistance together, and they soon found an ally in Margaret cer at the Joyce Foundation. Based in Chicago and geographically fo- cused on the Great Lakes region, Joyce runs an environment program with a traditional focus on resource- based issues such as water pollution and land use. For the foundation, antibiotic resistance would be a stretch, but it was one that O’Dell was inclined to make.
“We had to make a pretty strong case to our board,” said O’Dell, “that even though this was not our issue, there was this link to the spread of gigantic animal agricultural operations.” O’Dell won the support of her trustees, and in August 1998 she commissioned Goldburg, Mellon, and Jane Rissler of UCS to co-author a white paper is was our way of building intellectual capital on the issue,” O’Dell said.
Half a continent away and a few months later, a similar conversation took place between Michael Lerner and Mark Walters. Lerner, president of the Jennifer Altman Foundation, was also interested in the nexus between environmental issues and public health. He had just begun the Health & Environmental Funders Network (HEFN) with the express purpose of providing a forum in which like-minded colleagues from the philanthropic community could regularly share information and collaborate.
Mark Walters was a charter member of HEFN. As director of the environment program at the Nathan Cum- mings Foundation, Walters had launched the Ecological Health program to support projects where public health, ecosystem health, and animal health were all involved. Like Lerner, he recognized that some problems looming on the horizon could not be solved by discretely focusing on a single aspect such as environmental ey required a more holistic approach, and that meant program offi Lessons Along the Path of Most Resistance 4 ere are those who fund ecology, those who fund ani- • Michael Jacobson of CSPI, Karen Florini of mals, and others who focus on public health,” said Wal- ED, Mark Ritchie of IATP, and Margaret Mel- ters, “and they’re diff erent people. Th lon of UCS formed an executive committee ey dress diff erently. Antibiotics was the perfect issue to that would represent all coalition NGOs when cut across these areas.” Lerner agreed, and in the spring it came time for discussions with funders. The of 2000 he convened a conference call to bring together funders also formed an executive committee some of the funders and NGOs who were already work- with Michael Lerner, Mark Walters, and Her- ing on antibiotic resistance. While it would still be several bert Bedolfe of Homeland Foundation repre- months before a coalition would formally be created, the participants in the call quickly realized they were already • Finally, the coalition members agreed to hire united by a common vision, one that could only come by a director who could work full-time to co- looking at the problem through a wider lens.
ordinate internal discussions and centralize some key tasks (e.g., media outreach). Until …And Sweat the “Soft Stuff”
that person was found, the funders and NGOs asked Karen Florini of Environmental Defense In October 2000, a two-day conference supported by to continue as interim director, a role she had Cummings and Altman was held at the Airlie House been playing from shortly after the initial con- outside Washington, D.C., to gather all the key players. Along with those groups mentioned above, there was Looking back aft er four years of operation, coalition an eclectic mix representing the Humane Society, Del members agreed that they were well served by many of Marva Poultry Justice, the Cox Charitable Trust, Agua the choices made at this fi rst meeting (see sidebar, Th e Foundation, and several other organizations with a stake in the issue. Animated, if sometimes contentious, discus- committee among the NGOs recognized and honored the fact that some organizations were going to invest more • A coalition with clear operating guidelines was created, and a timeline was put in place to give “There are those who fund ecology, those who it a name, visual identity, and all the other ear- marks of an ongoing entity, including a formal decision-making even as ers who focus on public public launch. (At the same time, it was under- stood that individual NGOs could continue ferent people. They talk differently. They dress with their own projects and maintain separate • Coalition members agreed to proceed simul- taneously on three tracks: a media track, to increase public awareness of the issue; an in- constantly negotiate who puts out the release, requiring dustry track, to encourage food producers and bulk purchasers of meat to voluntarily elimi- copy, et cetera,” said Margaret Mellon. “And that meant at nate the unnecessary use of antibiotics; and a the end of four years, we still like each other.” policy track, to pursue legislation and regula- tions that would ban certain antibiotics from Shrewd streamlining was also applied to the dissemina- being used as routine feed additives in the ag- tion of certain funds. Early on, the Homeland Foundation made a grant of $200,000 to the Philanthropic Collabora- Lessons Along the Path of Most Resistance 5 tive to set up an “opportunity fund.” If the coalition or an individual group needed money quickly to capitalize on a time-sensitive opportunity, a representative could submit a brief, one- to two-page proposal with the expectation of receiving fund- ing in less than a week. Homeland still had oversight and could reject proposals if they didn’t fi t the overall strategy, but according to Herbert Bedolfe, the foundation never had to exercise this option. (In fact, he recently made a third grant to replen- ish the fund that continues to fast-track proposals today.) By sweating the big stuff (strategic planning, funding) and the small stuff (press The Big Break Nobody
releases), the Keep Antibiotics Working coalition laid the foundation for success. Having funders involved from the very beginning gave the NGOs fi nancial security and a level of confi dence they might not otherwise have had. But if you asked KAW’s members—NGOs and funders alike—what distinguished this coalition from oth- an unexpected — and significant — lift. ers, they would probably move the conversation to an entirely diff erent level.
anthrax as the weapon of choice led to a “Success requires a very high and developing basis of trust,” said Michael Lerner, run on the antibiotic Cipro, and that led “and that is not automatic. I have seen campaigns where that trust does not develop, to articles and editorials explaining how and absent that trust, this model doesn’t work.” Right from the start, the funders made it clear that decisions would be left to the NGOs. “Th ber 3, 2001, an op-ed in The New York much better than any of us,” said Mark Walters, “and we weren’t about to tell them Times entitled, “What If Cipro Stopped how to spend the money. We didn’t want to start a new program on our terms.” Working?” included this fact: “The wide- spread use of Baytril in chickens has al- Nowhere was this trust more evident than in the coalition’s decision to focus on the agricultural causes of antibiotic resistance. Several of the funders believed that the excessive use of antibiotics in human medicine—the other major cause of rising re- sistance—should also be addressed. As Lerner recalled, he and his colleagues made a strong recommendation in this regard, only to be turned down by the NGOs, who maintained that other groups were already focusing on medical overuse while the agricultural issue was being largely ignored. “And I was proud to be turned down,” at was the dynamic we were looking for. We wanted the capacity to make our case, but they were authentically responsible for the strategy.” Respect went hand in hand with trust, and Karen Florini saw this evidenced in the early conference calls that Lerner facilitated. “[Th tion behavior,” she recalled, “Michael in particular. He was always orderly about the process, started on time, and spoke in ways that were supportive and positive.” Margaret O’Dell came away from those early calls with a similar feeling. “Michael did an incredible job of getting people involved and interested. He was very quick to pick up on what people were saying—very Buddhist. He gently got everyone into the mix and moved things along in a way that got everybody heard.” As the funders invested more authority and accountability in the NGOs, it was evident that respect fl owed in this direction as well—especially where Karen Flo- rini’s contributions were concerned. “Karen’s exceptional set of skills, her ability to manage details, her strategic thinking—it all helped set the tone for the campaign,” Lessons Along the Path of Most Resistance 6 said Mark Walters. “She laid the foundation that a permanent coordinator could build on.” Herbert Bedolfe of the Homeland Foundation had a similar appraisal for KAW’s chair. “She kept everyone on the same page, moving ahead, and having concrete successes.” And yet, even words such as “trust” and “respect” may be too solemn to accurately describe what united, motivated, and sustained this particular group of people. “We tend to have a ‘come one, come all’ way of doing business,” said Rebecca Goldburg, refl ecting on her experience with other public interest coalitions, “but it sometimes leads to inaction.” On occasion, Goldburg added, it pays to be more selective in the people you invite to the party. Sometimes, you get more done simply because you’re working with people you like. Catherine Porter, former director of the Consultative Group on Biodiversity, now helps coordinate discussions between the funders and NGOs in the Keep Antibiotics Working coalition. “Being good on the issue isn’t enough,” said Porter. “Having experience in other coalitions, knowing how to work in partnership—that’s just as important.” From her per- spective, anyone who says, “It’s not personal—it’s just business,” is probably not cut out for at more broadly reducing antibiotic use by its suppli- coalition work. Porter recalled an experience she had trying to rescue a coalition that was starting to disintegrate. “More pancake breakfasts,” she said, laughing as she described the solution that sounds absurd but was, in fact, the way she got the coalition’s members e second it became personal again,” said Porter, “it all started Prognosis
Because of pressure from KAW, the majority of poultry producers in the U.S. have prom- ised to end the routine use of certain antibiotics that are also crucial in human medi- cine. McDonald’s, the world’s largest meat purchaser, has adopted a policy aimed at more broadly reducing antibiotic use by its suppliers, and KAW is pressuring other bulk pur- chasers to follow this example. In the Senate, Ted Kennedy and Olympia Snowe have worked to recruit additional bipartisan cosponsors to a bill that would create enforceable limits on feeding medically important antibiotics to healthy chickens, hogs, and cows; Sherrod Brown and Wayne Gilchrest have taken similar steps in the House. Periodic news reports about antibiotic resistance continue to keep the issue on the public radar, and other opportunities are pushing the issue forward in several states.
Recently, the coalition has also begun working directly with groups of farmers. As Karen ere are growing numbers of buyers who want meats produced without routine antibiotic use, and growing numbers of farmers who use husbandry practices that eliminate the need for routine antibiotics. Now we need to deal with the barriers that are Mark Walters has already identifi ed other human health issues that could benefi t for KAW-like partnerships. One example he off ered is Lyme disease, carried by a tick that Lessons Along the Path of Most Resistance 7 is itself carried by mice and deer, two species common to forests. Sprawl (an environmental issue) puts more people in closer contact with forests and its denizens. Th forests (a second environmental issue) drives out larger predators (an animal issue) that would normally control populations of deer and mice. Global warming (a third environmental issue) may be providing a friendlier breeding ground for the ticks. “You cannot eff ectively curb the spread of Lyme disease,” Walters said, “without addressing the environmental, animal, and hu- Michael Lerner off ered another reason why the emergence of coalitions similar to KAW would is kind of partnership strengthens NGOs by helping to reduce the power im- balance that’s inherent in their relationship with funders,” Lerner said. “It’s a legitimate transfer of both authority and responsibility.” While some foundations may talk about their grantees as “partners,” the funders behind KAW walked the talk—and Lerner believed this cut two ways. e beauty of this model is that if one of the NGOs blows an assignment, it’s not just between the NGO and the foundations. It’s between the NGO and the rest of the coalition.” In short: “You’ve enormously heightened accountability.” Nevertheless, funders wary of “mission creep” and losing focus may instinctively categorize the KAW story as a special case—insuffi cient evidence for stepping outside the carefully ar- ticulated guidelines of their respective programs. And as phrases such as “tangible outcomes” and “clear metrics” approach mantra status within the philanthropic community, funders may also be averse to such patently unmeasurable notions as “working with people you like.” ere is no disputing, however, that KAW’s holistic approach—both in terms of addressing an issue and deciding who will work together on it—has had real impact. Th emulate the KAW model may fi nd it to be a “path of most resistance” within their own world. But Walters had a fi nal thought for these individuals in particular. “Ecologists will tell you that it’s at the edge of habitats, not in the middle, where many of the most interesting processes oc- e same could be said of philanthropy.” Lessons Along the Path of Most Resistance 8 About the Author
ANDY GOODMAN
Andy Goodman wrote four stories of philanthropic innovation showcased on the Future of Philanthropy website, and advised the initiative at several crucial stages. He brings experi- ence in advertising, radio, and television (where he wrote for the broadcast network sitcoms e Nanny”) to his work as a nonprofi t communications consultant and trainer. Based in Los Angeles, he specializes in helping public interest groups and founda- tions reach more people more eff ectively through print, broadcast media, and the Internet. Current clients include the Edna McConnell Clark Foundation, Environmental Defense, Global Business Network, Campaign for America’s Future, and Th Foundation. Andy publishes a monthly journal, “free-range thinking,” to share best prac- tices in public interest communications, and is also author of the book, Why Bad Ads Hap- pen to Good Causes. He can be reached at andy@agoodmanonline.com.
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