Amir Attaran asks in PLoS Medicine of the UN’s Millennium Development Goals, “Could it be, despite an appearance of firm targets, deadlines, and focused urgency, that the MDGs are actually imprecise and possibly ineffective agents for development progress?” He answers this question with,

“I argue that many of the most important MDGs, including those to reduce malaria, maternal mortality, or tuberculosis (TB), suffer from a worrying lack of scientifically valid data. While progress on each of these goals is portrayed in time-limited and measurable terms, often the subject matter is so immeasurable, or the measurements are so inadequate, that one cannot know the baseline condition before the MDGs, or know if the desired trend of improvement is actually occurring. Although UN scientists know about these troubles, the necessary corrective steps are being held up by political interference, including by the organisation’s senior leadership, who have ordered delays to amendments that could repair the MDGs. In short, five years into the MDG project, in too many cases, one cannot know if true progress towards these very important goals is occurring. Often, one has to guess.”

Jeffrey Sachs and colleagues disagree, responding:

“Although Attaran raises important points on the poor quality of data for some indicators used to measure progress on the MDGs, he uses these findings to draw the wrong conclusions. Of course the data on the world’s poorest people are weak, as is just about every other effort regarding the poor. Rich countries invest little in helping save the poor from dying of malaria and tuberculosis. It is therefore no surprise that developing countries and the international system lack the resources to measure the diseases’ effects well. Attaran’s criticisms in this regard are justified, and have been made by many others before him, including many professionals working for the UN system. The world leaders who attended the 2000 Millennium Summit committed to halve poverty in its many forms by 2015, and the MDGs are the result of that political commitment. Attaran ignores that broad goals adopted by world leaders are distinct from the technical question of how to define and measure progress toward those goals.”

Attaran offers a rejoinder:

“Writing in response to my article, Jeffrey Sachs and colleagues at the UN Millennium Project, admit that my criticisms are justified. They concede that the same criticisms “have been made by many others before including many professionals working for the UN system”. So it does not seem debatable that what I am arguing is truthful: that progress (if any) towards the MDGs is not being measured as the UN claims. I therefore find it hard to understand why Sachs and colleagues have sought to refute my article in such negative terms. Maybe they are rebutting its political implications, which – if you have chaired the UN Millennium Project as Sachs has – and pinned your legacy on that, must touch a nerve. Certainly they do not deny the facts underpinning my argument, which when published in PLoS Medicine referenced 41 articles. Sachs and colleagues’ reply contains zero references to the literature – zero references to the evidence. A reply that contains no contrary evidence is not a rebuttal but a polemic.”

Read the full text of this exchange here. From where I sit Attaran has both the moral and intellectual high ground here, concluding,

“Imagine if the US president set a Millennium Unemployment Goal to halve the number of people without jobs by 2015. Then suppose some years later, an academic asked the government: “So, how much unemployment is there?” If the government’s answer were, “We never measured that, and you’re right that we don’t know, but shame on you for blaming us”, the public outcry would be huge. So would the realisation that the government was unaccountable and disdainful of the people it is meant to protect. This is exactly where the UN finds itself today over several of its most important MDGs: it pushed for goals that its own scientists knew it could not measure. Largely it gets away with that because world’s poorest people are seldom in a position to complain. Rebuking me for drawing attention to it is shooting the messenger. This does not solve the problem – which Sachs and colleagues concede exists. We all want the MDGs to succeed, but defending their existence with polemic is not the way. Setting measurable goals, measuring them to guarantee progress, and celebrating the progress as it happens – not just celebrating the goals because they are comforting – is the proper way to dignify and protect the lives of the world’s neediest citizens.”