Pur Autre Vie

I'm not wrong, I'm just an asshole

Monday, November 28, 2016


Along the lines of my previous post, consider the many dimensions along which we are trying to make the world a better place.  I had occasion over the holidays to read about infectious diseases.  The thing about disease control is that it is dependent on many other factors that doctors and public health officials have little or no control over.  So they are trying to optimize along one dimension in n-dimensional space, while we are are veering from place to place along the other n-1 dimensions, often without logic or purpose.

So for instance, anthrax control fell apart during Zimbabwe's civil war, and Zimbabwe remains one of the most anthrax-infested places in the world.  Polio eradication efforts were going reasonably well until wars in Africa and South Asia disrupted vaccination efforts.  (I am also given to understand that in the U.S. effort to capture/kill Osama bin Laden, the use of a vaccination program as a cover for U.S. intelligence may have compromised vaccination efforts going forward.)

There's really very little that infectious disease doctors can do about these things.  Like other citizens in democratic societies, they can vote against war and politicians who support it, but realistically they do not wield sufficient political power to keep things on track.  (For what it's worth, ID doctors in the United States are among the most Democratic-leaning of all physicians.)

Of course this works in the other direction too.  You can imagine how destabilizing HIV/AIDS has been to development efforts and to progress generally.  So while failures in non-medical policymaking have hampered anti-disease efforts, failures in disease control have hampered non-medical policymaking.  (Of course you have to judge these things in light of the circumstances.  HIV is pretty much the worst infectious disease you can imagine, and arguably the ID community acquitted itself fairly well after a few early blunders.)  And of course HIV also had huge detrimental impacts on other public health efforts.

Bear in mind that ID doctors generally don't have much control over resource allocation.  They have some influence with public health officials, but beyond that they have very little discretion to direct our efforts in one way or another.  When mad cow disease became a public concern, funding magically appeared to research kuru.  When mad cow disease receded from public attention, the funding for kuru dried up.  Vastly, vastly more is spent to help affluent white men grow hair and get erections than is spent on many devastating tropical diseases.

Anyway what I am trying to say is that the struggle to build a good world is truly an endless/hopeless one, and "for us, there is only the trying."  The consolation, I suppose, is that there are victories along the way, diseases that have been eradicated or banished to the margin.  (For instance, after all these decades, syphilis still has no resistance to penicillin, and so what was once a terrible affliction is now a mere annoyance for anyone who can obtain proper medical treatment.)  But it sometimes feels as though the destructive forces are bound to win in the end.


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