"The fox knows many things, but the hedgehog knows one big thing."

                --Archilochus

Glenn Reynolds:
"Heh."

Barack Obama:
"Impossible to transcend."

Albert A. Gore, Jr.:
"An incontinent brute."

Rev. Jeremiah Wright:
"God damn the Gentleman Farmer."

Friends of GF's Sons:
"Is that really your dad?"

Kickball Girl:
"Keeping 'em alive until 7:45."

Hired Hand:
"I think . . . we forgot the pheasant."




I'm an
Alcoholic Yeti
in the
TTLB Ecosystem



Monday, February 06, 2006

Recent Medical Advances

The Times (the real Times, in London, not that fake Times in New York that almost got us fired) reports that this April the Royal College of Nurses, at their annual convention, will take up the question of how best to assist patients who like to cut themselves:
NURSES want patients who are intent on harming themselves to be provided with clean blades so that they can cut themselves more safely.

They say people determined to harm themselves should be helped to minimise the risk of infection from dirty blades, in the same way as drug addicts are issued with clean needles.

This could include giving the "self-harm" patients sterile blades and clean packets of bandages or ensuring that they keep their own blades clean. Nurses would also give patients advice about which parts of the body it is safer to cut.
In a bid to retire the trophy for stating the obvious, The Times notes that the proposal "is likely to provoke controversy." A safe bet. Just to be sure its readers aren't confused, and have all necessary information at their fingertips, the article explains:
At present nurses are expected to stop anyone doing physical harm to themselves and to confiscate any sharp objects ranging from razor blades to broken glass and tin cans.
The pattern, of course, mirrors not only provision of syringes to junkies, but also passing out condoms to kids. The theme is that people are going to do certain dangerous, stupid, destructive things, so we might as well see to it that the damage isn't any greater than it has to be.

It would seem to any self-respecting undergraduate economics major that by reducing the cost of the behavior (by minimizing damage, and reducing the social stigma by this sort of official support) the result will be an increase in the underlying behavior. And it may well be that the negative effect of such encouragement completely overwhelms any positive result. For example, have unintended pregnancies declined since condoms, other birth control devices, and cradle-to-grave sex education became universal in the United States? We didn't think so.

And this principle has application to a wide range of dangerous behavior often accompanied by unintended or otherwise collateral damage: The arsonist whose ignorance causes an explosion, or the destruction of more than his target building; the murderer whose aim is so poor that he kills some pain-in-the-ass innocent bystander; the joy-riding teen whose defensive driving skills are inadequate to a high-speed chase; the poisoner whose potion causes unnecessary suffering. Extend the list at your leisure.

Can we make this stuff up? No, we can not. Complete story HERE.

Comments on "Recent Medical Advances"

 

Blogger Selfish Country Music Loving Lady said ... (4:59 PM) : 

I don’t know about compulsive cutting behaviors, but this post does touch on one topic (perhaps THE one topic) with which I’m moderately familiar, namely HIV epidemiology. Provision of condoms and provision of clean needles both result in lower incidence of HIV infection compared to analogous populations where they’re not available. Unquestionably, unequivocally. Does providing these things condone (or at least, fail to explicitly condemn) bad deeds? Maybe. But the perfect can’t be the enemy of the good. In a public health emergency involving, need I remind everyone, an infectious disease with an exponential transmission rate, immediate harm reduction trumps behavior modification.

 

Blogger Gentleman Farmer said ... (9:43 PM) : 

Let me say this about that.

I'm always a little confused about the transmission of HIV.

When somebody wants money, then HIV is "an infectious disease with an exponential transmission rate," that's about to break into the general population at any moment.

But when the question is whether my 5-year-old's teacher is infected, or whether my nurse is HIV positive, then I'm an ignorant homophobe for even asking, since everyone knows that HIV is very difficult to transmit.

Since neither condoms nor clean needles are either 100% effective, nor effective in and of themselves (they require use, proper use, and absence of re-use, all behaviors that are at the root of the problem to begin with), then we're back to the problem of how much the behavior is encouraged.

And the drug use, at least, is illegal. So let's tell the cops to bust into apartments and arrest kids for smoking dope, and then take a swing by the nearest shooting gallery, and pass out needles to the junkies.

This all seems very odd, and I'm very confused.

 

Blogger Selfish Country Music Loving Lady said ... (10:56 PM) : 

Hey, I'm just making an argument from evidence here. Giving out these things, 100% effective or not, DOES reduce transmission of a disease that makes people extremely sick, kills them in dreadful ways in the prime of life, and leaves their children orphans. (It's also way, way past "breaking into the general population" in many parts of the world.)

And for the record, yes, it is rather hard to transmit. I know, I know, the irony. Unless [censored] or [really really censored], your kid is not going to get it from his teacher.

 

Blogger Gentleman Farmer said ... (8:05 AM) : 

I sort of expected the content-less, "Well, unless your 5-year-old is . . . with the teacher, you don't have to worry." So you get a pass, and a question:

Tell me what it is that people are doing (that my 5-year-old doesn't have to worry about) that has caused the HIV infection rate in Botswana to be more than 37% among pregnant women, and nearly 10% for women 25-34, but only 3% for men of the same age? Are all of these women intravenous drug users? Assuming one "exposure event" doesn't result in one infection, am I really supposed to believe that between one-half and one-third of these pregnant women had repeated anal intercourse with infected men?

I'm just asking. And I'm still listening, despite the fact that you gave the standard answer from the catechism of the Holy Church of the New York Times in your last response.

(Stats above from the CDC.)

 

Blogger Selfish Country Music Loving Lady said ... (12:19 PM) : 

There’s a two-part answer to that question. The first involves some boring (but important!) clarifications about data-gathering. The vast majority of people in Southern Africa have never had an HIV test, and the health-care system is, in a word, awful. Screening at antenatal clinics is by far the simplest way to get prevalence information (even that 10% for women 25-34 very likely comes from antenatal-clinic data), but it’s not terribly reliable. By definition, after all, pregnant women have engaged in a high-risk behavior (unprotected sex), so their infection rate is going to be high compared to the overall population. That 10% has very likely gone through a bunch of adjustments, but it still may SLIGHTLY overestimate the male-female difference.

But anyway, you are correct that there is a very large discrepancy in prevalence rates between men and women. There is a straightforwaard biological explanation for this: women catch the virus more easily. I’ll leave out the anatomy lesson for now, because you can probably figure it out. Being unhealthy – say, carrying an STD, or malaria, or tuberculosis, or being malnourished, increases a woman’s susceptibility of infection more than ten-fold (those things aren’t great for men either, but the increase is more like 3- or 4-fold.)

There are also various social explanations for why the infection rate is so much higher among women. A lot of it has to do with the culture in Southern Africa, especially relatively wealthy countries like Botswana and South Africa, where many men are migrant workers. There is a lot of transactional sex and a lot of extramarital sex, by both men and women. Women have very little economic power compared to men so much of it, from their end, is de-facto coercive, especially when they’re very young. A very common pattern is that a man will be married but spend six months a year in another location, where he will have one or two young, unmarried “girlfriends” whom he supports financially. So women start having sex earlier than men, and go on to have as many (if not more) partners over a lifetime, AND are more likely to catch the virus from an infected partner than a man is. Hence the higher rate among young women than young men.

What’s the answer to this mess? Of course, abstinence until marriage and then monogamy would fix it. And in fact, as the AIDS epidemic becomes (finally!) openly discussed in Southern Africa, many people – especially girls – are (finally!) getting this message. And I sincerely hope that they can implement vast social change through sheer force of will, but the fact is, for that to work perfectly, the whole region would need to hugely overhaul its economic situation, its treatment of women, and its health-care system. In the meantime, there is no sense denying that people are going to put themselves at risk, through poor health and through these deeply entrenched behaviors, however repellent and foolish they seem. Teaching them about how to protect themselves and providing them the means to do so can at least stem the tide.

(Of course, what you REALLY need is a vaccine. But I’ll save THAT tirade for another occasion.)

 

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