Ezra Klein: Department of Tragically Unintended Consequences

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May 17, 2007

Department of Tragically Unintended Consequences

Researchers have long puzzled over why AIDS began in Africa, and why so recently. The monkey-to-human link was fairly well-established, but Africans had been killing and eating monkeys for tens of thousands of years -- why did AIDS only arise in a noticeable sense around the 60s?

According to some theorists, including Helen Epstein, it was medical technology. The massive vaccination campaigns of the era reused needles, sparking the pandemic. So the elimination of diseases like smallpox literally gave rise to the genocidal toll of AIDS. The universe doesn't laugh at us, it cackles.

May 17, 2007 in Africa | Permalink

Comments

It wasn't medical technology (if indeed the hypothesis is correct), but rather its improper application. The danger of non-sterile needles was certainly well-known to medicine at the time.

Posted by: idlemind | May 17, 2007 11:04:30 AM

This idea's made it's way though the zeitgeist before. Pretty sure it was shown to be false last time.

Posted by: Tim Worstall | May 17, 2007 11:36:23 AM

Hey, I recently read Patenting the Sun about the development of the polio vaccine.

Polio epidemics were an outgrowth of all the cleanups and sanitation efforts to eliminate cholera.
Apparently, in 3rd-world (and older dirtier times), infants got exposed to a milder degree of polio which they mostly recovered from. Once people were no longer "immunized" by early exposure, they didn't catch the disease until they were much older when it was much more severe...

Posted by: Lis Riba | May 17, 2007 11:47:13 AM

So is she really a theorist? Or maybe "merely" a theorist? My understanding is she does a shit load of research in the field. To my mind that makes her more than just a theorist but a practitioner as well, but I may be coming from a field that distinctly separates itself into experimental vs. the theoretical and that may not be what happens in biology.

Posted by: jerry | May 17, 2007 12:12:45 PM

Idlemind is right: this has nothing to do with the universe "cackling" at us. This isn't blowback; it's improper re-use of needles.

Posted by: Gorgle Erf | May 17, 2007 1:10:55 PM

While I'm a big fan of dirt and, as a parent, tried to keep plenty of dirt in my kids lives I've got to say, having lived in third world countries, that the notion that more problems were caused by cleaning up dirty environments than by the original environments themselves strikes me as hugely wrongheaded. I'm responding to Lis Riba's post. It makes intuitive sense to say that exposure to some mild version of a highly dangerous disease led to an immunity to a more dangerous form--that was the case with cow pox and small pox, of course. But what is the evidence that it holds true for polio? And what is the evidence that the hypothetical earlier, milder form of polio was eliminated by anythign that didn't need to be eliminated for its own sake. That is to say, a huge proportion of children died *and still die* from things like poor sanitation, dirty water, contaminated foods etc...etc...etc... If you survived *allthose* things you were much tougher at a later age than someone else not because of immunity but, because, you were just of tougher stock. Any change in that enviroment which led to more kids surviving infancy by definition let more kids survive who were "weaker" and who would die later in life from something else. Does that mean that cleaning up poor sanitation and letting more kids survive infancy "increased" deaths in childbirth? Well, yeah, in a sense, because the kids who would have died before reproducing now had a chance to die in childbirth. Does it mean that more kids die of old age than before? well, yeah, that too. If more people survive infancy more will survive to die of some other cause. But its not the period of infancy or the other cause that are "on the rise" its the *number of potential victims/age of the victim* that is on the rise.

aimai

Posted by: aimai | May 17, 2007 1:38:37 PM

Or perhaps what happened with polio is that all of the vulnerable victims died either because of polio itself or because of other diseases that would strike their already-weakened bodies before polio got to them. It's just that when you got rid of all of the diseases realted to poor sanitation, the diseases that remained became the most visible.

There are two needle-theories about HIV in africa. One is that one of the vaccines was developed using a tissue from other primates. I am pretty sure that this speculation has been mostly debunked. However, there was definitely a lot of reuse of needles, which also caused the spread of hepatitis, so the possibility that needle reuse seriosuly contributed to the spread of HIV isn't that far fetched.

Posted by: Constantine | May 17, 2007 1:52:22 PM

It wasn't medical technology (if indeed the hypothesis is correct), but rather its improper application. The danger of non-sterile needles was certainly well-known to medicine at the time.

"Improper application" turns out to be a relative measure. "Danger" is also a relative measure.

Google for medicine africa needles expensive bring own brings up these two intresting links:

http://www.emedicine.com/emerg/topic726.htm
eMedicine - Medicine in Africa : Article by James Li, MD

We reused everything, resterilizing our scalpel blades, syringes, needles, and latex gloves. We had no oxygen, pulse oximetry, or inhaled anesthetics. Postoperative analgesia was limited to acetaminophen and placebo injections. Serious skin infections, such as lepromatous and tropical ulcers, were treated with sugar packing, often followed by skin grafting.

http://www.princeton.edu/~sap/handbook/chapter-7_05-06.html
SAP : Handbook : Maintaining Health and Nutrition

Overseas Injections and AIDS: In the U.S., we take for granted that equipment such as needles and syringes are never reused. Be advised that in some foreign countries even disposable equipment may be used many times with different patients. In some countries, if an injection is required, you can buy needles and syringes and bring them to the hospital for your own use. The best rule is to avoid injections unless absolutely necessary. If injections are required, make sure the needles and syringes come straight from a package or have been sterilized with chemicals or by boiling for twenty minutes. When in doubt, ask to see how the equipment has been sterilized.

Caution regarding instrument sterilization applies to all instruments that pierce the skin, including tattooing, acupuncture, ear piercing, and dental work.

The Center for Disease Control recommends that "diabetics or other persons who require routine or frequent injections should carry a supply of syringes and needles sufficient to last their stay abroad." It is not uncommon to bring needles for your own use. Be aware, however, that carrying needles and syringes without a prescription may be illegal in some countries, so take along a note from your doctor. Some countries have needles and syringes for sale. Do not use or allow the use of contaminated, unsterilized syringes or needles for any injections.

Posted by: anon | May 17, 2007 2:07:33 PM

Addressing aimai's comments (above)

I don't have the book on-hand to provide the references, but polio rates rose to become an epidemic in the U.S. and England during the first half of the 20th Century, after being considered relatively rare before that.

It mostly seemed to hit elementary-school-aged kids, but during WW2, it also affected a lot of GIs serving abroad -- serving in places which didn't have much native polio epidemics. The GIs were a big key.

Either the disease was somehow specifically targetting Americans and ignoring the locals, or the virus was all around, but locals had somehow picked up an immunity.

I'm not trying to condemn sanitation efforts, just pointing out that if this theory about AIDS is correct, then it wouldn't be the first disease accidentally spread while trying to eradicate another.

Posted by: Lis Riba | May 17, 2007 10:48:31 PM

The law of unintended consequences has got to be the most abused notion in quasi-academic discourse.

It's undoubtedly true that a any goal-directed action may have unintended consequences. Well, duh.

In a more common guise, the "law" meant to imply that a goal-directed action will necessarily have an effect opposite to its intent, and probably ironically so. This is simply bullshit. Often things come off pretty much as planned, with "unintended consequences" which are trivial and easily managed -- inconsequential, in other words.

What's frustrating is when people with intellectual pretensions nod along with conservatives who argue that there's probably no point taking action to solve a problem, since the "law" "proves" it will do more harm than good.

This is more bullshit. Because to the extent that the "law" applies, it means that taking no action will also have unintended consequences.

Which means that the "law" is useless as a general guide to action or inaction. It's useless even as a cautionary tale to "look out for unintended consequences," because under the "law," better planning doesn't make unintended consequences any less inevitable.

It's like having a "law of forgotten items," which says that you will always forget something. In practice, you're not always going to forget something. Even if it were true, it's no argument for inaction, since in doing nothing you're equally likely to forget something. And it doesn't help to invoke the "law of forgotten items" as a way to try to get people not to forget things, since the law holds that no matter how much time you spend trying to remember, you're always going to forget something anyway.

Posted by: social democrat | May 20, 2007 6:36:27 AM

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