Forty Days

One of the many interesting aspects of how the US dealt with the AIDS epidemic is what we didn’t do – in particular, quarantine.  Probably you need a decent test before quarantine is practical, but we had ELISA by 1985 and a better Western Blot test by 1987.

There was popular support for a quarantine.

But the public health experts generally opined that such a quarantine would not work.

Of course, they were wrong.  Cuba instituted a rigorous quarantine.  They mandated antiviral treatment for pregnant women and mandated C-sections for those that were HIV-positive.  People positive for any venereal disease were tested for HIV as well.  HIV-infected people must provide the names of all sexual partners for the past sic months.

Compulsory quarantining was relaxed in 1994, but all those testing positive have to go to a sanatorium for 8 weeks of thorough education on the disease.  People who leave after 8 weeks and engage in unsafe sex undergo permanent quarantine.

Cuba did pretty well:  the per-capita death toll was 35 times lower than in the US.

Cuba had some advantages:  the epidemic hit them at least five years later than it did the US (first observed Cuban case in 1986, first noticed cases in the US in 1981).  That meant they were readier when they encountered the virus.  You’d think that because of the epidemic’s late start in Cuba, there would have been a shorter interval without the effective protease inhibitors (which arrived in 1995 in the US) – but they don’t seem to have arrived in Cuba until 2001, so the interval was about the same.

If we had adopted the same strategy as Cuba, it would not have been as effective, largely because of that time lag.  However, it surely would have prevented at least half of the ~600,000 AIDS deaths in the US.  Probably well over half.

I still see people stating that of course quarantine would not have worked: fairly often from dimwitted people with a Masters in Public Health.

My favorite comment was from a libertarian friend who said that although quarantine  certainly would have worked, better to sacrifice a few hundred thousand than validate the idea that the Feds can sometimes tell you what to do with good effect.

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87 Responses to Forty Days

  1. Ron Pavellas says:

    I was working as the CEO of a large hospital in California during the 1980s (I have MPH as my degree, by the way). I was outraged when the Public Health officials decided to not treat the HI-Virus as an STD for the purposes of case-finding, as is routinely and effectively done with syphilis, gonorrhea, etc. In other words, they decided to NOT perform classic epidemiology, thus sullying the whole field of Public Health. It was not politically correct to potentially ‘out’ individuals engaging in the kind of behavior which spreads the disease. No one has recently been concerned with the potential ‘outing’ of those who contract other STDs, due in large part to the confidential methods used and maintained over many decades. (Remember the Wassermann Test that was required before you got married?) As is pointed out in this article, lives were needlessly lost and untold suffering needlessly ensued.

  2. Mark F. says:

    I suspect being a totalitarian dictatorship and a country that actively persecuted gays was helpful in implementing their strategy. However, probably the main reason quarantines were not implemented elsewhere is because AIDS is not casually transmitted and is very hard to get. Once the public got over their irrational fear of the disease, gay men and junkies dying of AIDS was not a huge public concern.

    • There is something to be said for totalitarian dictators when it comes to controlling disease. The last time we had an Ebola breakout in Africa in 1995 Mobutu employed draconian measures to contain it.

    • R. says:

      I suspect being a totalitarian dictatorship and a country that actively persecuted gays was helpful in implementing their strategy.

      They persecute gays? Seems to me they stopped official policies in that regard more than 20 years ago.

      Most marxist countries just like to pretend that gays don’t exist.

  3. Chris B says:

    When the like of Foucault are pre-eminent in intellectual life, what do you expect? also, was Gaëtan Dugas patient zero? The aids issue is so encrusted with bullsh*t it’s almost impossible to get a straight answer on anything.

  4. Rudolf Winestock says:

    On the one hand, hundreds of thousands of human lives. On the other hand, a sacred cow. No contest.

    The plague that will wipe out most of humanity won’t be some super pathogen that’s immune to modern pharmacology, it’ll be an easy-to-treat pathogen so situated in the vector/target space that dealing with it rationally would make politically powerful groups howl.

    • Rudolf Winestock says:

      I’m replying to my own comment because I just got an idea.

      It would be possible for someone to weaponize this knowledge. Keep a sample of something already cured, say polio or smallpox. Release it into a flavor-of-the-month demographic group in a Western nation. Vigorous measures to combat it would bring cries of “discrimination” and so forth from the usual suspects, thus hampering efforts to stop the disease. The disease spreads beyond the initial target demographic group.

      I suppose someone in China or Russia has been playing out some scenarios. I can’t be the first person to think of this.

      • Greying Wanderer says:

        “I’m replying to my own comment because I just got an idea.”

        I’m pleased I’m not the only one.

      • Dale says:

        Such a release would only have that political effect if the infection remained confined to the particular group. If the infectiousness is not affected by group membership, it wouldn’t be long before the “general population” was infected, and the political effect would be eliminated.

      • Anthony says:

        So what’s the difference in Ebola’s infectiousness (and severity) among different racial groups?

  5. karch_buttreau says:

    Back then, I thought that tattooing someone who was HIV+ somewhere below the belt line would have been a good idea… I would not support the idea now, however, since HIV is no longer a death sentence..

    • You’re repeating an idea proposed by William F. Buckley, who had the same thought almost thirty years ago.

      • gcochran9 says:

        I’m pretty sure that that I thought of quarantine before he did, since I followed the epidemic story from early days.

        Quarantine itself is of course obvious. In earlier decades, it would have happened, without much argument.

        • Greg, I was responding to karch_buttreau and his idea of tattooing anyone who tested HIV-positive “below the belt.”

          From the 1986 Buckley column I linked:

          Everyone detected with AIDS should be tatooed in the upper forearm, to protect common-needle users, and on the buttocks, to prevent the victimization of other homosexuals.

          I assumed quarantine was discussed as a possibility among some informed people almost as soon as the nature of the disease became known, which would’ve been well before Buckley wrote his column.

    • F.J. says:

      Just because it’s not a death sentence doesn’t mean we should rely on the morality of someone who has a very potent disease gained through poor judgement in the first place to be a responsible citizen

  6. Mark F. says:

    People with HIV can’t even transmit the disease now, if they have undetectable viral loads.

  7. Dipitty Do says:

    I’d support quarantine.
    I also support an annual week-long holiday called “quarantine,” where everybody stays away from everybody else (except, obviously, your minor children, if you have them.)

  8. Frito Bandito says:

    So what you’re saying is, sometimes people are too stupid to know what’s good for them and others, and you need a quasi-dictatorial regime to get them into doing it?

    • gcochran9 says:

      Most people won’t wear seatbelts. You don’t need a dictatorship: just a government that isn’t crazy. In 1940, the government would have imposed quarantine without much agonizing. Of course, you couldn’t have had a big AIDS epidemic back then.

  9. Matthew M. Robare says:

    The Reagan administration has also been accused of ignoring the whole thing until 1987.

    • ivvenalis says:

      Randy Shilts has been accused of ignoring IV drugs and buttsex as vectors in favor of conservative politicians.

      • gcochran9 says:

        Not the impression I got from his book.

      • AErickson says:

        I am sure Randy Shilts has been accused of lots of things. He was accused of being a traitor to the gay community and spat on in the Castro, for example. In reality, his book is as well-done a piece of investigative journalism as one will find on most any topic, much less one that was as poorly covered as AIDS/HIV was in the late 1980s (And the Band Played On was published in 1987).

  10. Dale says:

    Of course, the interesting question is whether you support (or supported) quarantining people with HIV or not.

    But this matter leads to an observation on American political discussion: People don’t say “The natural and obvious solution to problem X is policy Y, but we shouldn’t do Y for reason Z.” Instead, they say “Y wouldn’t work”, even if it’s obvious that Y would work. This would count as dissembling, but it seems that everyone understands the game, and they spiritedly argue whether Y would work or not, while underneath the discussion, they’re really discussing whether they think Z is important or not.

  11. Mark says:

    Just because something would “work,” it does not follow it “should” be done. We might increase the average IQ by sterilizing all those with IQs below 90, for example. We might also decrease shoplifting by chopping off the hands of convicted thieves. Etc, etc.

    • gcochran9 says:

      The earlier the quarantine, the fewer people inconvenienced, and the more people saved. That is the nature of an exponentially growing process: quick action has a huge payoff.

      But you’re agin that sort of action. Huh.

      • Mark says:

        I didn’t say that you didn’t have a plausible argument, only that because something works, it does not follow it should be done. Of course, we should take into account all the consequences of acting or not acting.

    • Thanks for retroactively and proactively destroying the planet, Mark. says:

      I bet you feel real clever making this comment. Unfortunately for you, Cochran did give an ethical reason in his post that does entail the “should”. If you give a bunch of facts:

      (1) Fact or event one.
      (2) Fact or event two.

      (n) Fact or event n.

      Then add a normative premise:

      (N1) Normative claim.

      and then conclude:

      (C1) We should do x about facts (1) to (n), based on (N1).

      Then that is a perfectly sound ethical argument. This was Hume’s entire point about arguing from is-to-ought, i.e. you needed a normative premise to entail the normative conclusion.

      Cochran has given this as a purely consequentalist/utilitarian approach, e.g. the per-capita death toll.

      You on the other hand are just parroting some bullshit you saw on the internet so as to sound clever and signal to everyone how nuanced and learned you are as part of the blue/SWPL tribe.

  12. Piper says:

    Quarantine? Our wise prudent public officials wouldn’t even shut down the “bath” houses!

    As for the Reagan administration, when Reagan found out about AIDS he wanted to do something about it even though many of his advisors wanted him to ignore it. The gay+left lobby’s hate-on-Reagan is typically unjust–since Reagan was a symbol for old-fashioned morality, he had to be denounced even at the price of veracity because homosexuals’ main concern in the 80’s was to party more. The pinheads self-indulgently decided that AIDS was a political rather than a medical problem so the response to it should be parades and sit-ins (with plenty of “high-risk” side-entertainment in the nearby restrooms) instead of sober risk and harm reduction.

    It was actually late 1986 that Surgeon-General Koop published the big AIDS report that first explained to most Americans what was going on, and even if Koop had not been obstructed by don’t-rock-the-boat bureaucrats, homosexual fifth-columnists, and religious nuts it is unlikely that anything like that report would have been feasible before, say, 1984 due to sheer lack of info. However (look at page 5) even though he was Surgeon-General, Koop seems to have thought that his powers and those of State health officials did not include quarantining or otherwise interfering with AIDS transmittors!

    The reason other STD’s were dealt-with more effectively for decades is that the protocols were put in place in another era and maintained for a long time by bureaucratic inertia. One side-effect of the political AIDS public-health FAIL is that, due to extensive co-morbidity of AIDS and other STD’s, even those other STD’s are now allowed to flourish more freely because AIDS politics makes rational management politically-incorrect. (I wonder if that will change again when we run out of antibiotics that will work on them.)

    AIDS also gave us the gay-marriage movement, which started strictly as a scheme to get AIDS/ARC treatment paid-for by employers of victim’s not-yet-disabled “partners.”

    • Dale says:

      You write, “I wonder if that will change again when we run out of antibiotics that will work on them.”

      That’s an interesting consideration. The response to Ebola in the US has clearly been affected by the fact that the average American is not threatened with it under any foreseeable conditions. And similarly with AIDS, once the average American figured out that he was at little risk, the policies were driven by the passions of various advocacy groups rather than the fears of the masses. And other STDs are now in a similar situation, the averagely careful and averagely promiscuous American is at low risk for anything Really Bad, so stamping out the remaining STD transmission doesn’t bring calls for hard-ass actions.

    • AKAHorace says:

      I read that AIDS was caused by a decline in traditional gay values. Before 1960 there was a clear division between active and passive gays. Many seemingly straight men were also active gays who secretly had sex with passive gays. This is still the case in some Islamic countries (e.g. Afghanistan). As disease spreads more effectively from the active to the passive partner than the reverse this meant that there was a barrier that limited transmission.

      What happened after the gay rights movement was that many gays became more fluid in
      their sexual identities and so were both buggerers and buggerees. It would be interesting to know how HIV has spread in countries that still have traditional gay values.

  13. bob sykes says:

    As long as the right people die, who cares?

  14. Of course many people never got all that exercised about AIDS because they recognized that it was a very unpleasant disease for its victims but it was not really tragic.

    A truly tragic disease is infantile leukemia. But AIDS is not like that at all. AIDS is relatively easy to avoid. If you don’t want to get AIDS just avoid buggery and/or dirty needles. Part of the real terror of the Black Death in the fourteenth century was that no one knew how to avoid it. But everyone understood early on how to avoid AIDS. It wasn’t anything difficult like killing the Jews or trying not to breathe the miasma. You just had to not have sex.

    I went to Catholic schools as a kid. All the brothers, nuns, and priests never had sex (or so we thought at the time). Millions of religious people were voluntarily celibate. All anyone had to do even at the height of the AIDS crisis in the Castro was to just not have sex. You didn’t need a government program or quarantine. Celibacy worked every time.

    So unlike serious diseases, AIDS sufferers were complicit in their own infections. The public had some difficulty in being sympathetic.

  15. Abelard Lindsey says:

    Many of us practiced a form of “self quarantine” during the 80’s. which consisted of avoiding risky (e.g. anal sex) as well as sex with homosexuals, not to mention promiscuity in general. Avoiding getting HIV is remarkably easy if one has the self-control to not be promiscuous.

    • John Hostetler says:

      Outside the prostitution industry, promiscuity is rare among heterosexuals. To this day, few women who aren’t hookers are promiscuous, and few men have enough game to lay a promiscuous number of such women. For most people, avoiding promiscuity and being heterosexual amount to the same thing.

    • Dale says:

      As far as I could tell, the risk was even more narrow than that. I made a morbid specialty of reading the articles in Science magazine as the knowledge of the epidemic unfolded. The geographic distribution of AIDS was clearly very narrow, concentrated to a great degree in San Francisco, New York City, and Newark, NJ. The first two seemed to be driven by extremely promiscuous, dense gay subcultures and the latter by junkies. But Boston, which is said to have a vibrant gay community, barely registered on the incidence maps. My assumption was because its promiscuity level was low enough that the epidemic really couldn’t get going there.

      And the numbers that were reported from SF were staggering. One early survey noted that gays with AIDS in SF reported an average of 300 or so partners in the previous year. You didn’t seem to have to exercise much self-control to stay out of the danger zone.

      • Mark says:

        Actually, you were very safe if you didn’t have anal sex. You could still have 300 partners a year and stay negative it if you stuck to oral sex.

  16. a very knowing American says:

    Nancy Scheper-Hughes is an anthropologist, politically something of an Old Leftist, not especially starry eyed about Castro, but clear on the costs of the American response to AIDS.

    “In the US and Europe, individual rights issues were seen as central at the very start of the AIDS epidemic. … AIDS was different than all other previous epidemics in the extent to which members of the afflicted communities played an active role in limiting the public health responses to the crisis. …
    In Cuba the initial ignorance about the forms of transmission resulted in a panicky isolation of all seropositive people, the “worst case scenario” for American civil libertarians. But in the US, the individual rights agendas provoked a “hands off” response that was so virulent we lost sight of the real threat of the epidemic: mass death, not just stigma or loss of employment.
    This perception is reflected in the mountain of uninspiring social science literature on AIDS, a morass of repetitive, pious liturgies about stigma, blaming and difference. These writings conceal a massive, collective denial of the mounting deaths.”

    AIDS, Public Health and Human Rights in Cuba. American Anthropology Newsletter. October 1993. Nancy Scheper-Hughes

    • gcochran9 says:

      If it weren’t for Katyn Forest, the Gulag, and all that, I could wax nostalgic about the Old Leftists. It may still happen.

      I remember lots of ‘social science’ types explaining that regions and countries that were intolerant of homosexuality would be much more vulnerable to AIDS: but it was the other way around, mostly.

      Even funnier, I had a long conversation with a science reporter, perhaps the dumbest human being I have ever talked to for an extended period, who kept telling me that the solution to HIV in Africa was female empowerment.

      • Toddy Cat says:

        “a libertarian friend who said that although quarantine certainly would have worked, better to sacrifice a few hundred thousand than validate the idea that the Feds can sometimes tell you what to do with good effect.”

        That’s a joke, right? RIGHT!?!

        • melendwyr says:

          “Give me Liberty, or give them Death!”

          • gcochran9 says:

            Not “or” : “and”

          • Toddy Cat says:

            As I believe Steve Sailer said about protectionism, “It works in practice, but it doesn’t work in theory” Ditto an AIDS quarantine.

            • gcochran9 says:

              The optimal course of action, assuming that saving lots of lives was the goal, would have started with restricting the opportunities for promiscuous homosexual activity – closing down the bathhouses, having the cops interfere with assignations in public toilets, etc. Turn back the clock. For those that say that you can never entirely stop that kind of activity – true, but you can reduce it, and that counts in slowing transmission. Transmission was much slower in pre-Stonewall type environments. Also, to the hypothetical pinhead making that objection – you ARE a pinhead, and I’m damn tired of hearing people claim that anything other than 100% success is utter failure. That’s moron talk – have I made myself clear?

              Then you could work hard on a test and treatments: after a decent test, internment. The faster you move, the fewer people you inconvenience and the more people you save: that’s a natural consequence of aborting an exponentially growing lethal process. Step on it before it multiplies. Which the powers that be don’t understand, judging from Jerry Brown and the Medfly infestation. Any more than they understand anything else.

              I figure that a rational, energetic anti-AIDS policy would have saved half a million lives.

              Of course, in our actual history, we had people saying that it was important to keep bathhouses open, because they were a natural place to hand out all-powerful educational flyers!

              Over on “less wrong”, someone call the my post ‘tone-deaf’. It’s fair to say that I can live with that.

    • Abelard Lindsey says:

      My understanding of in it in SoCal in the 80’s is that the bathhouses did shutdown, simply because gays stopped patronizing them. The gay people I knew at the time (who admitted to being in the bathhouse scene in the late 70’s) were actually quite careful about whom they had sex with. Of course they had seen the majority of their friends die during the early 80’s, and it had a salutary effect on them.

  17. AppSocRes says:

    Back in the late 1980s when people were still getting a handle on HIV/AIDS (it was still just AIDS back then) a colleague and I created an epidemiological model of AIDS as part of a project for what was then the Health Care Finance Administration. We based this model on three facts that were pretty well established by that point: (1) that there were several rather small (altogether < 5% of the population) high-risk population pools; (2) transmission rates within these pools were much higher than in the general population and transmission rates among these pools were a bit higher than in the general population; and (3) transmission rates from these groups into the general population were almost non-existent. This latter assumption was basically true at the time and became more so once blood donors were screened and the risks of infection from fluid exchanges with the at-risk populations became common knowledge.

    We derived a range of estimated parameters for our model , did some sensitivity testing, and projected disease rates and death rates from HIV/AIDS out about twenty years. Our estimates of the eventual toll from the disease were much, much lower than almost all those being bruited about at the time. Most of these assumed a uniform population and some form of the logistic equation to do projections. There was only one reason for this, a purely political one; to frighten and stampede the general public into legislating massive funding for AIDS research and treatment when the disease actually was and would remain rather a minor threat to the public at large. About five years later the federal project manager commended us for giving him a good picture of what was going on. Our projections were quite accurate but even ours were on the high side.

    At the time, I remember saying that my worst nightmare was a very expensive treatment regimen that would create a permanent pool of infectious and healthy vectors. And that's exactly where we are now. For whatever reason, homosexual activists have had exceptional success at lobbying their various agendas. This has not been particularly good for the general public nor for the homosexual population.

    • gcochran9 says:

      I didn’t create my own formal model, but I had the same impression, since the virus was only showing an r > 1 in a couple of small populations. I really didn’t like watching the health establishment pretend that it was a threat to everybody: too bad I wasn’t King.

    • Dale says:

      You write, “And that’s exactly where we are now.”

      Well, not exactly. Over time, the gold rush for HIV drugs has caused competition, and over time the patents expire. And, out of luck, someone who is well-treated with drugs is not infectious (or perhaps just barely so, but his r is well lower than 1). This has caused the per-case treatment costs to decline (at least if well managed) and the infectiousness of the infected pool to decline. Things have gotten to the point where it’s considered possible that we could afford to eradicate HIV in Africa by putting every HIV-positive person under treatment.

    • Andrew Ryan says:

      Even as a teenager, I noticed a trend where the incubation time for the disease kept increasing to explain why the predicted bloom of infections among the heterosexual population was not happening. It was 5 years in 1985, 10 years in 1990 and then 15 years in 1995–but just keep waiting, the heterosexual epidemic will begin any day now!

      Also in high school (early 90’s) we had an HIV-positive, obviously gay, young man come in and lecture us about safe sex. He took the time to explain that he most likely contracted HIV before he became homosexual, back when he used to fool around with girls. I put the odds of that happening at one in a million.

      BTW, I highly recommend Michael Fumento’s “The Myth of Heterosexual AIDS” on this topic, a truly devastating takedown of the whole public health edifice during the AIDS era.

  18. I will simply add that at my (psychiatric) hospital trainings on AIDS 1983-86 we were not allowed to notice or to mention that homosexuals were at particular risk*. When a psychologist at an initial staffing of an obvious but undeclared gay person suggested that he should be tested for AIDS, two nurses got up and left the room in protest. By 1987 it was the opposite: it was important for us to understand that AIDS was a particular danger to the gay community, and its cure was unfunded because Reagan and the religious right were so evil and wanted them dead.

    *What’s the hardest thing about AIDS? Trying to convince your parents that you’re a Haitian dentist.

    • gcochran9 says:

      Did those nurses not know the odds? if they did, can you explain what miasmatic vapors were flowing through their pointy heads? I know that in fact many people react that way, and I can predict it fairly well. But I don’t really understand it, in the sense of empathizing, imagining myself in their shoes & feeling the same way.

    • Dale says:

      Given the dates, I’d guess that the change was that AZT therapy had been introduced. Before that, knowing that you had HIV couldn’t help you; after that, it was key to saving your life. The individual faced different incentives in the two situations. If you assume that psychiatric treatment is to help the person, to advance their agenda, then the standards of psychiatric treatment would likely change. OTOH, if you assume the purpose of treatment is to advance society’s agenda, then the standards of treatment wouldn’t change so much.

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  20. Dale says:

    The situation is an interesting test case. Since both the costs of quarantine and the benefits would have been concentrated on the same small sub-population, from a policy point of view, you should let them decide which problem to endure. And if it’s true that the idea was floated long ago, then you can probably find things written about it in the gay press that would tell what the “gay public opinion” was.

    • gcochran9 says:

      In those days, the gay press made most of its money from bathhouse ads.

      You have a gift. Really.

    • melendwyr says:

      “And the Band Played On” is hardly objective evidence. But as I have no better source to facilitate guessing at the positions of niche cultural groups: IIRC the homosexuals who might have supported closing bathhouses stopped going, and the ones that kept going considered attempts to shut them as disguised persecution – not an unreasonable conclusion, unfortunately.

      It’s neither wise nor appropriate to try to help people against their wills, and sparing people the consequences of their mistakes without their first recognizing them is a recipe for disaster.

      I sympathize with Dr. Cochran’s friend to this degree: given the tension between the desires for centralized power and the desires for individual autonomy, a benevolent and effective dictator is far more frightening in the long term than the incompetent ones history has presented us with. Bad kings give monarchy a bad name, but good ones make it harder to convince people that monarchy itself shouldn’t be adopted.

      • gcochran9 says:

        My libertarian friend was not all that unusual, as libertarians go. See?

        • melendwyr says:

          Well, duh. If you’re convinced that strong centralized political power causes more problems than it solves, you’re not going to be thrilled about highly visible examples of such power being used practically and effectively.

          I take it that you would advocate saving the maximum number of lives… which makes me wonder whether you also advocate appropriate measures to maximize lives saved from a variety of threats in today’ world. I would be very, very surprised if you actually did.

        • Toddy Cat says:

          “a benevolent and effective dictator is far more frightening in the long term ”

          In other words, the worse, the better. Lenin said that. See I told you guys libertarians had something in common with Commies!

          But seriously, we’re not talking dictatorship here. This country, and almost every country in the world, has instituted quarantines when confronted with fatal epidemic disease. But the world went nuts sometime around 1968, and we can’t do that any more. Besides, not all the people who died of AIDS were gay. Didn’t they deserve some consideration?

          • melendwyr says:

            The people who were infected from transfusion (including beloved author Isaac Asimov) get my sympathy. So do the unknowing spouses of infected people. The people who were using intravenous drugs, or didn’t absolutely stress ‘safer sex’ practices, even after people became aware of AIDS? Get no sympathy whatsoever. If you’d rather die than behave reasonably, you’ll probably do so – and the rational response is to help the process along, not try to stop it.

          • melendwyr says:

            I feel the need to expand: we’re talking AIDS here, eventually recognized as HIV. Not, say, Ebola. If there’s an outbreak of an easily-communicable form of Ebola in the US, I’d break out Martial Law first and worry about civil liberties later. And that’s despite being very leery of power structures and generally believing that ends don’t justify means. We can evaluate our actions once we’ve finished not hemorrhaging to death – with our relatively undamaged brains. (By my standards, Ebola leaves no survivors.)

            Obesity has lots of health consequences and is extremely widespread. If we let the government institute mandatory dietary and exercise changes for the populace, we could save far more than half a million lives. And we could improve the quality of life for countless people, too. But most people consider the probable consequences of granting such authority to outweigh the benefits. Maybe you, and Dr. Cochran, don’t. I have no objection to anyone giving up their own autonomy, so if you want to let some authority control how you act and eat, go nuts! Just don’t try to impose that strategy on others.

          • JayMan says:


            “Obesity has lots of health consequences and is extremely widespread. If we let the government institute mandatory dietary and exercise changes for the populace, we could save far more than half a million lives. And we could improve the quality of life for countless people, too.”

            Come on man, are you serious?

            Obesity Facts | JayMan’s Blog

          • melendwyr says:

            I am seriously pointing out what a terrible idea it is to use “the greatest good for the greatest number” as a metric. If the prospect of saving a few hundred thousand lives from a disease that’s transmitted through certain kinds of self-destructive behavior is enough to justify intervention on the scale of a quarantine, shouldn’t the prospect of saving millions of lives from another type of self-destructive behavior justify intervention as well?

            The issue isn’t the number of lives saved or improved, and you all know that without having to think about it. Admitting it seems to be harder for some of you, though.

      • Jasper says:

        An obvious difference between the obesity epidemic and a potential air borne Ebola virus is that the former isn’t contagious and is well understood. The whole point here seems to be to recognize that there are potential circumstances (high lethality and easy transmission) where a rational response requires sacrificing normal civil rights for a period of time in order to reduce the chance for runaway mass death.

        • melendwyr says:

          ‘Well-understood’ isn’t actually relevant, as long as it’s clear how it can be avoided. Except for relatively rare cases of illness, obesity is the direct result of an individual’s choices. Given that’s the case, it doesn’t matter how seriously the consequences of obesity are; harmless or utterly lethal doesn’t matter.

          HIV is remarkably easy to avoid. If it spread like the flu, I would totally support violating civil rights to control it. IF. That’s not how our reality happens to work.

  21. Diana says:

    So, um, you think that maybe we should not allow people from the Ebola zone to fly to the US? What kind of a person are you? We take precautions! Precautions!

    “Sneezing is uncommon in people with Ebola.” This, from a TV reporter.

    I’m reassured. (Not.)

  22. Toddy Cat says:

    “The people who were infected from transfusion (including beloved author Isaac Asimov) get my sympathy.”

    With all due respect, Mel ( and I mean that, you seem like a sharp guy) didn’t we owe them more than that?

    Incidentally, AIDS has turned out to be primarily confined to the gay community in this country, but no one knew that at the time – in fact, as I’m sure you’ll remember, the papers and newsmagazines at the time were full of stories about heterosexual AIDS. If these stories had turned out to be true, would you have favored a quarantine? Since you are open to the idea with Ebola, I’d assume so. If not, why not?

    • melendwyr says:

      “With all due respect, Mel ( and I mean that, you seem like a sharp guy) didn’t we owe them more than that?”
      Indeed. Which is why I’m still angry that more care isn’t taken to ensure that weird stuff doesn’t end up in the blood supply. But no one wants to pay for a gram of prevention when kilos of cure are available at exorbitant prices. I can only recommend stockpiling some of your own before expected surgeries, and so on.

      “If these stories had turned out to be true, would you have favored a quarantine?”
      It’s not a matter of gay vs. straight, but of how communicable and consequential the illness is. The more communicable, and the more consequential, the stronger the response I’d approve of. AIDS is clearly consequential, but is communicable only through specific and easily-avoidable activities. It’s hard to justify a quarantine given those properties.

      • F.J. says:

        It really doesn’t take much for HIV to be transmitted. Infected, destructive and pseudo-nihilistic barista? Just a drop of blood’ll do ya

        • Dale says:

          You write “Infected, destructive and pseudo-nihilistic barista?”

          Perhaps I misunderstand you, but despite all the fretting about spilled blood as a hazmat, there are precious few cases of orally-transmitted HIV. (Or at least, as far as I’ve heard in the mainstream media, heh.) And even though sperm has substantial HIV content, male homosexuals who only engage in oral sex are effectively immune to HIV.

          Now, I may be underestimating the risks, or the mainstream media may be biased, but once the death toll is less than the highway deaths, we really do have more important things to fret about.

      • Dale says:

        You write, “I’m still angry that more care isn’t taken to ensure that weird stuff doesn’t end up in the blood supply.”

        Being a regular blood donor, I’m rather impressed by the amount of work that is done to keep dangerous stuff out of the blood supply. E.g., they screen people for mad cow disease, even though it’s not clear that there’s any substantial risk that humans can get CJD from eating tainted beef.

        What precautions do you recommend that aren’t being taken already?

        • melendwyr says:

          As I understand it, there are many known but obscure diseases that aren’t screened for because the loss of blood from false positives outweighs the benefits from occasionally transmitting a nasty – or so the reasoning goes. That should go right out the door.

          I’m reminded of the story “The Giving Plague”. Recipients of transfused blood should be banned from donating for a lengthy period of time, years at the minimum.

          For all non-emergency surgery that is expected to require blood, patients should be required to stock their own in sufficient quantities to permit the surgery to go forward, and the surgery should be postponed for as long as is required to meet that requirement.

          Those are a few of the changes I would make.

          • Dale says:

            OK, I think I see your position. But if the policy change would be a net loss to society, why should we adopt it? OTOH, if you can demonstrate that the benefits of the change would exceed the costs, I’d think you could petition the relevant authorities and (at least in theory) they’d change the rules. Or maybe my point is, you write “That should go right out the door.” without making it clear (at least to me) why it should go out the door.

          • melendwyr says:

            Regarding that one point: today’s obscure and rare disease is tomorrow’s global plague. The best way to stop existential threats is to ‘nip them in the bud’ and take care of them when they are small, or before they exist at all.

  23. ErisGuy says:

    “past sic months”

    So…. is this missing a “k” or should the “c” be an “x” or should the “ic” be an “ex?”

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