A post from Gregory Cochran's and Henry Harpending's excellent blog West Hunter.

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 institute 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.

The commenter Ron Pavellas adds:

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.

The Wasserman Test.

Dalrock writes an interesting article related to Dr. Helen Smith's book the Marriage Strike. I really have to bump it up on my too rapidly growing reading list. (^_^)

Dr. Helen has a thoughtful post up asking if the title of her book is an accurate description of men’s response to the changes in the law and culture.  While the title of her book is extremely effective in opening the discussion (which is what it needs to do), it isn’t an accurate description of problem we face in the West.  A strike can be negotiated with;  offer them a bit more and they’ll get back to work.  Better yet, offer a few of them a side deal and break the cohesion.  True strikes require moral or legal force to avoid this sort of peeling off.  The problem for the modern West is far worse.  What we are seeing isn’t men throwing a collective temper tantrum, noble or otherwise.  What we are seeing is men responding to incentives.  Even worse, inertia has delayed the response to incentives, which means much more adjustment is likely on the way.

There was an old joke in the Soviet Union to the effect of:

""We pretend to work.  They pretend to pay us.""

The problem for the Soviets was this wasn’t a movement.  They knew how to handle a movement, and Siberia had plenty of room above ground and below.  The Soviets were masters at coercion through fear, but the problem wasn’t a rebellion, it was that they had reached the limits of incentive through fear.  In the short and even medium term fear is a very effective motivator.  But over time if overused it loses some of its power, especially when it comes to the kind of productivity which requires creativity and risk taking.  Standing out is risky;  you don’t want to be the worst worker on the line in a fear based system, but you also have reason to fear being the best worker on the line.  This doesn’t happen so much by conscious choice, but due to the influence of the incentive structure on the culture over time.  Conscious choices can be bargained with, and threats of punishment are still effective.  The culture itself is far harder to negotiate with.  No one is refusing anything.  So the Soviets had no choice but to assign quotas, and severely punish those who failed to meet them.  But while the quota/coercion system keeps production running, it works against human nature.  If you become the best producer you end up being assigned a larger share of the quota burden;  from each according to his abilities.  Over time the logic of this works its way into the culture, as everyone gets just a little more inclined to go with the flow and not do more than required.  The problem is while momentum causes the response to be slow, it also means it is very difficult to deal with once you have enough of it to recognize.

The problem we presently face in the West is similar.  While we have a small number of men who have decided to slack off as a form of protest, the far more insidious risk to our economy is the across the board weakening of the incentive that a marriage based social structure creates for men to produce at their full potential.  We’ve moved from a mostly reward based incentive structure to a model the Soviets would have been proud of.

You can see this at the micro level with a man whose wife goes Jenny Erickson on him.  The courts understand that throwing a man out of the home and taking away his children naturally reduces the man’s normal incentive to work to support his family.  How could it not?  It isn’t that most men in this situation will stand by and watch their children starve, but they won’t be motivated to produce quite as much.  You can confiscate a percentage of his income in the form of child support, but he no longer has the incentive to fight his way quite so high up our progressive tax structure.  This is why the courts have to assign the man an income quota he has to meet, Soviet style.  Imputation of income isn’t incidental to the child support family model;  it is essential to the function of the model.  Note that this doesn’t mean the courts have to formally calculate an income quota for each man who ends up in the new child support family structure;  in most cases the man has already assigned himself a quota based on past production.  All the family courts need to do in most cases is make sure he doesn’t fall below this quota.

As I mentioned above coercion is generally a very effective incentive in the near and medium term.  Part of the reason conservatives are so enamored with child support is the threatpoint it provides to keep existing husbands working as hard as possible.  While in the long run this will ultimately create a culture where husbands are less inclined to become stand out earners, as Keynes famously put it in the long run we are all dead.  The other problem is the changes in the culture in response to over use of coercion are by their very nature difficult to identify and quantify.  This isn’t unlike the Laffer Curve;  while both liberals and conservatives agree regarding the principle of the curve, the shape of the curve is impossible to get agreement on.  Eventually you can raise tax rates so high that you end up with lower revenue, but due to the problems of momentum identifying exactly when you have (or will) hit that point can be very difficult.

The more immediate problem in the West is the reduced incentive young men perceive to compete as breadwinners due to the continuing delay in the age of marriage.  Again this isn’t a movement, it is a delayed response by the culture to reality.  When the average woman marries in her late teens or even her early twenties, the average young man will see himself as competing with his peers for the job of husband.  Not only is he competing to not be left out of the game entirely, but he is jockeying for a better choice of wife.  But move the age of marriage out far enough, and eventually young men don’t see themselves so clearly as competing for the job of husband.  Extend the age of marriage far enough and eventually the culture of young men will be less focused on competing to signal provider status, and their priorities will shift (on the margin) toward slacking off.  The question isn’t if this will happen, but how long you can push the age of marriage out before this starts to happen, how much this will reduce the motivation of young men, and how long between the change in reality and the change in culture.  Note also that this doesn’t require men to swear off marriage entirely for this to greatly impact our tax base.  Changing the culture of men in their formative years will have a lasting impact.  You can’t rewind time and undo a decade of (relative) slacking.  Additionally, momentum tends to start working against you at some point.  As the expectations of men as providers declines it eventually creates an expectation of decline.  As each generation of new husbands come to the table with less to offer as providers, we eventually will start to expect future generations of husbands to offer even less.

As I’ve said before, all of this places our elites in a very difficult bind.  Eventually the momentum which initially masked the problem makes it extremely difficult to address.  Denial of the problem is a flawed strategy but it has important advantages.  Once you acknowledge that the incentive structure is flawed you tend to accelerate the delayed response to the new structure.  At the same time, the changes at the core of the problem are very close to the hearts of both liberals and conservatives.  However, ignoring the problem will become more and more difficult because of the impact on the bottom line.  Because of this, we can expect to see more of what we already see.  Feminists will continue their handwringing tentatively asking if perhaps we have gone a bit too far, and conservatives will redouble their efforts to convince men they need to man up and stop sabotaging the glorious feminist progress.  Less conspicuously I also expect we will see some dialing back of the worst excesses of the family courts.  However, because of the momentum involved and the reluctance to acknowledge the fundamental problem, these changes will at best only slow the problem, and they will always run the risk of initially accelerating it.

Related: Son of Low Hanging Fruit

Another post on finding low hanging fruit from Gregory Cochran's and Henry Harpending's blog West Hunter.

Clostridium difficile causes a potentially serious kind of diarrhea triggered by antibiotic treatments. When the normal bacterial flora of the colon are hammered by a broad-spectrum antibiotic, C. difficile often takes over and causes real trouble.  Mild cases are treated by discontinuing antibiotic therapy, which often works: if not, the doctors try oral metronidazole (Flagyl), then vancomycin , then intravenous metronidazole.  This doesn’t always work, and C. difficile infections kill about 14,000 people a year in the US.

One recent trial shows that fecal bacteriotherapy, more commonly called a stool transplant, works like gangbusters, curing ~94% of patients. The trial was halted because the treatment worked so well that refusing to poopify the control group was clearly unethical.  I read about this, but thought I’d heard about such stool transplants some time ago.  I had.  It was mentioned in The Making of a Surgeon, by William Nolen, published in 1970. Some crazy intern – let us call him Hogan – tried a stool transplant on a woman with a C. difficile infection. He mixed some normal stool with chocolate milk and fed it to the lady.  It made his boss so mad that he was dropped from the program at the end of the year.  It also worked. It was inspired by a article in Annals of Surgery, so this certainly wasn’t the first try.  According to Wiki,  there are more than 150 published reports on stool transplant, going back to 1958.

So what took so damn long?  Here we have a simple, cheap, highly effective treatment for C. difficile infection that has only become officially valid this year. Judging from the H. pylori  story, it may still take years before it is in general use.

Obviously, sheer disgust made it hard for doctors to embrace this treatment.  There’s a lesson here: in the search for low-hanging fruit,  reconsider approaches that are embarrassing, or offensive, or downright disgusting.

Investigate methods were abandoned because people hated them, rather because of solid evidence showing that they didn’t work.

Along those lines, no modern educational reformer utters a single syllable about corporal punishment: doesn’t that make you suspect it’s effective?  I mean, why we aren’t we caning kids anymore?  The Egyptians said that a boy’s ears are in his back: if you do not beat him he will not listen. Maybe they knew a thing or three.

Sometimes, we hate the idea’s authors: the more we hate them, the more likely we are to miss out on their correct insights. Even famous assholes had to be competent in some areas, or they wouldn’t have been able to cause serious trouble.