Response to Africa-Aid Comments--Posner

Great comments! But let me start with clearing up a misunderstanding. Two consecutive comments read: "I would like everyone to know that I wrote a comment critical of Posner's view on AIDS treatment that was apparently censored from the blog." "My last comment was intercepted with a message that a feature had been enabled to allow Posner to approve posters. The comment has yet to appear." There is no censorship of our blog. There is a feature that enables us to disable comments, but we have never used it and do not plan to use it. Also, we don't read comments as they come in, but only en masse when we are ready to respond to them at the end of the week. So there is no screening. On to substance: here is a thoughtful blog with which however I disagree. After quoting my statement that "Pending development of a vaccine (still not in sight), the only effective way of dealing with the African AIDS epidemic is adoption of safe sex. The AIDS drugs will retard that adoption by reducing the benefits," the comment states: "So then subsidize safe sex too! Pay for condoms and for non-catholic, realistic sex-ed. No rational human being who understands the disease and the possibilities for free prevention will decide to have unprotected sex in Africa just because new AIDS drugs will prolong certain death by 4 years. That is absurd. I agree that education and legal/political reform are the highest priorities, but you MUST treat the sick and the dying. What kind of respect for the rule of law will people develop when they are told that they can't have AIDS drugs for their sick child because the G8 is trying to teach Africans personal responsibility!" True, no one who has a keen understanding of AIDS, the side effects of the antiretroviral drugs, etc., will deliberately engage in unprotected sex, unless perhaps he thinks the risk of infection very slight although not zero (at that margin, the availability of the drugs might sway choice). But as another comment points out, there is enormous misunderstanding of AIDS in Africa, and learning that a "cure" is available could have significant behavioral consequences. Another comment points out correctly that even if there is no misunderstanding about the limited efficacy of the drugs, just the fact that they increase longevity means that there will be more living people with AIDS, and they will infect others. As for the issue of denying health care to sick and dying people, no one is suggesting that. The question is whether the United States and other nations should subsidize the treatment of a particular illness in another group of nations. There is no moral duty to do this if, on balance, the effects of the subsidy on the people of the donee nations are likely to be negative. I agree with the comments that point to constructive investments for foreign aid funds, such as birth control and education. The problem is getting the funds invested productively in such programs without the donee nation's simply reducing its own investment in them, thus in effect diverting the foreign aid funds to unauthorized uses. Will the donor nations employ enough auditors to detect such diversions, and if such diversions are detected will the donors actually withhold the aid? I am skeptical. One comment usefully invokes the concept of "resource curse," observing that countries rich in natural resources seem not to benefit on balance from the wealth that the revenue from the export of such resources generates. A major reason is that a source of money that does not require an educated, hard-working population, the development of commercial values, a rational legal system, and other prerequisites to economic development reduces the pressure for developing the necessary framework for development. Foreign aid, as the comment points out, has the same characteristics. Money flows in without need to develop the proper legal, attitudinal, and institutional framework for sustained development, and thus enables national leaders to defer the often painful construction of such a framework. The analogy to the debilitating effects of welfare, and the benefits from Clinton's reform of the welfare system, is evident. Foreign aid is welfare writ large.

Comments

[Palooka]

"Great comments!

But let me start with clearing up a misunderstanding. Two consecutive comments read: "I would like everyone to know that I wrote a comment critical of Posner's view on AIDS treatment that was apparently censored from the blog." "My last comment was intercepted with a message that a feature had been enabled to allow Posner to approve posters. The comment has yet to appear." There is no censorship of our blog. There is a feature that enables us to disable comments, but we have never used it and do not plan to use it. Also, we don't read comments as they come in, but only en masse when we are ready to respond to them at the end of the week. So there is no screening."

I once had a comment blocked, but soon after I was able to post comments again. That was many months ago. Maybe the same happened to Corey. Maybe it is some kind of spam filter. I'm not sure if that helps resolve the issue, but the commenter is likely telling the truth, though he is mistaken that it's intentional censorship.

[Corey]

What happened was that I wrote a comment, hit
submit, and got a message about a moderator function having been turned on. I didn't use
offensive language or anything. It apparently
happened to a couple people, but has not happened since. If nothing was changed mid-week, then it looks and sounds like a software bug.

No big deal if it wasn't done purposefully.
There was just no way to tell at the time.

[David]

The same thing happened to me that happened to Corey. The "approval" message appeared when I submitted my comment, but the comment never appeared on the blog. I waited two days before posting the message that my comment had been apparently "censored." Perhaps it was a software bug; I would suggest the new "feature" be checked out. I would also ask Judge Posner to explain how this approval feature works, because apparently only some comments trigger it. Like Corey's, my comment did not contain offensive language, though it was highly critical of Judge Posner's view of AIDS treatment.

[David]

To the substance: I simply cannot condone Judge Posner's view, which he himself calls "heartless," opposing discounted drugs for African AIDS victims. First, these drugs do not cost the west anything: they are very cheap to produce, and the drug companies are giving them away at cost, understanding that many African victims cannot afford the market price and will die a horrible death without them.

While, of course, there is a concern that infected individuals will spread the virus, that should be addressed with education programs and condom distrubutions, not with condemning millions of people to die a horrible and unnecessary death. If the spread of the infection becomes completely uncontrollable, quarantine would be a more humane solution than non-treatment. The suggestion that we should just let victims die, when they can be saved at basically no cost to western taxpayers, is shocking.

[Brian H]

Congratulations for glancing at the elephant in the living room. From an epidemiological point of view, providing a life-lengthening course of treatment which does not eliminate infectiousness is the absolute worst possible strategy; nothing could be designed to better maximize the spread of the disease -- or, for that matter, to better assist in its evolution into a more virulent form.

Given the reality that this course of events is politically inevitable, there is a desperate urgency in developing BOTH a vaccine and a cure (meaning TOTAL elimination of infectiousness as well as of symptoms.) Even reducing it to the level at which we now hold influenza at bay is insufficient. The medical solutions must be total. Otherwise we will see the continuation and acceleration of current trends: more infections, deaths, and economic-social ruin.

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