OPINION
A price on suffering, by Trevor Butterworth, and what social media can’t fix about the Arab world, by Ann Marlowe.
A price on suffering
In an age of red ink, we must target real health risks, not guesses
BY TREVOR BUTTERWORTH MONDAY, FEBRUARY 28, 2011
How much are your legs worth? I’d like to think mine are too valuable to forgo — and priceless when you add in my arms. I’d sacrifice everything I own to keep my senses and my sanity intact, and I’d like to think that society would feel the same way about me — and you — too. But the truth, in a world of finite health resources, is that we are not infinitely valuable to anyone but ourselves. So how much is it worth to alleviate the suffering of a few people?
Take the following example: Fifteen years ago, Lisa Naumann thought her 13-month-old daughter, Sarah, was coming down with the flu. Sarah had been running a slight fever and had vomited during the night. But then, quite suddenly, spots started to appear. “It was like you took grape juice and spattered her face,” said Lisa. Alarmed, she rushed Sarah to her pediatrician, who immediately rushed her to the intensive care unit of a nearby hospital.
Sarah had meningococcal septicemia, a deadly bacterial form of meningitis. Over the next 72 hours, her legs were amputated above her knees and her right arm below her elbow; she also lost her nose, her upper lip and her front palate. “It was,” said Lisa, “horrendous.”
Most of the doctors I’ve talked to about meningococcal disease describe it using one word — “frightening.” Its etiology is complicated; it haunts infants and teenagers but not adults; it can kill or cause debilitating injuries in 24 to 48 hours; and, worst of all, it starts out resembling any number of routine illnesses. The spots are clots cutting the supply of blood to tissue. Once they appear, it can take just an hour for flesh to start rotting.
Meningococcal disease was also unpreventable in 1996; but, in a staggering advance in immunology, new infant vaccines are now in health care’s wings. There are three major varieties of infant meningococcal disease in the United States: Serogroup B accounts for 50 percent of cases, while groups C and Y account for the remainder.
The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, or ACIP, estimates that the CY vaccines would prevent 80 to 120 cases and four to six deaths per year. But if the ACIP recommends that infants should get the CY vaccination, the government — by dint of federal mandate — will be obligated to pay about $300 for each child who isn't covered by insurance, or about $500 million. Right now, there is a sense in public health-land that the numbers justify the B vaccine, but next to the ballooning costs of health care, they don’t justify the CY vaccine.
Dr. Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia, is on the ACIP’s Meningococcal Working Group, and while he wouldn’t discuss the forthcoming approval process, he explained the horrible dilemma: “How,” he said, “do you put a price on suffering? How do you cost that out in health care? In a statistical argument, you don’t know who will die, but it’s different when you know the victim. We spend amazing amounts of money treating people we know.”
Huge amounts were spent on real Sarah, including years of facial reconstruction surgery. But statistical Sarah — the child fated to show up in the next set of morbidity and mortality statistics — is easier to dismiss, until he or she actually shows up in the hospital, and the human face unlocks the health care kitty. Then you wonder about the value of a $300 vaccine.
With meningococcal disease, the gap between suffering and statistics can be bridged by looking at the potential cost to everyone: 35,000 people had to be vaccinated and given antibiotics in Mankato, Minn., after a handful of cases and the death of a single child in 1995 — a public health operation which, in the words of the official in charge, “pushed one of the premier state health systems in the country to the edge.” Plus, you never know when the development of one expensive treatment for a few can lead to breakthrough treatments for the many.
But another answer to “How do you put a price on suffering?” is that you start doing a better job of pricing risk. And this is not something government seems to be especially good at doing. While the ACIP is forced to play Scrooge over how many amputations or deaths justify a vaccine, the Environmental Protection Agency is a spendthrift in pursuit of hypothetical risks to children.
Earlier this month, EPA administrator Lisa Jackson gave a protean explanation of how the agency conducts cost benefit analysis: “I don’t know how you price the ability to try to forestall a child who may not get autism if they are not exposed to contaminated water.”
Well, here’s a first step: We know that a number of children will get
meningococcal disease and suffer, and we also know that children aren’t developing autism from contaminated water. So while finite resources must beggar all our sympathies, surely the better part of accountancy is to first spend on those with the greatest likelihood of suffering the most.
Antisocial networking
New media leave brutish, sexist values untouched in Mideast
BY ANN MARLOWE MONDAY, FEBRUARY 28, 2011
The power of social media like Facebook and Twitter has been part of the giddy, feel-good narrative of the Arab uprisings. And we Americans have a tendency to think that as our technologies and pastimes spread, so will our values. But it’s equally true that technologies are fitted into existing social forms, benign or otherwise.
When news broke of television reporter Lara Logan's abuse at the hands of an Egyptian mob, I felt instant regret: When writing a story a few days earlier, I'd edited out references to beastly conduct by some Egyptian men.
During a long-ago visit to Egypt, men would shout to me in the street asking whether I wanted to have sexual intercourse. (They used a four-letter Anglo-Saxon word.) They asked even while I was bicycling with my boyfriend.
During the recent uprising, though, this sort of thing seemed at first to be ancient history. Women participated in the Tahrir Square demonstrations and the groping that they often meet with on the streets of Cairo was absent in the square.
And so I wrote of my visit to Egypt not that I had been constantly harassed, but that "what struck me was the lack of civility in the public street."
Then the story of the Feb. 11 attack on Logan broke. The boorishness I experienced in 1978 was not outdated at all. And that is bad news for Egypt.
Democracy doesn’t develop just anywhere. It’s nourished by certain kinds of civil society. It’s hard to imagine a strong democracy in a country where, say, 50 percent of the citizens routinely abuse the others. And Egypt seems to be this sort of place. An oft-cited 2008 survey by the Egyptian Center for Women's Rights found not just that 83 percent of Egyptian women and 98 percent of foreign women in Cairo had been harassed, but that 62 percent of men admitted to perpetrating this abuse.
It’s not just a few bad apples, but 62 percent of Egyptian men. Sexual harassment isn’t even a crime in Egypt. The Egyptian Parliament was supposed to consider criminalizing it, but then the revolution came.
The Logan incident has a few more bitter lessons for those of us who support democracy in the Middle East.
If 62 percent of Egyptian men are sexual thugs, it’s likely that some of those Facebook- and Twitter-using, democracy-supporting Egyptian men we’ve been seeing on TV are sexual thugs, too. Nor should this be all that surprising. In the U.S., teenagers have driven other teenagers to suicide by online teasing, and the persecutors in such cases probably believe in democracy and the Bill of Rights.
Technologies like movies, television and mobile phones have increased the general knowledge base in developing countries, and allowed poor people more economic options. Anglo-American pop music has had real cultural effects in the rest of the world. But social media let any given society be itself more efficiently — not something better. Social media may "empower" ordinary people in repressive societies, to the extent of making it easier for them to gather together and protest. But social media leave basic power relationships and habits intact. They are egalitarian in the sense that any literate person with access to a computer can use them — but they don’t make societies more egalitarian. (Nor do they determine who becomes literate or has access to a computer.) You can just as easily tweet a call for genocide as a report of police brutality.
Technology doesn’t change a traditional society. As I’ve seen in Afghanistan, where I spend a few months a year, you can be a mobile-phone-mad university graduate with a Facebook page, and still unquestioningly accept that your parents will choose your spouse.
Kabul has movie theaters that show foreign films, but only men go to theaters in Afghanistan. You can buy a frozen chicken from China in Mazar-i-Sharif (in fact, it’s cheaper than a fresh, locally raised chicken), but the chicken buyers are men, because women don’t shop for food in Afghanistan. And while Egyptian men are part of the online community of Facebook, women in the streets of Egypt are not treated the same way as they are in the West.
I wish the democrats of Egypt, Libya, Bahrain and other Arab nations every success. But some of the men in those protests need to get out of their own way — and that of their women. The democracy they say they want involves a level of respect for women that isn’t in evidence. And as Americans watch the inspiring events unfolding in the Arab world, we need to remember that having a Facebook page doesn’t make a man modern, or ready for civil society.
Ann Marlowe is a visiting fellow at the Hudson Institute and a blogger for World Affairs.
Antisocial networking
New media leave brutish, sexist values untouched in Mideast
BY ANN MARLOWE MONDAY, FEBRUARY 28, 2011
The power of social media like Facebook and Twitter has been part of the giddy, feel-good narrative of the Arab uprisings. And we Americans have a tendency to think that as our technologies and pastimes spread, so will our values. But it’s equally true that technologies are fitted into existing social forms, benign or otherwise.
When news broke of television reporter Lara Logan's abuse at the hands of an Egyptian mob, I felt instant regret: When writing a story a few days earlier, I'd edited out references to beastly conduct by some Egyptian men.
During a long-ago visit to Egypt, men would shout to me in the street asking whether I wanted to have sexual intercourse. (They used a four-letter Anglo-Saxon word.) They asked even while I was bicycling with my boyfriend.
During the recent uprising, though, this sort of thing seemed at first to be ancient history. Women participated in the Tahrir Square demonstrations and the groping that they often meet with on the streets of Cairo was absent in the square.
And so I wrote of my visit to Egypt not that I had been constantly harassed, but that "what struck me was the lack of civility in the public street."
Then the story of the Feb. 11 attack on Logan broke. The boorishness I experienced in 1978 was not outdated at all. And that is bad news for Egypt.
Democracy doesn’t develop just anywhere. It’s nourished by certain kinds of civil society. It’s hard to imagine a strong democracy in a country where, say, 50 percent of the citizens routinely abuse the others. And Egypt seems to be this sort of place. An oft-cited 2008 survey by the Egyptian Center for Women's Rights found not just that 83 percent of Egyptian women and 98 percent of foreign women in Cairo had been harassed, but that 62 percent of men admitted to perpetrating this abuse.
It’s not just a few bad apples, but 62 percent of Egyptian men. Sexual harassment isn’t even a crime in Egypt. The Egyptian Parliament was supposed to consider criminalizing it, but then the revolution came.
The Logan incident has a few more bitter lessons for those of us who support democracy in the Middle East.
If 62 percent of Egyptian men are sexual thugs, it’s likely that some of those Facebook- and Twitter-using, democracy-supporting Egyptian men we’ve been seeing on TV are sexual thugs, too. Nor should this be all that surprising. In the U.S., teenagers have driven other teenagers to suicide by online teasing, and the persecutors in such cases probably believe in democracy and the Bill of Rights.
Technologies like movies, television and mobile phones have increased the general knowledge base in developing countries, and allowed poor people more economic options. Anglo-American pop music has had real cultural effects in the rest of the world. But social media let any given society be itself more efficiently — not something better. Social media may "empower" ordinary people in repressive societies, to the extent of making it easier for them to gather together and protest. But social media leave basic power relationships and habits intact. They are egalitarian in the sense that any literate person with access to a computer can use them — but they don’t make societies more egalitarian. (Nor do they determine who becomes literate or has access to a computer.) You can just as easily tweet a call for genocide as a report of police brutality.
Technology doesn’t change a traditional society. As I’ve seen in Afghanistan, where I spend a few months a year, you can be a mobile-phone-mad university graduate with a Facebook page, and still unquestioningly accept that your parents will choose your spouse.
Kabul has movie theaters that show foreign films, but only men go to theaters in Afghanistan. You can buy a frozen chicken from China in Mazar-i-Sharif (in fact, it’s cheaper than a fresh, locally raised chicken), but the chicken buyers are men, because women don’t shop for food in Afghanistan. And while Egyptian men are part of the online community of Facebook, women in the streets of Egypt are not treated the same way as they are in the West.
I wish the democrats of Egypt, Libya, Bahrain and other Arab nations every success. But some of the men in those protests need to get out of their own way — and that of their women. The democracy they say they want involves a level of respect for women that isn’t in evidence. And as Americans watch the inspiring events unfolding in the Arab world, we need to remember that having a Facebook page doesn’t make a man modern, or ready for civil society.
Ann Marlowe is a visiting fellow at the Hudson Institute and a blogger for World Affairs.
Credit: The Daily (www.thedaily.com)
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