Once upon a time, there was an old man who used to go to the ocean to do his writing. He had a habit of walking on the beach every morning before he began his work. Early one morning, he was walking along the shore after a big storm had passed and found the vast beach littered with starfish as far as the eye could see, stretching in both directions.
Off in the distance, the old man noticed a small boy approaching. As the boy walked, he paused every so often and as he grew closer, the man could see that he was occasionally bending down to pick up an object and throw it into the sea. The boy came closer still and the man called out, “Good morning! May I ask what it is that you are doing?”
The young boy paused, looked up, and replied “Throwing starfish into the ocean. The tide has washed them up onto the beach and they can’t return to the sea by themselves,” the youth replied. “When the sun gets high, they will die, unless I throw them back into the water.”
The old man replied, “But there must be tens of thousands of starfish on this beach. I’m afraid you won’t really be able to make much of a difference.”
The boy bent down, picked up yet another starfish and threw it as far as he could into the ocean. Then he turned, smiled and said, “It made a difference to that one!”
It's possible people should spend a little time, and I do mean a little time, looking at what level of cause they want to address. Caring for people injured in a war is one level. Working toward a peace treaty is another. Opposing war in general is a third, and I'd give it a maybe.
Well, first of all, it actually does prevent the spread of disease! Second, a single life-time supply of PEPFAR treatments does save lives. Everyone would agree that it would be good to give a person in the U.S. HIV treatment rather than refraining on grounds that it doesn't address the root cause of the problem.
It doesn't address the underlying cause of African dysfunction. It just means more Africans. Which means more dysfunctional people that are constantly AIDSing themselves in the world.
At best those dysfunctional people stay in Africa and bother each other while we waste some small amount of money on sustaining them. At worst these overpopulated hordes immigrate to the west and destroy it, making all of human existence dramatically worse. Given most PEPFAR supporters are immigration supporters this is a fairly likely event.
It's telling to me that you believe that if you had to raise $6B a year from people voluntarily, not enough people would find AIDS treatments for Africans a worthy enough cause.
> Everyone would agree that it would be good to give a person in the U.S. HIV treatment rather than refraining on grounds that it doesn't address the root cause of the problem.
The whole reason PEPFAR treatment in Africa got so salient is that an African orphan dying of AIDS is a more sympathetic victim than a Western sexual degenerate who got AIDS from participating in too many chemsex orgies.
This article reads like a longform response to my last comment, so let me respond quickly:
Moral hazard.
People are not at fault for getting shot. They are not at fault for contracting malaria, or smallpox.
You ABSOLUTELY, except in rare cases, ARE at fault when you contract the virus that causes AIDS. Heterosexuals have to be rampantly, shockingly promiscuous; and homosexuals at minimum need to be irresponsible about protection (male homosexuals are already shockingly promiscuous, not b/c of being gay but by being male).
Why is it my responsibility to protect Africans from their bad decisions?
Babies are not at fault. If a baby is born with AIDS (just typing that sentence made me want to murder any mother and father selfish enough to commit this crime) of course it is not to blame. But there is no "PEPFAR but just for babies" on offer. And more PEPFAR means more promiscuity, more AIDS, and more AIDS babies.
If you at the very least agree that a baby being born with HIV is bad, then you should support medical treatment for adults no? If everyone's viral load is suppressed and all prenatal procedures are done right, then you have eliminated the root cause of babies being born with HIV - their parents having untreated HIV.
It seems your guiding star is punishing people who do irresponsible things not the babies' welfare. Also, if treating HIV were a moral hazard, that would be clear by now. But, HIV transmission in Sub Saharan Africa peaked in the 90s (according to OWID)before PEPFAR was even launched so clearly, people aren't engaging in risky behaviour so they can get free ARVs, which aren't fun to take btw.
Almost a good reply. I give you credit for dealing with the actual issue of moral hazard (a bit), instead of handwaving toward strawman arguments ("what if all the women are virtuous? and some people who get shot deserve it!") or name-calling as argument ("bigotry!").
I support medical treatments. And I am not punishing anyone--nature is. The question is, should I have to PAY for a disease that is entitled self-inflicted? I would not want to pay for malaria treatments either if I learned all the malaria sufferers were drinking tall cans of Malaria Juice!
Where you go wrong is the claim " if treating HIV were a moral hazard, that would be clear by now". Um, it...IS clear. And saying that b/c HIV peaked in the 90s, that something-something no moral hazard, is just so clearly wrong.
Maybe strains were more transmissible then. Maybe there was more promiscuity then, but there is not "zero" now. This is a disease transmitted through voluntary activity. If you are in an area endemic with it, then even in a monogamous relationship you should either abstain or use protection for your safety. Apparently this is too much to ask.
I have no problem with promiscuity. Nature does. Every functional society is based on monogamy. Promiscuity is an acid dissolving any incentive to marry; any fidelity in marriage; any investment in society or the next generation; and leads to genetic losers who strike back violently.
Given this, again I ask: why should the American people pay for these people to continue their self-defeating behavior? And if we do continue, when does it stop--when DO we get to walk away, if ever? And if this is supposed to be a "forever" program, where we care for an entire half-continent of people like benevolent farmers caring for sheep that can't care for themselves--then by God, admit it! Say so! And then say why this is ok.
Almost a good reply but you showed your hand. Your problem is with promiscuity hence statements like "even in a monogamous relationship you should either abstain or use protection for your safety. " which yeah, it is too much to ask that people in monogamous relationships abstain.
There is no situation under which you are convinced that AIDS is bad and that it's good to treat people suffering from HIV as an end to itself. You would rather babies be born with HIV and then treat them for their entire lives using some 'PEPFAR for babies' program than fund a program (like PEPFAR) that would prevent them from being born with HIV in the first place just so those promiscuous people get some divine punishment. I don't think anything I say about how PEPFAR has saved >20 million lives and works to promote abstinence, faithfulness and condom use etc will change your mind.
As for the American people, they can vote for whatever they like, it seems that even Trump sees the utility of treating HIV in Africa, so maybe vote for someone even more callous than Trump.
It's bad enough you cannot construct a logical argument; make a reasoned response; or debate in good faith. That makes you ordinary, like most people.
What is absolutely pathetic is that you (and many others here, unfortunately) are so goddamn insecure, so butthurt, that if someone points out the gaps in your argument you rush to your keyboard to "win" by insulting them.
You have called me a religious bigot (I never brought God into it); said that I thought AIDS was good; and that I want babies to die just so people who fuck can be punished.
All because I pointed out that you made a bad argument.
You're a pathetic loser, dude. Delete your account and log off for a while, and get some goddamn self-esteem.
I appreciate you writing this because you gave me the drive to really look into these things. I respectfully disagree with basically everything you have said.
I don't think PEPFAR is a moral hazard for HIV/AIDS infection because PEPFAR doesn't just provide Antiretroviral Therapy (ART). It also provides PReP, sexual education, HIV testing, and condoms. I suspect these effects counteract whatever moral hazard effect there is of providing antiretrovirals, if any. If you are concerned about the moral hazard effects of ART on promiscuity, then maybe there are more concerns. It doesn't seem like your main objection is to promiscuity. It's still hard to say though, because people need to be aware of the availability of free ART to be influenced, and the perceived benefit would only impact marginal decision-makers. I think the set of marginal decision-makers is small to non-existent. I believe this because a marginal decision-maker must have the following properties: 1) they must be aware of access to free ART (not at all obvious), 2) they must be aware of the risk of HIV (quite likely, but still something like 10% of young adults between 10 and 25 are not aware), 3) the expected value of sex when there is free ART must be greater than the expected value of sex when there is not free ART. Condition 3 is hard to meet because it requires the benefits of ART to be relatively high, the probability of infection to be relatively high, and the benefits of sex relatively low.
On a tangential note, the claim that "You ABSOLUTELY, except in rare cases, ARE at fault when you contract the virus that causes AIDS," strikes me as clearly false. It ignores rape and IPV as a mechanism of coercing unsafe sex. Your response to Robert was unconvincing to me (although I agree with you about the rakish husband, virtuous wives trope) because even if both partners are unfaithful, that does not mean they are equally responsible for infection with the virus. It is possible to be unfaithful and protect yourself from HIV. Of course, if you object to promiscuity in itself, then this is not particularly compelling. Taking you at your word, I think your primary objection is to the transmission of AIDS/HIV not promiscuity.
I genuinely hope you respond with the same level of verve and vigor that you have with other commenters; it's provided me with a lot of motivation to learn more about PEPFAR and the transmission of HIV/AIDS. I need some yang to my yin!
This is a fantastic comment. You actually dealt with the issue, respectfully, rather than show up and make personal attacks like a couple of other losers in this thread. Thank you.
You make solid points. Where I disagree is the overall assumption behind your logical breakdown. I think it is referred to as the "homo economicus" myth is behavioral economics--the idea that everyone is a rational actor; that we effectively "math" things out before making decisions, so real world behavior must conform to the theory. It is a myth for an obvious reason--very few behave that way.
And in my opinion, some are more rational than others.
Let's try a thought experiment. Let's say you and I, Nadja and Tony, woke to find ourselves in sub-saharan Africa. This was our new life. In our village, AIDS was epidemic. You and I would both reasonably conclude that any sexual partners we took had a very high likelihood of infection; and we would stay celibate IN THIS SCENARIO. If, for some reason, we fell in love with a native, we would either 1) insist on some sort of "proof" of non-infection (maybe we could really investigate the sexual history; or maybe there was a PCR test available. Barring that, 2) we would insist on protection, or even sex without intercourse ("everything but" is what the kids used to call it!).
And if the whole village was full of Nadjas and Tonys, then the infected would be quickly "sexually quarantined"; celibacy would reign for a time; and the infection would burn out. All would happen, again, if the natives were like Nadja and Tony.
Clearly, they aren't. Clearly, they do not make "maximal" calculations on their life; they live, literally, like there is no tomorrow.
So my question for you:
Can they help it? Are they "homo economicus" actors like us, who need to exert self reliance? Or are they in some way deficient in impulse control, or executive function, or some other capacity that would help them not ingest this poison?
The average IQ in sub Saharan Africa is 70, Contrasted with 85 for African Americans; 100 for white Americans; and 110 for east Asians. At a 70 IQ, I could imagine that one would not be able to plan and judge consequences correctly.
So, if these folks cannot help themselves, then I agree with you: we have a moral responsibility to help those who cannot help themselves. PEPFAR stays; we should fund it indefinitely, b/c the need will be indefinite.
However, if this continent is full of Nadjas and Tonys, then sorry--they need to exert agency and take responsibility for their lives.
(I do agree that sex ed and condoms are very beneficial, and we should continue to provide this aid regardless. Thank you for clarifying the extent of PEPFAR)
Your argument is self defeating. If African men are shockingly promiscuous and also married to virtuous non-promiscuous wives, what do you think happens to the wives, and how are they to blame?
You can graph this out if it helps, but you are basically suffering from runaway chivalry.
To have an AIDS epidemic, even just a cluster, among heterosexuals, you need promiscuous and infidelitous men AND women. The women are not virtuous; apologies if my comment was not clear. You can graph this and see the logic; if only the men are promiscuous and the women are not, then there really won't BE promiscuity. A cluster of men could theoretically contract AIDS from a harlot, but again, the sheer amount of sex required to accomplish this effectively rules it out as an explanation for ANY cluster of cases.
You can always hypothesize innocent victims; they do exist. But bringing them up is not an argument; it is an attempt at emotional manipulation ("what about women who are pregnant with RAPE INCEST babies! Shouldn't THEY be able to get abortions?"). We have to set policy for the average and usual, not the exception.
Say there's 1,000 married men, all of whom frequent once a month a brothel where the 5 inmates have AIDS. Even if the 1,000 wives are utterly monogamous, in a year or two you have 2005 AIDS sufferers plus the children. You yourself just said that men are differentially promiscuous, so what is unrealistic about this scenario?
I have spent months in East Africa, and that's pretty much the setup. Even if a married woman wants to be promiscuous there's serious obstacles in her way. I deduce from your non comedic use of the word harlot that you have not travelled outside the Bible Belt.
I used the word "harlot" b/c it was the most irenic and distanced of a list of pretty inflammatory terms. But since you decided to be condescending, let me say in kind that you come off as a nerd trying to win this day's Game of Interneting.
Your comment: "I have spent months in East Africa, and that's pretty much the setup"--really? The way you have personally seen that AIDS spreads is that virtuous maidens are undone by faithless husbands-cum-johns?
I don't know whether to laugh at such errant bullshit, or feel sorry for you since you obviously constructed that comment solely as a way to drop in your worldly travels. Congrats I guess?
Here's the deal, Robert: as I mentioned above (literally in the comment you responded to), it is easy to construct edge-tail hypotheticals to AVOID grappling with an issue ("since hermaphroditism exists, binary sex categories must be useless!"). But this is just emotional manipulation and fails to deal with the issue at hand.
What IS that issue? Well, for the third time:
Where AIDS is endemic in Africa among heterosexuals (and some bisexuals), promiscuity is rampant among both men and women:
--early age of sexual activity;
--many, many partners;
--women having children by multiple or even unknown fathers;
--men mostly unemployed or loosely employed;
--sex and violence as the main pursuit, as men fight and sometimes kill other men as the women replace them (through infidelity or serial relationships).
This is all happening while education on the transmission of AIDS is thoroughly taught. Sexual activity remains high even where AIDS is off-the-charts; survivors continue to spread the disease to new partners and their own children.
Given this backdrop, which I didn't need a plane ticket to learn, why should the US protect these people from themselves? What is our responsibility?
Any other comment about any niggling hypothetical is beside the point. And after giving you this well-deserved dunking for being condescending, I will refrain from responding to any more word games.
So if you need the last word, take it. And congrats again on your travels, you clearly are proud of them.
Oh one more thing, I missed responding to your final question. I think it seems reasonable to pull the plug when pulling the plug will not violate the 95-95-95 goals and will not result in more than 250,000 deaths per year for the foreseeable future. These are the UN goals that are most relevant to me.
>People are not at fault for getting shot. They are not at fault for contracting malaria, or smallpox
Actually, many people who get shot are themselves participants in gun violence, or have been at some point in the past. Should we pull someone's criminal record before deciding whether to stitch them up?
Why would Bentham bother writing a whole post to respond to your comments given how uninteresting and poorly reasoned they are? Seems like a waste of his time (or anyone's) time
Sooo…an insult, not an argument. And you apparently wasted your own time making it ….why?
This place is a fucking cesspool. All the tolerant libs resorting to ad hominem attacks. Low IQ indeed.
I’m guessing you’re buddies with one of the other losers I owned, doubt you just randomly showed up on a days old post and combed through the comments just to say hi.
But hi anyway. Done responding, feel free to have the last word. You chuds really need it
Was happy to spend the time because it takes a moment to write a comment, unlike the considerable time it would take Bentham to write an entire post responding to you. Another example of bad faith argument on your part, as I clearly said "Why would Bentham bother writing a whole post" not "Why would anyone bother writing anything".
Your mind-reading e.g. assuming baselessly that I'm a lib (i'm not) or that I'm buddies with one of the 'loser' you 'owned' (I'm not) is a cognitive distortion that suggests you could use you some CBT. It might improve your wellbeing and disposition :)
If you think it's a cesspool please leave because you're bringing down the quality of the discourse.
How it started: "Why would Bentham bother writing a whole post to respond to your comments given how uninteresting and poorly reasoned they are? Seems like a waste of his time (OR ANYONE'S) time"
Then: "Was happy to spend the time because it takes a moment to write a comment"
Too stupid to make a cogent insult.
OMG--I just realized...you have a Substack! You're not just some random loser on a comment board; you are an "aspiring writer" :D with no followers, who comes to more popular Substacks to start arguments!
What a pathetic way to live man. And look--all the other losers do too! Wow. Just a chef's kiss of a morning.
Listen loser--you should hope that you never actually succeed (you won't). Because if you do, there will be these receipts of you being petty and small-dicked all over the place. And these comments flatly contradict the kind of "persona" you are trying to fake on your stack, like a poor man's Bantham or Scott without any talent or wit.
Addressing root causes is fine as long as it does not get in the way of other policy making. It's probably true that parental poverty impedes student learning in school and we should address poverty (the EITC being about the most effective instruments available) but schools should still teach statistics however poor the student body.
There's no evidence that changing the poverty status of the parents changes the student outcomes (as shared environmental factors have no effect on these outcomes, intelligence or personality), so that's certainly a gigantic waste of money if that is the reason.
I think the counterargument to this is that plausibly addressing root causes has extremely large effects across a wide range of problems. I obviously agree that there's no normative case for preferenceing root causes, but I think you've underrated the empircal case.
For instance, the root cause of the continuation of many communicable diseases is poverty caused by bad and weak government. It's plausible that we should target interventions at this instead, for instance by trying the replicate the success of the world and bank and IMF improving the economic policy of China and India respectively.
I think the analogy to the dying gun crime victim is a poor one. In that case, it's extremely clear that the marginal effect of helping the gun crime victim directly is much greater than what would have been done counterfactually with ones time for gun policy - but this is often not the case for considering interventions (although plausibly is for Pepfar.) I also this that it activates deontic intuitions, are it's fine to make non-consequentalist arguments, but I don't think that that's what was being argued for in the rest of the peice.
Wow based on all the comments this was definitely a provocative post.
I do think your analogy fell flat because crime is always a bad subject to analyze for root causes. If we’re being honest the cause should be irrelevant to policymakers because the cause is always bad judgement by human beings. So the policy must always starts with deterrence (policing and jail time). Like any medical problem or disease your response should always be to treat the effects (call 911 so medical treatment can be taken). If there is EVIDENCE that some intermediate action can reduce gun violence (but clearly nothing can prevent an individual from acting irrationally), then I would agree that you advance such a policy (but only if the money comes from private donors—NOT TAX PAYERS).
It’s obvious but worth repeating and you do it well. Only part I don’t love is the bit about the left wing stupidity. A guilty pleasure perhaps, but a straw man.
The flip side is also important. While helping a small case, here and now, still also think big.
We can do and think about both. We can toss the proverbial starfish into the sea, AND devise ways to bulldoze all of them into the sea someday. I see the opposite problem: YES deal with immediate pain, and ALSO discuss the root cause tenaciously.
Don’t let one be an excuse to not do the other. Do what you can. But don’t artificially limit what you do out of allegiance to hands-on one-on-one help. Maybe it’s just me but I see that as the bigger problem.
I enjoyed the article and found myself agreeing with a lot of it. The example of smallpox in particular is useful and convincing in showing that when it is unrealistic for us to be able to attack the root causes we should still combat the bad effects.
However, I think the earlier point with the drowning child needs to be amended. I think that the (more genuine) critics of effective altruism are saying with the root causes objection something like "the best way to reduce the suffering caused by this issue is to target the root cause, so you should target the root causes". Because of this, a better example is one in which you are on your way to vote on the issue of whether the local government should build more fences around muddy ponds to prevent children from drowning, and you have good reason to think that your vote could decide whether the fences are built. You see a child drowning in a muddy pond. Should you save him and risk the majority vote being against building the fences?
I think that this example shows that if you have a genuinely high impact on changing the root causes, you ought to focus on the root causes. Otherwise, you are right that the existence of a root cause means absolutely nothing to whether you should mitigate the effects or not.
I think people bring it up because they think that if you don't address the root cause, you're stuck plugging holes on a sinking ship. "When is the problem going to be solved?" is a totally fair question to ask, hence why I like donating (or will, when I resume my pledge) to economic development charities, which presumably stand a real chance of solving the root problem. I know EA does consider some of those to be effective, but I should probably look into those claims.
The PEPFAR stuff is silly yeah, it's an insignificant slice of the budget. I do wonder how much ideological work USAID is up to, and how much is being lost due to inefficiency.
Once upon a time, there was an old man who used to go to the ocean to do his writing. He had a habit of walking on the beach every morning before he began his work. Early one morning, he was walking along the shore after a big storm had passed and found the vast beach littered with starfish as far as the eye could see, stretching in both directions.
Off in the distance, the old man noticed a small boy approaching. As the boy walked, he paused every so often and as he grew closer, the man could see that he was occasionally bending down to pick up an object and throw it into the sea. The boy came closer still and the man called out, “Good morning! May I ask what it is that you are doing?”
The young boy paused, looked up, and replied “Throwing starfish into the ocean. The tide has washed them up onto the beach and they can’t return to the sea by themselves,” the youth replied. “When the sun gets high, they will die, unless I throw them back into the water.”
The old man replied, “But there must be tens of thousands of starfish on this beach. I’m afraid you won’t really be able to make much of a difference.”
The boy bent down, picked up yet another starfish and threw it as far as he could into the ocean. Then he turned, smiled and said, “It made a difference to that one!”
Do starfish not take fall damage?
It's possible people should spend a little time, and I do mean a little time, looking at what level of cause they want to address. Caring for people injured in a war is one level. Working toward a peace treaty is another. Opposing war in general is a third, and I'd give it a maybe.
You're conflating several different things: treatment for chronic illnesses, triage for wounds, curing diseases, preventing diseases.
Someone dying of a gunshot wound, if stitched up, probably won't be shot again unless they are gangster.
Smallpox vaccines eradicated the illness.
PEPFAR reduces deaths from a disease by providing lifelong treatment for symptoms. It does not reduce disease endemicness.
Well, first of all, it actually does prevent the spread of disease! Second, a single life-time supply of PEPFAR treatments does save lives. Everyone would agree that it would be good to give a person in the U.S. HIV treatment rather than refraining on grounds that it doesn't address the root cause of the problem.
Who is paying for this HIV treatment?
It doesn't address the underlying cause of African dysfunction. It just means more Africans. Which means more dysfunctional people that are constantly AIDSing themselves in the world.
At best those dysfunctional people stay in Africa and bother each other while we waste some small amount of money on sustaining them. At worst these overpopulated hordes immigrate to the west and destroy it, making all of human existence dramatically worse. Given most PEPFAR supporters are immigration supporters this is a fairly likely event.
It's telling to me that you believe that if you had to raise $6B a year from people voluntarily, not enough people would find AIDS treatments for Africans a worthy enough cause.
> Everyone would agree that it would be good to give a person in the U.S. HIV treatment rather than refraining on grounds that it doesn't address the root cause of the problem.
The whole reason PEPFAR treatment in Africa got so salient is that an African orphan dying of AIDS is a more sympathetic victim than a Western sexual degenerate who got AIDS from participating in too many chemsex orgies.
Oh c'mon.
This article reads like a longform response to my last comment, so let me respond quickly:
Moral hazard.
People are not at fault for getting shot. They are not at fault for contracting malaria, or smallpox.
You ABSOLUTELY, except in rare cases, ARE at fault when you contract the virus that causes AIDS. Heterosexuals have to be rampantly, shockingly promiscuous; and homosexuals at minimum need to be irresponsible about protection (male homosexuals are already shockingly promiscuous, not b/c of being gay but by being male).
Why is it my responsibility to protect Africans from their bad decisions?
Babies are not at fault. If a baby is born with AIDS (just typing that sentence made me want to murder any mother and father selfish enough to commit this crime) of course it is not to blame. But there is no "PEPFAR but just for babies" on offer. And more PEPFAR means more promiscuity, more AIDS, and more AIDS babies.
When do we get to pull the plug?
If you at the very least agree that a baby being born with HIV is bad, then you should support medical treatment for adults no? If everyone's viral load is suppressed and all prenatal procedures are done right, then you have eliminated the root cause of babies being born with HIV - their parents having untreated HIV.
It seems your guiding star is punishing people who do irresponsible things not the babies' welfare. Also, if treating HIV were a moral hazard, that would be clear by now. But, HIV transmission in Sub Saharan Africa peaked in the 90s (according to OWID)before PEPFAR was even launched so clearly, people aren't engaging in risky behaviour so they can get free ARVs, which aren't fun to take btw.
Almost a good reply. I give you credit for dealing with the actual issue of moral hazard (a bit), instead of handwaving toward strawman arguments ("what if all the women are virtuous? and some people who get shot deserve it!") or name-calling as argument ("bigotry!").
I support medical treatments. And I am not punishing anyone--nature is. The question is, should I have to PAY for a disease that is entitled self-inflicted? I would not want to pay for malaria treatments either if I learned all the malaria sufferers were drinking tall cans of Malaria Juice!
Where you go wrong is the claim " if treating HIV were a moral hazard, that would be clear by now". Um, it...IS clear. And saying that b/c HIV peaked in the 90s, that something-something no moral hazard, is just so clearly wrong.
Maybe strains were more transmissible then. Maybe there was more promiscuity then, but there is not "zero" now. This is a disease transmitted through voluntary activity. If you are in an area endemic with it, then even in a monogamous relationship you should either abstain or use protection for your safety. Apparently this is too much to ask.
I have no problem with promiscuity. Nature does. Every functional society is based on monogamy. Promiscuity is an acid dissolving any incentive to marry; any fidelity in marriage; any investment in society or the next generation; and leads to genetic losers who strike back violently.
Given this, again I ask: why should the American people pay for these people to continue their self-defeating behavior? And if we do continue, when does it stop--when DO we get to walk away, if ever? And if this is supposed to be a "forever" program, where we care for an entire half-continent of people like benevolent farmers caring for sheep that can't care for themselves--then by God, admit it! Say so! And then say why this is ok.
Almost a good reply but you showed your hand. Your problem is with promiscuity hence statements like "even in a monogamous relationship you should either abstain or use protection for your safety. " which yeah, it is too much to ask that people in monogamous relationships abstain.
There is no situation under which you are convinced that AIDS is bad and that it's good to treat people suffering from HIV as an end to itself. You would rather babies be born with HIV and then treat them for their entire lives using some 'PEPFAR for babies' program than fund a program (like PEPFAR) that would prevent them from being born with HIV in the first place just so those promiscuous people get some divine punishment. I don't think anything I say about how PEPFAR has saved >20 million lives and works to promote abstinence, faithfulness and condom use etc will change your mind.
As for the American people, they can vote for whatever they like, it seems that even Trump sees the utility of treating HIV in Africa, so maybe vote for someone even more callous than Trump.
Sad.
It's bad enough you cannot construct a logical argument; make a reasoned response; or debate in good faith. That makes you ordinary, like most people.
What is absolutely pathetic is that you (and many others here, unfortunately) are so goddamn insecure, so butthurt, that if someone points out the gaps in your argument you rush to your keyboard to "win" by insulting them.
You have called me a religious bigot (I never brought God into it); said that I thought AIDS was good; and that I want babies to die just so people who fuck can be punished.
All because I pointed out that you made a bad argument.
You're a pathetic loser, dude. Delete your account and log off for a while, and get some goddamn self-esteem.
I appreciate you writing this because you gave me the drive to really look into these things. I respectfully disagree with basically everything you have said.
I don't think PEPFAR is a moral hazard for HIV/AIDS infection because PEPFAR doesn't just provide Antiretroviral Therapy (ART). It also provides PReP, sexual education, HIV testing, and condoms. I suspect these effects counteract whatever moral hazard effect there is of providing antiretrovirals, if any. If you are concerned about the moral hazard effects of ART on promiscuity, then maybe there are more concerns. It doesn't seem like your main objection is to promiscuity. It's still hard to say though, because people need to be aware of the availability of free ART to be influenced, and the perceived benefit would only impact marginal decision-makers. I think the set of marginal decision-makers is small to non-existent. I believe this because a marginal decision-maker must have the following properties: 1) they must be aware of access to free ART (not at all obvious), 2) they must be aware of the risk of HIV (quite likely, but still something like 10% of young adults between 10 and 25 are not aware), 3) the expected value of sex when there is free ART must be greater than the expected value of sex when there is not free ART. Condition 3 is hard to meet because it requires the benefits of ART to be relatively high, the probability of infection to be relatively high, and the benefits of sex relatively low.
On a tangential note, the claim that "You ABSOLUTELY, except in rare cases, ARE at fault when you contract the virus that causes AIDS," strikes me as clearly false. It ignores rape and IPV as a mechanism of coercing unsafe sex. Your response to Robert was unconvincing to me (although I agree with you about the rakish husband, virtuous wives trope) because even if both partners are unfaithful, that does not mean they are equally responsible for infection with the virus. It is possible to be unfaithful and protect yourself from HIV. Of course, if you object to promiscuity in itself, then this is not particularly compelling. Taking you at your word, I think your primary objection is to the transmission of AIDS/HIV not promiscuity.
I genuinely hope you respond with the same level of verve and vigor that you have with other commenters; it's provided me with a lot of motivation to learn more about PEPFAR and the transmission of HIV/AIDS. I need some yang to my yin!
This is a fantastic comment. You actually dealt with the issue, respectfully, rather than show up and make personal attacks like a couple of other losers in this thread. Thank you.
You make solid points. Where I disagree is the overall assumption behind your logical breakdown. I think it is referred to as the "homo economicus" myth is behavioral economics--the idea that everyone is a rational actor; that we effectively "math" things out before making decisions, so real world behavior must conform to the theory. It is a myth for an obvious reason--very few behave that way.
And in my opinion, some are more rational than others.
Let's try a thought experiment. Let's say you and I, Nadja and Tony, woke to find ourselves in sub-saharan Africa. This was our new life. In our village, AIDS was epidemic. You and I would both reasonably conclude that any sexual partners we took had a very high likelihood of infection; and we would stay celibate IN THIS SCENARIO. If, for some reason, we fell in love with a native, we would either 1) insist on some sort of "proof" of non-infection (maybe we could really investigate the sexual history; or maybe there was a PCR test available. Barring that, 2) we would insist on protection, or even sex without intercourse ("everything but" is what the kids used to call it!).
And if the whole village was full of Nadjas and Tonys, then the infected would be quickly "sexually quarantined"; celibacy would reign for a time; and the infection would burn out. All would happen, again, if the natives were like Nadja and Tony.
Clearly, they aren't. Clearly, they do not make "maximal" calculations on their life; they live, literally, like there is no tomorrow.
So my question for you:
Can they help it? Are they "homo economicus" actors like us, who need to exert self reliance? Or are they in some way deficient in impulse control, or executive function, or some other capacity that would help them not ingest this poison?
The average IQ in sub Saharan Africa is 70, Contrasted with 85 for African Americans; 100 for white Americans; and 110 for east Asians. At a 70 IQ, I could imagine that one would not be able to plan and judge consequences correctly.
So, if these folks cannot help themselves, then I agree with you: we have a moral responsibility to help those who cannot help themselves. PEPFAR stays; we should fund it indefinitely, b/c the need will be indefinite.
However, if this continent is full of Nadjas and Tonys, then sorry--they need to exert agency and take responsibility for their lives.
(I do agree that sex ed and condoms are very beneficial, and we should continue to provide this aid regardless. Thank you for clarifying the extent of PEPFAR)
Your argument is self defeating. If African men are shockingly promiscuous and also married to virtuous non-promiscuous wives, what do you think happens to the wives, and how are they to blame?
You can graph this out if it helps, but you are basically suffering from runaway chivalry.
To have an AIDS epidemic, even just a cluster, among heterosexuals, you need promiscuous and infidelitous men AND women. The women are not virtuous; apologies if my comment was not clear. You can graph this and see the logic; if only the men are promiscuous and the women are not, then there really won't BE promiscuity. A cluster of men could theoretically contract AIDS from a harlot, but again, the sheer amount of sex required to accomplish this effectively rules it out as an explanation for ANY cluster of cases.
You can always hypothesize innocent victims; they do exist. But bringing them up is not an argument; it is an attempt at emotional manipulation ("what about women who are pregnant with RAPE INCEST babies! Shouldn't THEY be able to get abortions?"). We have to set policy for the average and usual, not the exception.
Say there's 1,000 married men, all of whom frequent once a month a brothel where the 5 inmates have AIDS. Even if the 1,000 wives are utterly monogamous, in a year or two you have 2005 AIDS sufferers plus the children. You yourself just said that men are differentially promiscuous, so what is unrealistic about this scenario?
I have spent months in East Africa, and that's pretty much the setup. Even if a married woman wants to be promiscuous there's serious obstacles in her way. I deduce from your non comedic use of the word harlot that you have not travelled outside the Bible Belt.
I used the word "harlot" b/c it was the most irenic and distanced of a list of pretty inflammatory terms. But since you decided to be condescending, let me say in kind that you come off as a nerd trying to win this day's Game of Interneting.
Your comment: "I have spent months in East Africa, and that's pretty much the setup"--really? The way you have personally seen that AIDS spreads is that virtuous maidens are undone by faithless husbands-cum-johns?
I don't know whether to laugh at such errant bullshit, or feel sorry for you since you obviously constructed that comment solely as a way to drop in your worldly travels. Congrats I guess?
Here's the deal, Robert: as I mentioned above (literally in the comment you responded to), it is easy to construct edge-tail hypotheticals to AVOID grappling with an issue ("since hermaphroditism exists, binary sex categories must be useless!"). But this is just emotional manipulation and fails to deal with the issue at hand.
What IS that issue? Well, for the third time:
Where AIDS is endemic in Africa among heterosexuals (and some bisexuals), promiscuity is rampant among both men and women:
--early age of sexual activity;
--many, many partners;
--women having children by multiple or even unknown fathers;
--men mostly unemployed or loosely employed;
--sex and violence as the main pursuit, as men fight and sometimes kill other men as the women replace them (through infidelity or serial relationships).
This is all happening while education on the transmission of AIDS is thoroughly taught. Sexual activity remains high even where AIDS is off-the-charts; survivors continue to spread the disease to new partners and their own children.
Given this backdrop, which I didn't need a plane ticket to learn, why should the US protect these people from themselves? What is our responsibility?
Any other comment about any niggling hypothetical is beside the point. And after giving you this well-deserved dunking for being condescending, I will refrain from responding to any more word games.
So if you need the last word, take it. And congrats again on your travels, you clearly are proud of them.
No, that is not why you said "harlot"
Arrant, not errant
Not an edge case, just the way STDs naturally propagate in traditional societies. Utterly mainstream.
You don't dispute my central claim that you have never left Alabama.
Many primitive or traditional societies don't have problems with AIDS the way Africa does.
Oh one more thing, I missed responding to your final question. I think it seems reasonable to pull the plug when pulling the plug will not violate the 95-95-95 goals and will not result in more than 250,000 deaths per year for the foreseeable future. These are the UN goals that are most relevant to me.
Jesus Christ. This "good AIDS versus bad AIDS" bigotry was already being mocked nearly 30 years ago.
https://youtu.be/f3xUjw2BCYE?si=LVYPu9nm3WoHcQH0
>People are not at fault for getting shot. They are not at fault for contracting malaria, or smallpox
Actually, many people who get shot are themselves participants in gun violence, or have been at some point in the past. Should we pull someone's criminal record before deciding whether to stitch them up?
I admit that I would be reluctant to call an ambulance for someone who would rob me when given the chance, or worse.
A very large minority, if not an absolute majority, of people who get shot are at fault for getting shot. Gunshot wounds are a lifestyle disease.
Why would Bentham bother writing a whole post to respond to your comments given how uninteresting and poorly reasoned they are? Seems like a waste of his time (or anyone's) time
Sooo…an insult, not an argument. And you apparently wasted your own time making it ….why?
This place is a fucking cesspool. All the tolerant libs resorting to ad hominem attacks. Low IQ indeed.
I’m guessing you’re buddies with one of the other losers I owned, doubt you just randomly showed up on a days old post and combed through the comments just to say hi.
But hi anyway. Done responding, feel free to have the last word. You chuds really need it
Was happy to spend the time because it takes a moment to write a comment, unlike the considerable time it would take Bentham to write an entire post responding to you. Another example of bad faith argument on your part, as I clearly said "Why would Bentham bother writing a whole post" not "Why would anyone bother writing anything".
Your mind-reading e.g. assuming baselessly that I'm a lib (i'm not) or that I'm buddies with one of the 'loser' you 'owned' (I'm not) is a cognitive distortion that suggests you could use you some CBT. It might improve your wellbeing and disposition :)
If you think it's a cesspool please leave because you're bringing down the quality of the discourse.
How it started: "Why would Bentham bother writing a whole post to respond to your comments given how uninteresting and poorly reasoned they are? Seems like a waste of his time (OR ANYONE'S) time"
Then: "Was happy to spend the time because it takes a moment to write a comment"
Too stupid to make a cogent insult.
OMG--I just realized...you have a Substack! You're not just some random loser on a comment board; you are an "aspiring writer" :D with no followers, who comes to more popular Substacks to start arguments!
What a pathetic way to live man. And look--all the other losers do too! Wow. Just a chef's kiss of a morning.
Listen loser--you should hope that you never actually succeed (you won't). Because if you do, there will be these receipts of you being petty and small-dicked all over the place. And these comments flatly contradict the kind of "persona" you are trying to fake on your stack, like a poor man's Bantham or Scott without any talent or wit.
Thanks for the great start to my day!
Addressing root causes is fine as long as it does not get in the way of other policy making. It's probably true that parental poverty impedes student learning in school and we should address poverty (the EITC being about the most effective instruments available) but schools should still teach statistics however poor the student body.
There's no evidence that changing the poverty status of the parents changes the student outcomes (as shared environmental factors have no effect on these outcomes, intelligence or personality), so that's certainly a gigantic waste of money if that is the reason.
The “root cause” people are the folk who like to let perfect be the enemy of good.
Some may truly take that stance out of an adherence to principle. But my suspicion is most use it to simply excuse inaction.
If you can address root causes , it's likely to be more effective than addressing the effects individually.
"The genius of AND versus the tyranny of OR."
"The genius of AND versus OR."
I think the counterargument to this is that plausibly addressing root causes has extremely large effects across a wide range of problems. I obviously agree that there's no normative case for preferenceing root causes, but I think you've underrated the empircal case.
For instance, the root cause of the continuation of many communicable diseases is poverty caused by bad and weak government. It's plausible that we should target interventions at this instead, for instance by trying the replicate the success of the world and bank and IMF improving the economic policy of China and India respectively.
I think the analogy to the dying gun crime victim is a poor one. In that case, it's extremely clear that the marginal effect of helping the gun crime victim directly is much greater than what would have been done counterfactually with ones time for gun policy - but this is often not the case for considering interventions (although plausibly is for Pepfar.) I also this that it activates deontic intuitions, are it's fine to make non-consequentalist arguments, but I don't think that that's what was being argued for in the rest of the peice.
Wow based on all the comments this was definitely a provocative post.
I do think your analogy fell flat because crime is always a bad subject to analyze for root causes. If we’re being honest the cause should be irrelevant to policymakers because the cause is always bad judgement by human beings. So the policy must always starts with deterrence (policing and jail time). Like any medical problem or disease your response should always be to treat the effects (call 911 so medical treatment can be taken). If there is EVIDENCE that some intermediate action can reduce gun violence (but clearly nothing can prevent an individual from acting irrationally), then I would agree that you advance such a policy (but only if the money comes from private donors—NOT TAX PAYERS).
It’s obvious but worth repeating and you do it well. Only part I don’t love is the bit about the left wing stupidity. A guilty pleasure perhaps, but a straw man.
The flip side is also important. While helping a small case, here and now, still also think big.
We can do and think about both. We can toss the proverbial starfish into the sea, AND devise ways to bulldoze all of them into the sea someday. I see the opposite problem: YES deal with immediate pain, and ALSO discuss the root cause tenaciously.
Don’t let one be an excuse to not do the other. Do what you can. But don’t artificially limit what you do out of allegiance to hands-on one-on-one help. Maybe it’s just me but I see that as the bigger problem.
I enjoyed the article and found myself agreeing with a lot of it. The example of smallpox in particular is useful and convincing in showing that when it is unrealistic for us to be able to attack the root causes we should still combat the bad effects.
However, I think the earlier point with the drowning child needs to be amended. I think that the (more genuine) critics of effective altruism are saying with the root causes objection something like "the best way to reduce the suffering caused by this issue is to target the root cause, so you should target the root causes". Because of this, a better example is one in which you are on your way to vote on the issue of whether the local government should build more fences around muddy ponds to prevent children from drowning, and you have good reason to think that your vote could decide whether the fences are built. You see a child drowning in a muddy pond. Should you save him and risk the majority vote being against building the fences?
I think that this example shows that if you have a genuinely high impact on changing the root causes, you ought to focus on the root causes. Otherwise, you are right that the existence of a root cause means absolutely nothing to whether you should mitigate the effects or not.
I think people bring it up because they think that if you don't address the root cause, you're stuck plugging holes on a sinking ship. "When is the problem going to be solved?" is a totally fair question to ask, hence why I like donating (or will, when I resume my pledge) to economic development charities, which presumably stand a real chance of solving the root problem. I know EA does consider some of those to be effective, but I should probably look into those claims.
The PEPFAR stuff is silly yeah, it's an insignificant slice of the budget. I do wonder how much ideological work USAID is up to, and how much is being lost due to inefficiency.