The chances that the trials will win international recognition appear slim. Initial enthusiasm for them among foreign governments has worn off. Many Western diplomats think the government has taken to using the courts to pursue rivals and enemies—as many say it did when it insisted recently that Muhammad Yunus, a Nobel laureate, should retire as head of Grameen Bank, a microcredit institution. The war-crimes process was supposed to produce a measure of truth and reconciliation. It has taken an inauspicious turn.
Libya
I saw this anti-war poster next to the Hopkins shuttle stop in Baltimore:
A mixture of probably true and not-so-true rhetoric about Libya. It's about oil! Well, partly -- but a single intervention can have multiple motivations, both humanitarian and otherwise. And then: "Attacking LIBYA is Attacking AFRICA!" which is helpfully illustrated with a map of Libya showing that it's, well, in Africa. This is a fascinating reimagination of the "all Africa is the same" meme. Another interesting observation: the poster is all about the Pentagon, with no mention of President Obama.
On the other hand, I think anti-war voices are healthy and helpful, even if the rhetoric is misguided. I'm torn on the Libyan intervention -- I believe it's justified, but I'm deeply worried about what happens next. Sometimes there are no good options, and the best possible option (intervening) can still lead to terrible outcomes.
Kristof provides this powerful justification that I can't get away from:
I’ve seen war up close, and I detest it. But there are things I’ve seen that are even worse — such as the systematic slaughter of civilians as the world turns a blind eye. Thank God that isn’t happening this time.
But another valuable voice is Alex de Waal, who doesn't have quite the audience of Kristof. De Waal shares these troubling thoughts:
Much of Libya is now ungoverned. That is particularly true of southern Libya. There has been little attention to the towns of the south, such as Sebha and Kufra, with no international correspondents there. These places are matters of great concern to neighbouring governments such as Niger, Chad and Sudan, because these towns have served as the rear base for armed rebellions in their countries, and rebel leaders still reside there. Gaddafi’s opening of the Libyan arsenals to anyone ready to fight for the regime, and the collapse of authority in other places, means that such rebels have been able to acquire arms and vehicles with ease. [....]
I spoke with one African military officer who welcomed the NATO action in Libya, saying “nothing could be worse than Gaddafi.” I suggested that he wait and see.
Update: Andrew Sullivan links to Daniel Larison's critique of Kristof's view that the intervention averted civilian slaughter:
Saying that the war has averted a humanitarian catastrophe is an extremely useful claim, and there’s no obvious way to disprove it. Outside governments intervened, and a humanitarian catastrophe hasn’t happened, and supporters of the war take it for granted that one would have happened otherwise. Of course, this is why they supported the war, but this points to the dilemma that humanitarian interventionists have. If they intervene in a timely fashion and don’t make the situation drastically worse in the process, there is nothing concrete they can point to that vindicates the decision.
How much can farming improve people's health?
The Economist opines on agriculture and micronutrient deficiencies:
Farming ought to be especially good for nutrition. If farmers provide a varied diet to local markets, people seem more likely to eat well. Agricultural growth is one of the best ways to generate income for the poorest, who need the most help buying nutritious food. And in many countries women do most of the farm work. They also have most influence on children’s health. Profitable farming, women’s income and child nutrition should therefore go together. In theory a rise in farm output should boost nutrition by more than a comparable rise in general economic well-being, measured by GDP.In practice it is another story. A paper* written for the Delhi meeting shows that an increase in agricultural value-added per worker from $200 to $500 a year is associated with a fall in the share of the undernourished population from about 35% to just over 20%. That is not bad. But it is no better than what happens when GDP per head grows by the same amount. So agriculture seems no better at cutting malnutrition than growth in general.
Another paper† confirms this. Agricultural growth reduces the proportion of underweight children, whereas non-agricultural growth does not. But when it comes to stunting (children who do not grow as tall as they should), it is the other way round: GDP growth produces the benefit; agriculture does not. As a way to cut malnutrition, farming seems nothing special.
Why not? Partly because many people in poor countries buy, not grow, their food—especially the higher-value, more nutritious kinds, such as meat and vegetables. So extra income is what counts. Agriculture helps, but not, it seems, by enough.
How to talk about countries
Brendan Rigby, writing at WhyDev.org, has these useful tips for how to talk about countries and poverty and whatnot while avoiding terms like "Western" and "developing":
- Qualify what you mean
- Avoid generalisations althogther (highly recommended)
- Use more discrete and established categories, such as Least Developed Countries (LDCs), or Low Income & Middle Income Countries, which have set criteria
- Reference legitimate and recognised benchmarks such as the UNDP’s Human Development Index or the World Bank’s poverty benchmark (These have there own methodology problems)
- Examine development issues and challenges of individual communities, countries in the context of regional geography, history and relations rather than losing countries within references to regions and continents. There is a big different between ‘poverty in Africa’ and ‘poverty in Angola’ or ‘poverty in South Africa’.
Good rules to follow. I'm generally OK with using "low and middle income countries," except that I'm not sure "income" should be the standard by which everything is defined. I wish there were a benchmark that took into account human development, but was uncontroversial (ha!) and thus accepted by all, and then we could easily classify nations (and these naming conventions are, after all, useful shorthands) by that index without worrying about accuracy or offense. Until we get to that point, I think using clearly defined measures of income and qualifying what we mean is the best way forward when generalizing -- when that's necessary or helpful at all. Which is at least sometimes, and maybe often.
"Small Changes, Big Results"
The Boston Review has a whole new set of articles on the movement of development economics towards randomized trials. The main article is Small Changes, Big Results: Behavioral Economics at Work in Poor Countries and the companion and criticism articles are here. They're all worth reading, of course. I found them through Chris Blattman's new post "Behavioral Economics and Randomized Trials: Trumpeted, Attacked, and Parried." I want to re-state a point I made in the comments there, because I think it's worth re-wording to get it right. It's this: I often see the new randomized trials in economics compared to clinical trials in the medical literature. There are many parallels to be sure, but the medical literature is huge, and there's really one subset of it that offers better parallels.
Within global health research there are a slew of large (and not so large), randomized (and other rigorous designs), controlled (placebo or not) trials that are done in "field" or "community" settings. The distinction is that clinical trials usually draw their study populations from a hospital or other clinical setting and their results are thus only generalizable to the broader population (external validity) to the extent that the clinical population is representative of the whole population; while community trials are designed to draw from everyone in a given community.
Because these trials draw their subjects from whole communities -- and they're often cluster-randomized so that whole villages or clinic catchment areas are the unit that's randomized, rather than individuals -- they are typically larger, more expensive, more complicated and pose distinctive analytical and ethical problems. There's also often room for nesting smaller studies within the big trials, because the big trials are already recruiting large numbers of people meeting certain criteria and there are always other questions that can be answered using a subset of that same population. [All this is fresh on my mind since I just finished a class called "Design and Conduct of Community Trials," which is taught by several Hopkins faculty who run very large field trials in Nepal, India, and Bangladesh.]
Blattman is right to argue for registration of experimental trials in economics research, as is done with medical studies. (For nerdy kicks, you can browse registered trials at ISRCTN.) But many of the problems he quotes Eran Bendavid describing in economics trials--"Our interventions and populations vary with every trial, often in obscure and undocumented ways"--can also be true of community trials in health.
Likewise, these trials -- which often take years and hundreds of thousands of dollars to run -- often yield a lot of knowledge about the process of how things are done. Essential elements include doing good preliminary studies (such as validating your instruments), having continuous qualitative feedback on how the study is going, and gathering extra data on "process" questions so you'll know why something worked or not, and not just whether it did (a lot of this is addressed in Blattman's "Impact Evaluation 2.0" talk). I think the best parallels for what that research should look like in practice will be found in the big community trials of health interventions in the developing world, rather than in clinical trials in US and European hospitals.
On community health workers
Sometimes I start writing a post and it ends up somewhere completely different than I had originally imagined it. My last post, on why there might be less good global health blogging out there than you'd expect, was actually originally going to be a simple link and quote from what I think is a very good post. A global health blogger named Emma notes some recent coverage of community health worker programs in the NYTimes (Villages Without Doctors). Then Emma writes:
There’s nothing more valuable than a good community health worker. [...Some reasons they're good....] When this happens, it’s a beautiful model.
When it doesn’t—and it doesn’t far more often than anyone would like to admit—community health workers are at best a drain on expenses with little to show for it and at worst a THREAT to community health instead of an asset. They can lure organizations and communities into complacency and miss opportunities for training higher level health care workers, breed antibiotic resistance strains of diseases by misuse of antibiotics, or give a false sense of security to people who actually need higher levels of care, among other things. If you think about CHWs usually are—rural, uneducated and as often as not illiterate or semi-literate people pulled from their communities and given tremendous responsibility with short training courses—this isn’t terribly surprising.
Emma also highlights a companion NYT piece called What Makes Community Health Care Work?
The article talks about really important things—make the program sustainable enough so that it can last after the donor leaves! Teach the CHWs to teach so even if the CHW doesn’t last some of their lessons will! Provide support for newly trained CHWs so they don’t feel stranded and alone! Expand in ways that make sense for the specific setting and situation! Get the country’s government on board! But…
There’s always a but. These things are HARD. Really hard. Of COURSE we want to do supportive supervision for the CHW, to watch how they practice and build their skills one-on-one based on each CHWs specific strengths and weaknesses. Of COURSE we want to design a program that can last long after we don’t have money from a donor anymore (emergency grants are usually 1-2 years at most). Of COURSE we want the CHWs to teach their communities how live healthier lives. But supportive supervision involves enough organization employees to conduct regular visits to remote and widely dispersed sites, and a security situation that allows these workers to safely go out into communities, and enough vehicles to get out to remote sites (and donors are often reluctant to fund vehicles and the fuel and insurance they take).
A formula for informed global health commentary
Here's a formula for intelligent conversation on pretty much anything in public health:
"[Method/Project/Tactic/Strategy X] is an awesome idea, and we need more of [X], but it can be challenging to do well because of problems with education / technology / resources, etc."
Now you know the secret. When you hear about Technology Y or Strategy Z, you can sound like a global health expert too.
I think this problem is one reason why there are fewer really good global health blogs than there are in some other fields. There are good ones -- Karen Grepin and Alanna Shaikh for starters -- and I can't quantify the shortfall, but there do seem to be more good blogs on economic development and aid work in general than global health in particular. (There are a lot of organizational blogs, of course, but they tend to be more self-promotional, and thus less interesting to a more critical reader.)
One possible reason is that the arguments in global health tend to be about the best way to do things, such as the best mix of resources or the right tactic for fighting a particular disease like malaria, rather than what we should be doing in the first place.
The truth is that a lot of the things we want to do in global health are inherently good. Vaccinating more children = good. Stopping disease outbreaks = good. More trained health care workers = good. More funding for [insert favorite disease] = good. And so on. Disagreements typically arise because advocates of these different approaches are sometimes pulling from the same pot of resources, but it's hard to argue that any single tactic or disease or organization should be getting less money.
Contrast that with the broader debates in development. Bill Easterly recently argued that "We don't know how to solve global poverty and that's a good thing." There's just so much still up for debate. Which leaves a lot more room for interesting commentary and argument that amongst global health experts. As a final example, I'll offer this Lancet article by several of my professors: "Can the world afford to save the lives of 6 million children each year?" (for the record, they answer "yes"). From their abstract:
"the lives of 6 million children could be saved each year if 23 proven interventions were universally available in the 42 countries responsible for 90% of child deaths in 2000."
Behavioral observation: Powerpointia grad-studentus
Slide proliferation is a well-documented evolutionary phenomena that results from cooperative behavior in the species powerpointia grad-studentus. Not observed in solitary p. grad-studentus, but in ecological systems where p. grad-studentus must work together to forage for grades, we observe an arms race to add more slides. Each p. grad-studentus thinks that adding another slide will yield a better grade, when in reality their collective action makes the whole presentation less compelling, and the entire flock may starve (ie, not get an A). By limiting the number of slides, faculty are applying selective pressure which in the end will result in a more fit powerpointia grad-studentus. Punctuated equilibrium for powerpoint.
Monday Miscellany
Bad news: 3rd term final exams and projects are this week at JHSPH. Good news: next week is Spring Break! Some links for the week:
Japan: Hard to think of good things in the wake of tragedy, but it could have been much worse: Millions saved in Japan by good engineering and government building codes.
On GAVI: Some coverage by Tom Paulson of Seth Berkley's appointment as the new CEO of the GAVI Alliance, which funds vaccinations in many developing countries. Paulson also links to a thought-provoking read, "Six Ideas and Questions for GAVI's New CEO," by Amanda Glassman of the Center for Global Development, and an article Paulson wrote on the early days of GAVI. (And I spent a good chunk of my weekend working on a paper comparing policy alternatives for GAVI's co-financing policy for a class taught by @orinlevine.)
Cote d'Ivoire: Close to half a million people have been displaced by the Cote d'Ivoire crisis so far.
Microcredit: Is microfinance a neoliberal fairtytale?
Baltimore: David Simon (creator of The Wire) on the drug war in Baltimore and beyond.
Refugees: Jina Moore with this disturbing story: "Why an American lawyer is pulling the plug - literally - on a Rwandan refugee."
Rwanda: The Trouble with Rwanda by Lindsay Morgan.
Religion (or lack thereof): Sociological Images presents demographics of the non-religious.
Random: The blog Best of Wikipedia has been on a roll lately: see Errors in the US Constitution, dihydrogen monoxide hoax, and Mozart and scatology (ie, toilet humor).
Atlas Shrugged
My oldest brother, Drew, is a professional oboist, reedmaker, and composer. He also writes witty things on Facebook which don't get out the wider world, like the bullet-point review of Atlas Shrugged below. While I still haven't gotten around to reading anything by Ayn Rand (shocking!), this hits the high points of pretty much everything I've heard of her, so I'm re-posting it here (with his permission). With a new movie coming soon we're all going to be inundated with a new generation of Objectivists, so it's time to read up. His review:
- Atlas Shrugged is 50% story and 50% sermon. It would've been a better book had it been half as long, or at least half a venomous.
- Atlas Shrugged is an eloquent expression of a beautiful idea that (like all beautiful ideas) becomes grotesque when unchecked by counterbalancing forces.
- Atlas Shrugged is a fantasy novel. The real world is not powered exclusively by a dozen productive geniuses who all happen to agree on everything. Elves and dwarves are more believable.
- In the real world, businessmen are not demigods, and politicians are not devils.
- In the real world, wealth is inherited by George W Bush, not Francisco d'Anconia.
- Ivy Starnes says, "The plan was a noble ideal, but human nature was not good enough for it." Sadly, Rand does not realize that her villain's words apply equally to her own ideology.
- At first it's confusing that an author capable of such brilliantly concise dialogue so often launches into long-winded and half-baked rambles. But there's a reason for it: outrageous ideas seem less outrageous with repetition. Partisan media understand this. You don't have to justify a claim if you repeat it often enough. I laughed out loud when Rand first referred to the "looters." But by the end of the book, that peculiar usage seemed almost normal.
- Not since Zen and the Art of Motorcycle Maintenance has a book so clearly shown that brilliant novelists often make lousy philosophers. Of course, brilliant philosphers often make lousy philosophers, too.
Sentinel chickens
"In May 2000 Canadian Health authorities stationed cages of sentinel chickens along 2500 km (1550 miles) of the border with the United States in an effort to identify the presence of West Nile virus in susceptible animals before the disease was detected in humans in Canada. Ultimately, the sentinel chickens were key in detecting a new viral epidemic."
Source here. And then there are "Super Sentinel" Chickens...
Monday Miscellany
Things and links I liked:
- I just renewed my membership in the National Association of Rocketry (I maintain a separate rocketry blog but haven't updated in a while because it's not flying season), which includes a $2 million liability insurance policy for rocket launches. Oddly, the notice I got with my renewal says this: "NAR insurance does not cover any activities which involve use of alcoholic beverages, criminal assaults and batteries, nuclear accidents or sexual abuse." I can understand the others, but seriously, "nuclear accidents?" Was that necessary?
- My favorite blog discovery of last week is "Covering Health" on health care journalism. Here's a post on balancing daily reporting and narratives.
- Dave Algoso (who I met at the AidWatch conference this weekend) writes "Would you hire me if I disagreed with you? What if I did it publicly?"
- My friend Kate Otto on planning and pregnancy in Indonesia.
- On DFID's aid review.
- Something that brings left and right together (sort of): cancer research.
- The typical human is a 28 year old Chinese man.
- For those currently applying to grad school, here's a useful video on the Harvard Kennedy School application.
Something powerful, ctd
Yesterday I posted about HU Queer Press, an online magazine published by an anonymous group of LGBTQ students at my alma mater, Harding Unviversity. Since then the issue has gotten a lot of press, including Jezebel, The New Yorker blog, KARK, and others. I got a call earlier today from a gay Harding student who is upset by HUQP's approach to the issue and says that some of what they say is factually incorrect. I said that if he wanted to write a response, I'd publish it for him and keep him anonymous as well. I'll reserve my reactions for the comment space, and would love to hear other views as well. Here's what he said:
I am a gay student currently attending Harding University who wants to voice my own experiences and give voice to the experiences of other gay students at HU. While the accounts presented in “The State of The Gay” e-zine are compelling, sad, frustrating, and even downright infuriating, they are not representative of the current environment on campus.
Harding University does not have a rule against “being gay.” I am open about my sexuality all over campus—to students, faculty, staff, and members of the administration. The fact that I am a gay man is common knowledge, not just at Harding University, but also at my church (a Church of Christ). Never once have I been threatened with expulsion or forced reparative therapy. If anyone was threatened with disciplinary action unless they received counseling, it was not for simply identifying themselves as gay. When a rule is broken, action is taken, but there is no rule against “being gay.” This hasn’t always been the case, and Harding isn’t a perfect place. Is there bigotry there? Yes, and we must deal with that. We should not blast them, however, for things that simply aren’t true.
Additionally, there is a growing impression that Integrity Ministries at Harding is a place where people are forced to go and be “fixed.” This is simply not true. Everyone who is a part of Integrity Ministries is there of their own free will and choice. The names of the persons attending meetings and/or utilizing resources are not even known by anyone in the administration, faculty, or staff. Students approach the ministry, the ministry does not approach (or impose upon) students, and their identity is kept highly confidential.
If the ethic driving the current debate is freedom of choice, then we must extend that freedom to those whose faith and personal relationship with God have led them to CHOOSE to address their sexuality in the way they see fit. The reason my friends and I remain anonymous in this debate is not because we fear oppression from Harding University—but the exact opposite. Those who are driving this debate are not allowing us our own freedom, and not creating a “safe place” for us to be honest about who we are and who we want to be. These people who demand a safe place for themselves are guilty of denying the same thing to us. At Harding University, we have found many, many, many people who are loving, accepting, nurturing, and inclusive. Simply put: HUQueerPress does not represent the majority of gay students at Harding University, and everyone at the University (administration included) is not the grotesque stereotype that HUQueerPress is trying to make them out to be.
--Joe Gay
Something powerful
I've tried to keep this blog professionally relevant, focusing on global health and development. But I want to share something a little different, and this is the best way I know how--hope you'll forgive the tangent. I went to college at Harding University, a conservative, private Christian University in my hometown of Searcy, Arkansas. Harding is strict -- you can get kicked out for dancing,* having sex, being gay, or drinking alcohol. The 5,000+ undergraduates are required to live on campus at first, with guys' dorms and girls' dorms and a nightly curfew where your RA's check to see if you're in your room. Daily chapel is required and everyone must take a Bible class each semester. It's like Footloose but with more Jesus and a lot less Kevin Bacon.
Except that earlier today, a bunch of gay and lesbian students at Harding spoke out:
We are here to share with you our struggle. We are here to be a voice for the voiceless who are quietly dying inside the walls of our campus. We want you to know us. We are your friends, co-workers, students, family members, fellow worshipers, professors, athletes, and scholars.[...] We are queer. We are gay, lesbian, bisexual and transgender. While the rest of you fall in love with the opposite sex, we share our lives and beds with those of our own gender.
All is not well for us at Harding. Our voices are muted, our stories go unheard, and we are forced into hiding. We are threatened with re-orientation therapy, social isolation, and expulsion. We are told stories and lies that we are disgusting sinners who are damned to hell, that we are broken individuals and child abusers....We have felt the pain of the deep, dark closet, and we are here to announce that we will not stand for it any longer.
That's the opening statement from HU Queer Press, a group of anonymous LGBTQ students, who are publishing a webzine about being gay at Harding. You can find the first issue, "State of the Gay at Harding University" at their website:
It's powerful stuff, ranging from the sweet to the visceral. The stories mix courage with self-hatred, love of friends and allies at Harding with hatred for its oppressive atmosphere and teachings. You really should read the whole thing, but here are a few of my favorite parts:
First is this sweet piece from "Dovey" writing about "How I Realized I Like Girls (And Why I'm Surprised I Didn't Realize Sooner.)":
When I was13, I, like most every girl my age, had a best friend (we'll call her Elle.) We spent almost all of our free time together, wrote several-page-long notes to each other that we passed when we met in the school halls, wrote stories about what our lives would be like when we grew up. We loved all the same movies, all the same books, and some of the same music....
I began to realize, though, that every time Elle had a boyfriend (and she had a LOT of them) I got immensely jealous. Even if he was someone who had always been a good mutual friend, I would begin to resent him. It wasn't just that Elle was spending less time with me, or that I felt left out. I wanted to hold her hand like they did. I wanted her to look at me the way she looked at them. I wanted to kiss her goodbye when we all left at the end of the school day.
Then "C" writes about coming out:
Most of the people I first told just kind of smiled and said "I figured." And of course they still loved me. Soon I had this great group of people encouraging me. I got enough confidence to finally tell my parents. They too already had some idea that this might be coming, but there was no smile on their face when they said so. "We were afraid of this." "I'm very disappointed."
"Z" chronicles his history:
[Age 13] Jeff kissed me... One day Jeff took me in the woods and said that he liked me, like he liked Kathleen. He leaned in and kissed me. I felt more alive in that moment than I had ever felt before. The next day in school, Jeff told the entire locker room that I tried to kiss him and that I was a Fag. I knew what it meant now. I sat alone in the lunchroom for the rest of middle school. I never had one friend from school. I turned to church....
[Age 17] Brad pulled me in the back of the room. He kissed me. I kissed him back. He unbuttoned my shirt and I pulled his off. He took off my belt and got down on his knees. He took me in his mouth and I came. I punched him in the face. I called him a Faggot and kicked him in his ribs. What had I done? God please save me. Take this away from me and I'll be a slave to you. I'll never do this again. I want you to take me under your wings and rescue me? Rescue me from whom? ME.
"K" criticizes the "Toxic Teachings" at Harding by highlighting the following course notes for a currently offered class. These were written by a Harding professor:
Certain signs of pre-homosexuality: 1) repeatedly stated desire to be other sex or act like other sex, 2) strong preference for cross dressing or pretending to dress like other gender, 3) strong and persistent desire for opposite roles.
Single Mothers: Cub Scouts and male Sunday school class is not enough to help a boy reach a clear gender identity: the boy must have one salient (good and strong) man who takes a special interest in him - one male chooses him. Men: find those fatherless boys and invite them to go fishing. Play catch with him - especially the quiet boy in the background... the one in the background - he is the one we have to go after.
Seriously? Who's recruiting who?
"K" also shares notes from a journal entry after a therapy session at Harding:
I need to make this decision. Will I go through with this or not. If so I need to truly count the cost and realize that this will cost me. If yes, that I for sure want to pursue my life as a Godly person with Him above all else:
I would have to see myself as heterosexual.
Every time I am attracted or want to look at another guy I would have to say "No. I am a heterosexual and I do not have these desires. They are not natural." I would completely have to capture my thoughts, deny them, and never intend to pursue or continue these thoughts.
There's a lot, lot more. Some amazing introspection, some self-loathing. A little coming out, a lot of the closet, some falling in love. They write a how-to for reading the Bible as gay-neutral, if not gay-friendly. They write about getting called fags.
And they write about the problems they have with "Integrity Ministries," the fairly new support group for students who "struggle with same-sex attraction." In some ways, Harding, or at least the people who are associated with it, have come a long way. The creation of Integrity Ministries a couple years ago suggest that the administration at Harding has realized it has a "gay problem" that isn't going away with denial and condemnation alone, the previous approach. I know that some of my friends saw the inception of Integrity Ministries as a step forward. But taking a tiny step forward from a wallowing pit of homophobia still leaves Harding far short of where it should be.
I really admire the authors for doing this, in part because even writing anonymously, they still face big risks. If someone rats them out they could all get kicked out, and they could lose many friends. And just because they're gay doesn't mean they can easily leave Harding. Some students can only afford college with their parents' support, and some parents will only send their kids to Christian colleges. I guess others stay at Harding because they love the institution despite its flaws and want to go to a Christian school because of their deep faith, and they hope to change it from the inside out. If it were easy and they had no other ties, they'd transfer elsewhere and start a new life with people who love them regardless of their sexuality. But it isn't that easy.
I sympathize with them because I have mixed feelings about Harding as well. My dad teaches there and I grew up around the school. I went to Harding of my own free will because I wanted to be a missionary. I deconverted during my third year there. The process was a gradual one. The more I studied theology and the Bible and war and history and science (some through courses at Harding but also much on my own) the more my views shifted towards progressive theologies. I maintained an unhappy equilibrium as a liberal Christian with a belief in a vaguely Einsteinian God for somewhat less than a year. In hindsight the shift from fundamentalist belief to liberal belief was driven by an intellectual desire to believe something that was compatible with science and history and critical thought, but the choice to go from liberal theology to discarding my faith in faith altogether was more about choosing my allegiances. In the South, and especially at Harding, the association between that particular Christian tradition and reactionary filth was just too strong for me. At some point I couldn't stomach being associated with all that was anti-science, anti-feminist, and yes, anti-gay. If it wasn't clear before you read the HU Queer Press, one reason people get turned off by Christians like many at Harding is that their beliefs and actions cause a world of pain to those they label as sinful.
I have a lot of good memories, and I still love many people associated with Harding -- family, professors and mentors, and classmates. I doubt Harding will change much, or fast. They still don't let women speak in chapel or lead prayers, and you get kicked out for having straight sex too. My hope is more for the students who go to Harding and then move on, that they will emerge more compassionate and less homophobic than they might otherwise have been. Maybe we'll get a step closer to that if everyone at Harding reads this webzine (probably on their laptops at Midnight Oil since I'm sure they'll block www.huqueerpress.com on campus!).
One last thing: Early on, like many other straight male dorm student at Harding I called everyone a fag -- man, don't be such a fag! I used to be part of that putrid homophobic culture, and for that -- to anyone who reads this who I knew at Harding -- I'm sorry. It was as if by joking about it we could make "the gays" all just disappear." But they can't. They're there and they're not going away no matter how hard you pray, and now they're finding a way to speak out. Awesome. Read it and share it with your friends.
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One note: I was not involved in the production or hosting of HU Queer Press, and I don't know who they are. I just received an anonymous email a few days ago asking me to help with getting the word out since I have a blog. In fact I think it's more powerful not knowing because they could be anyone I knew at Harding.
*Update 1: a commenter points out that they've never heard of anyone getting kicked out for dancing, and I think that's right. My apologies for the imprecision -- I should have said that dancing is against the rules.
Update 2: I'm tracking who all has written about the zine. If you notice a blog I haven't listed please mention it in the comments. So far: Hemant Mehta, Political Cartel, Ian Thomas, NWA Equality, Don Gaines, Talk About Equality, Arkansas Times' Arkansas Blog, Coleman Yoakum, Change.org petition, Nelson Shake,
Evaluation in education (and elsewhere)
Jim Manzi has some fascinating thoughts on evaluating teachers at the American Scene. Some summary outtakes:
1. Remember that the real goal of an evaluation system is not evaluation. The goal of an employee evaluation system is to help the organization achieve an outcome....2. You need a scorecard, not a score. There is almost never one number that can adequately summarize the performance of complex tasks like teaching that are executed as part of a collective enterprise....
3. All scorecards are temporary expedients. Beyond this, no list of metrics can usually adequately summarize performance, either....
4. Effective employee evaluation is not fully separable from effective management
When you zoom out to a certain point, all complex systems in need of reform start to look alike, because they all combine social, political, economic, and technical challenges, and the complexity, irrationality, and implacability of human behavior rears its ugly head at each step of the process. The debates about tactics and strategy and evaluation for reforming American education or US aid policy or improving health systems or fostering economic development start to blend together, so that Manzi's conclusions sound oddly familiar:
So where does this leave us? Without silver bullets.
Organizational reform is usually difficult because there is no one, simple root cause, other than at the level of gauzy abstraction. We are faced with a bowl of spaghetti of seemingly inextricably interlinked problems. Improving schools is difficult, long-term scut work. Market pressures are, in my view, essential. But, as I’ve tried to argue elsewhere at length, I doubt that simply “voucherizing” schools is a realistic strategy...
Read the rest of his conclusions here.
Monday Miscellany
I do most of my blog writing on weekends, scheduling posts ahead of time. Last week was midterms, and last weekend I was in DC visiting friends and studying, thus I got little writing done. I'm glad to be back this week, and will kick things off with a roundup of recent fascinatingness:
- There's a measles outbreak in the US. Interesting fact: we know that measles transmission has been stopped within the US because every time there's an outbreak, investigators are able to sequence the virus and eventually match it to the region from which it was imported. See the CDC's MMWR on the subject for more.
- Amanda Glassman of the Center for Global Development comments on proposed new rules for kidney transplant prioritization in the US -- a percentage of donated kidneys would be reserved for the youngest, healthiest transplant recipients. Glassman recently hosted an event at CGD on rationing that I was able to attend. Speakers included Andrew Dillon of the UK's NICE and Sheri Fink, who recently reported this excellent series at PRI on various approaches to health care rationing around the world. Fink's one book, War Hospital, is a compelling look at the struggles of doctors in the embattled Srebrenica enclave (pre-massacre) during the Bosnian War.
- Risks of rare events are hard to conceptualize. Enter the micromort, a one-in-a-million probability of death.
- The website for Poor Economics, a forthcoming book by Banerjee and Duflo, is pretty awesome. The overview section makes it sound like they overemphasize interesting findings about behavioral priorities and downplay structural reasons (lousy governments, poor trade policies, etc) but maybe that's now born out in the text. I'm looking forward to reading this as well as Karlan and Appel's forthcoming More Than Good Intentions.
- Edward Carr recently finished live-blogging Dambisa Moyo's Dead Aid--it's a scathing review worth reading if you haven't read the book but run into fans. I'll admit that I didn't get through it -- I got frustrated early on with the imprecise definitions of terms and poor logic. I hope to finish at some point, but for now it's pretty low on my list of priorities. This review of Moyo's new book, How the West Was Lost is pretty damning: "[Dead Aid]’s runaway success baffled many with prior knowledge of the issues, even those broadly sympathetic to its sceptical tone, consisting as it did of a tendentious one-sided account of tired and inconclusive old academic literature about aid effectiveness. How the West was Lost contrives to lower these standards yet further."
- "Marauding Gay Hordes Drag Thousands Of Helpless Citizens From Marriages After Obama Drops Defense Of Marriage Act" (story)
- John Shea argues in American Scientist, more or less, that the caveman from GEICO commercials is more accurate than the current anthropological view (sort of).
Incentives?
From a lab assignment for my Professional Epidemiology Methods course:
...but part of this exercise is to remember that public health practice does not happen in a vacuum. And if you do your job well, nothing happens and you may be blamed for interrupting daily life activities. If you do not do your job well, people get sick or die--and you still get blamed.
Why World Vision should change, but won't
Note: I've edited the original title of this post to tone it down a bit. World Vision has recently come under fire for their plan to send 100,000 NFL t-shirts printed with the losing Super Bowl team to the developing world. This gifts-in-kind strategy was criticized by many bloggers -- good summaries are at More Altitude and Good Intentions are Not Enough. Saundra S. of Good Intentions also explained why she thinks there hasn't been as much reaction as you might expect in the aid blogosphere:
So why does Jason, who did not know any better, get a barrage of criticism. Yet World Vision, with decades of experience, does not? Is it because aid workers think that the World Vision gifts-in-kind is a better program? No, that’s not what I’m hearing behind the scenes. Is it because World Vision handled their initial response to the criticism better? That’s probably a small part of it, I think Jason’s original vlog stirred up people’s ire. But it’s only a small part of the silence. Is it because we are all sick to death of talking about the problems with donated goods? That’s likely a small part of it too. I, for one, am so tired of this issue that I’d love to never have to write about it again.
But in the end, the biggest reason for the silence is aid industry pressure. I’ve heard from a few aid workers that they can’t write - and some can’t even tweet – about the topic because they either work for World Vision or they work for another nonprofit that partners with World Vision. Even people that don’t work for a nonprofit are feeling pressure. One independent blogger told of receiving emails from friends that work at World Vision imploring them not to blog about the issue.
While I was one of the critical commentators on the original World Vision blog post about the NFL shirt strategy, I haven't written about it yet here, and I feel compelled by Saundra S.'s post to do so. [Disclosure: I've never worked for World Vision even in my consulting work and -- since I'm writing this -- probably never will, so my knowledge of the situation is gleaned solely from the recent controversy.]
And now World Vision has posted a long response to reader criticisms, albeit without actually linking to any of those criticisms -- bad netiquette if you ask me. Saundra S. responds to the World Vision post with this:
Easy claims to make, but can you back them up with documentation? Especially since other non-profits of similar size and mission - Oxfam, Save the Children, American Red Cross, Plan USA - claim very little as gifts-in-kind on their financial statements. So how is it that World Vision needs even more than the quarter of a billion dollars worth of gifts-in-kind each year to run their programs? To be believed, you will need to back up your claims with documentation including: needs assessments, a market analysis of what is available in the local markets and the impact on the market of donated goods (staff requests do not equal a market analysis), an independent evaluation of both the NFL donations (after 15 years you should have done at least one evaluation) and an independent evaluation of your entire gifts-in-kind portfolio. You should also share the math behind how World Vision determined that the NFL shirts had a Fair Market Value - on the date of donation - of approximately $20 each. And this doesn't even begin to hit on the issues with World Vision's marketing campaigns around GIK. Why keep perpetuating the Whites in Shining Armor image.
So to summarize Saundra S.'s remaining questions:
1. Can WV actually show that they rigorously assess the needs of the communities they work in for gift-in-kind (GIK)? especially beyond just "our staff requested them"?
2. Why does WV use a much larger share of GIK than other similarly sized nonprofits.
3. Has WV tried to really evaluate the results of this program? (If not, that's ridiculous after 15 years.)
4. How did WV calculate the 'fair market value' for these shirts? (This one has an impact on how honestly WV is marketing itself and its efficiency.)
Other commenters at the WV response (rgailey33 and "Bill Westerly") raise further questions:
5. Does WV know / care where the shirts come from and how their production impacts people?
6. Rather than apparently depending on big partners like the NFL to help spread the word about WV is doing and, yes, drive more potential donors to WV's website (not in itself a bad thing) shouldn't they be doing more to help partners like the NFL -- and the public they can reach -- realize that t-shirts aren't a solution to global poverty? After all, wouldn't it be much more productive to include the NFL in a discussion of how to reform the global clothing and merchandise industries to be less exploitative?
7. WV must have spent a lot of money shipping these things... isn't there something better they could do with all that money? And expanding on that:
Opportunity cost, opportunity cost, opportunity cost. The primary reason I'm critical of World Vision is that there are so many things they could be doing instead!
For a second, let's assume that GIK doesn't have any negative or positive effects -- let's pretend it has absolutely no impact whatsoever. (In fact, this may be a decently good approximation of reality.) Even then, WV would have to account for how much they spent on the programs. How much did WV spend in staff time, administrative costs like facilities, and field research by their local partners coordinating donations with NFL and other corporate groups? On receiving, sorting, shipping, paying import taxes, and distributing their gifts-in-kind? If they've distributed 375,000 shirts over the last few years, and done all of the background research they describe as being necessary to be sensitive to local needs... I'm sure it's an awful lot of money, surely in the millions.
Amy at World Vision is right that their response will likely dispel some criticism, but not all. But that's not because we critics are a particularly cantankerous bunch -- we just think they could be doing better. Her response shows that, at least in one sense, they are a lot better than Jason of the 1 Million Shirts fiasco, if they're spreading the shirts out and doing local research on needs -- but those things are more about minimizing potential harm than they are maximizing impact. In short, World Vision's defense seems to be "hey, what we're doing isn't that bad" when really they should be saying "you know what? there are lots of things we could be doing instead of this that would be much greater impact." So in another way World Vision is much worse than Jason, because they have enough experts on these things to know what they're doing and that this sort of program has very little likelihood of pulling anyone out of poverty, they know there are better things they could be doing with the same money, and they still do it.
To get to why I think that's the case, let's go back to WV's response to the GIK controversy. From Amy:
At the same time, I’ll also let you know that, among our staff, there is a great deal of agreement with some of the criticisms that have been posted here and elsewhere in the blogosphere. In my conversations, I’ve heard overwhelming agreement that product distribution done poorly and in isolation from other development work is, in fact, bad aid. To be sure, no one at World Vision believes that a tee shirt, in and of itself, is going to improve living conditions and opportunities in developing communities. In addition, World Vision doesn’t claim that GIK work alone is sustainable. In fact, no aid tactic, in and of itself, is sustainable. But if used as a tool in good development work, GIK can facilitate good, sustainable development.
There are obviously a lot of well-intentioned and smart people at World Vision, and from this it sounds like there are differences of opinion as to the value of GIK aid. One charitable way of looking at the situation is to assume that employees at WV who doubt the program's impact justify its use as a marketing tool -- but if that's the case they should classify it as a marketing expense, not a programmatic one. But I imagine the doubts run deeper, but it's pretty hard for someone at any but the most senior of levels to greatly change things from inside the organization, because it's simply too ingrained in how WV works. Clusters of jobs at WV are probably devoted to tasks related to this part of their work: managing corporate partnerships, coordinating the logistics of the donations, and coordinating their distribution.
One small hope is that this controversy is giving cover to some of those internal critics, as the bad publicity associated with it may negate the positive marketing value they normally get from GIK programs. Maybe a public shaming is just what is needed?
[I really hope I get to respond to this post in 6 months or a year and say that I was wrong, that World Vision has eliminated the NFL program and greatly reduced their share of GIK programs... but I'm not holding my breathe.]
Global health effects of nuclear war
Some morbid weekend reading: "The global health effects of nuclear war," by Brian Martin, published in Current Affairs Bulletin in 1982. A section on overkill:
Many people believe that the capacity of nuclear weapons for 'overkill' means that all or most of the people on earth would die in a major nuclear war. In spite of the prevalence of this idea, there is little scientific evidence to support it.
Many calculations of 'overkill' appear to be made using the nuclear attacks on Hiroshima and Nagasaki as a baseline. Estimates of the number of people killed at Hiroshima from a 13kt bomb range from 63,000 to over 200,000. Adopting a figure of 130,000 for illustrative purposes gives ten people killed for each tonne of nuclear explosive. By linear extrapolation, explosion of a third of a million times as much explosive power, 4000Mt, would kill a third of a million times as many people, namely 40,000 million, or nearly ten times the present world population.
But this factor of ten is misleading, since linear extrapolation does not apply. Suppose the bomb dropped on Hiroshima had been 1000 times as powerful, 13Mt. It could not have killed 1000 times as many people, but at most the entire population of Hiroshima perhaps 250,000. Re-doing the 'overkill' calculation using these figures gives not a figure of ten but of only 0.02. This example shows that crude linear extrapolations of this sort are unlikely to provide any useful information about the effects of nuclear war.
History refresh: AZT and ethics
A professor pointed me to this online history and ethics lesson from the Harvard Kennedy School's Program on Ethical Issues in International Research: The Debate Over Clinical Trials of AZT to Prevent Mother-to-Infant Transmission of HIV in Developing Nations. It's surprisingly readable, and the issues debated are surprisingly current.
In 1994, researchers in the US and France announced stunning news of a rare victory in the battle against the AIDS pandemic. Studies conducted in both countries had shown conclusively that a regimen of the drug AZT, administered prenatally to HIV-positive pregnant women and then to their babies after birth, reduced the rate of mother-to-infant transmission of HIV by fully two-thirds. The results of the clinical trials constituted "one of the most dramatic discoveries of the AIDS epidemic," the New York Times declared, and one of the most heartening as well.The new regimen--known by its study name, AIDS Clinical Trials Group (ACTG) 076 or, often, simply "076"--offered the epidemic's most vulnerable targets, newborns, their best hope thus far of a healthy childhood and a normal life span. The number of infants who might benefit from this research was significant: according to World Health Organization (WHO) figures, as many as five to ten million children born between 1990-2000 would be infected with HIV. In the mid-1990s, it was estimated that HIV-infected infants were being born at the rate of 1,000 a day worldwide.
So impressive were the findings of ACTG 076--and so substantial the difference in the transmission rate between subjects given AZT and those given a placebo (eight percent versus 25 percent)--that the clinical trials, which were still ongoing, were stopped early, and all participants in the studies were treated with AZT. In June 1994, after reviewing the study results, the US Public Health Service recommended that the 076 regimen be administered to HIV-infected pregnant women in the US as standard treatment to prevent transmission of the virus.
But while 076 was hailed as a major breakthrough, the celebration was somewhat muted. For a variety of reasons, the new treatment regimen would not likely reach those who most desperately needed it: pregnant women in the developing nations of the world and, most particularly, sub-Saharan Africa, where AIDS was wreaking devastation on a scale unimagined in the West.
I think one reason why graduate school can be so overwhelming is that you're trying to learn the basic technical skills of a field or subfield, and also playing catch-up on everything that's been written on your field, ever. True, some of it's outdated, and there are reviews that bring you up to speed on questions that are basically settled. But there's a lot of history that gets lost in the shuttle, and it's easy to forget that something was once controversial. Something as universally agreed upon today as using antiretrovirals to prevent mother-to-child transmission of HIV was once the subject of massive, heart-wrenching debate. I tend to wax pessimistic and think we're doomed to repeat the mistakes of the past regardless of whether we know our history, because we either can't agree on what the mistakes of the past were, or because past conflicts represent unavoidable differences of opinion, certainty, and power. But getting a quick refresher on the history of a is valuable because it puts current debates in perspective.