Sunday, October 09, 2005

AIDS in Developing Countries -- Let them die quietly

People have been giving Bill Bennett enormous grief over his hypothetical argument, posed as a logical construct merely to refute it, that the nation's crime rate could be reduced by aborting black babies. That he never for an instant endorsed the argument hasn't save him.

So it is only with the secure knowledge that not a millionth as many people will ever note this proposal that I suggest a policy that on the surface is as comparably racist, heartless, and many other adjectives. In the developing countries, people who develop AIDS should be given a place to die in as much peace as possible. Attempts to prolong their lives are a waste of resources.

Too many people think that health care in developing countries is somehow analogous to what happens in the United States. Not so. In the U.S., we attempt to save everybody who gets sick or is injured, no matter how pointless the attempt. We keep Teri Schiavo alive in a vegetative state for years. By comparison with much of what we do, treatment for HIV is almost rational, although an aggressive anti-smoking campaign with the same amount of money would probably save more lives. But I'm not trying to discuss American healthcare priorities.

In developing countries, it's much clearer. As long as there is no prospect of actually curing the infection, keeping an HIV-positive person alive will require a lifetime of medication. Meanwhile, millions of people are living in unhygienic conditions with no access to health care. Compared with the low tech solutions such as sanitation and simple medical procedures, the cost to save an HIV life is probably a thousand times as expensive. Until we've exhausted the low-hanging-fruit options, we should be ignoring HIV treatment.

That's not the same as HIV prevention. We should be shipping out billions of free condoms with instruction manuals attached, and paying no attention to the moralists who think we should restrict our approaches to abstinence. Actually, that would be a good idea in this country as well.

1 comment:

Joseph Hunkins said...

Most people, especially in politics, have a powerful aversion to facing the realities of how spending priorities affect lives and health.

I'd like to see an ROI analysis for all major health spending decisions. This is partly political reality and partly aversion to simple math.

This aversion to math lies at the heart of a large number of social ills where spending priorities are based on politics and not reason.

PS - I'm BET Bill Bennett $50 that his reputation is in jeopardy more for his hypothetical musing than for the glaring hypocrisy of a compulsive gambler lecturing on Christian virtue.