Malaria has no Ideology

A hot topic of discussion which I have seen mention of on a large number of blogs is the question of mosquito control for the purpose of reducing the impact of malaria. This is an excellent subject to look at the irrelevance of ideology to problem solving. Questions I have seen addressed are 1) should DDT be used 2) should treated nets be used and 3) should the nets be distributed freely or for cost.

There is a lot of room here for a preexisting ideology to dominate the conversation. If you are pro-technology you leap in with the suggestion to use DDT, if you are anti-technology you leap in with the suggestion to use the nets. If you are free-market capitalist you say we should charge for the nets, and if you are liberal you say we should distribute the nets for free, because cost shouldn’t be a dis-incentive for health care.

Now — the environmentalists are SURE that DDT is a bad idea, and the free marketeers are SURE that charging for the nets would increase their adoption — but what I think is interesting is that for all the discussion I have seen among all these people that are so sure about everything (and I have read a lot of it) I haven’t seen any references to data.

ALL of the argument is focused on different parties reciting their own preconceptions.

Some people further impugn the motives of people with differing preconceptions, or provide defenses for the purity of their own preconceptions (I used to be an environmentalist, and then I grew up. etc.)

In all of this discussion, what is lost sight of is the point — which is the reduction of mosquito born illness. What SHOULD happen is this — we all agree that the bottom line is to reduce mosquito born illness, and then we lay out the various strategies to do that. We then look at the areas where there is incomplete knowledge (Does charging for the nets lead to higher adoption rates? Can DDT be applied without widespread negative consequences?)

These are EMPIRICAL questions — they have answers that can be gotten to through trying different things, and not by the application of over-general economic theories, or technophile or environmentalist agendas which border on religious faith.

What needs to be done, and it needs to be done with regard to every question of public health and governance, is to define the problem, discuss the various solutions, select the two or three top contenders and then apply them in controlled situations, gather data, discuss the options, pick the new top 3 or 4 strategies and do it again.

We obviously have to start where we are, but we have the option to stay open that we MIGHT BE WRONG in our initial assumptions, and to gather and consider data that will help us determine if that is in fact the case.

Ideology of any ilk does not help with this process. Ideology has no place in this discussion, unless it is the form of a hypothesis – and once it starts moving in the direction of being a hypothesis it becomes subject to the rule-sets which we have discovered are useful for constructing hypotheses. It needs to be clearly stated in operational terms, with outcomes predicted based on knowable metrics.

People often say that questions of starvation and disease are too important for a lot of lallygagging about trying to find the right answer, we need to act and we need to act now.

Emotionally this is satisfying, but it is not the path to the best outcome.

Careful action following from careful reasoning is always the path to the best outcome.

BBC on DDT and Malaria

BBC on treated nets

Washington Post on DDT

Thomas Barnett on charging a token price to increase technology adoption

Washington Post article on net distribution

As a positive example of what I am talking about, from the Washington Post article:
“Among a monitored group of 3,500 children in four of those districts, the number sleeping under the nets increased nearly tenfold from 2004 to 2006, WHO said, citing Kenyan government figures. The result was 44 percent fewer deaths than among children not sleeping under nets.”