Two cautionary tales about cholera, the plague, and politics

1665-mortality-100x168The plague hit London again in the hot summer of 1665. Panic struck and rumors abounded about its cause. The Lord Mayor of London was convinced of one theory: the plague was spread by cats and dogs. So he ordered all the city’s cats and dogs killed, and an estimated 40,000 dogs and 200,000 cats were exterminated.

The truth is that the plague’s germs were carried by fleas that lived on rats. Cats are a natural enemy of rats. Killing the cats enabled the rat population to explode, thus causing the plague to spread more easily.

The lesson: Faulty science combined with top-down political power can be deadly.

Cholera hit London regularly between 1831 and 1854, and in the summer of 1854 an especially terrible outbreak occurred. London was a fast-growing urban center and its infrastructure had not kept up with its growth. Human feces and urine were often stored in cesspools dug into the basements or open pits. One can only imagine the stench.

The leading explanation for cholera was the miasma theory: that it was airborne and contracted by inhaling noxious fumes. So London’s public health authorities ordered that the nasty cesspools be emptied and the sewage dumped into the Thames — the very river from which most Londoners got their drinking and washing water.

snow-1857-100x118The truth is that the cholera bacterium is almost always spread via impure drinking water. (One of my new heroes is John Snow.)

The lesson: Ditto.

Caveat: File these two under unintended consequences — but not to downplay the challenging issues about the proper relationship between evolving scientific knowledge, public health, and political power, I recommend them only as cautionary tales, in case there are any politicians in great haste to save the day by imposing policies based on the most recent hypothesis for our own good. I am sure they are a dying breed.

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7 Responses to Two cautionary tales about cholera, the plague, and politics

  1. Bob Marks says:

    Good examples. More recently, there is the banning of DDT spraying in the tropics to protect the environment. Deaths from malaria rose by several hundred thousands a year.

  2. Pace says:

    I think Unintended Consequences are important, but one of the places I do generally stray from pure libertarianism is Public Health. In a time of true emergency, infrastructure and procedures should be in place to contain any biological threat. The world is chaotic, but the better our information and technology, the more effective the result. Where negative externalities exist, there will usually be a role for government.

  3. Bob Marks says:

    I posted Dr. Hicks’ “Two Cautionary Tales” on a skeptics’ website and got the following response:

    “Of course, Thabo Mbeki certainly followed Hicks’ cautions and refused to accept the ‘current’ theory that AIDS is caused by HIV and can be held back by anti-retrovirals. Thank goodness, eh, otherwise South africe would not be the AIDS-free country it is today. http://en.wikipedia.org/wiki/HIV/AIDS_in_South_Africa

    Stupidity slices both ways and an example here or there is not an argument.”

  4. Thanks for passing on the interesting reply, Bob. I didn’t think my point was THAT easy to misinterpret. As if Mbeki was exercising careful scientific judgment and a measured use of political power.

  5. Pace raises an excellent, broader set of issues about how or whether libertarianism can handle public health matters.

    As a start, “public health” includes the following functions:

    1. Researching generalized health threats and benefits.

    2. Informing the general public about the state of knowledge about health threats and benefits (e.g., the risks from second-hand smoke).

    3. Encouraging the general public to utilize known health benefits (e.g., use protection against STDs).

    4. Providing access to the benefits (e.g., vaccines).

    5. Coordinating responses to general threats (e.g., swine flu, avian flu).

    6. Quarantining immediate threats (e.g., those with dangerous, highly communicable diseases).

    Some follow up questions for open discussion:

    Which of these can either a market or a government provide?
    Which can only a market or a government provide?
    Which should markets or governments provide?
    Which is a market or a government most likely to provide most efficiently?

    I don’t see why private research institutions, non-profit organizations (e.g., the Red Cross), and personal responsibility can’t handle the first five functions.

    As for the sixth, that does seem an arguably legitimate function of government from a libertarian perspective: any unquarantined diseased person is objectively a physical threat to others’ lives, and if he is not voluntarily isolating himself then forceful methods are appropriate.

    I haven’t thought any of the above through thoroughly, so take this as a discussion starter.

  6. Rafe says:

    Practically nobody is being paid to think through the alternatives to public provision but tens or hundreds of thousands of highly skilled and educated people are professionally committed to public provision of health and education and everything else. It is a shock for many people to discover that private “penny schools” delivered a higher level of literacy than the current public education system, until they were put out of business by “free” public schools.

    For a nice account of the explosion of costs in a system that is not subjected to market forces, check out the reprint of the 1955 classic statement of Parkinson’s Law (work expands to fit the time available).

    http://www.economist.com/daily/news/displaystory.cfm?story_id=14116121&fsrc=nwl

  7. Pace says:

    Your points for open debate are so broad and so many it is hard to know what to say.

    If we can agree that communicable disease is a form of negative externality, than yes Private Institutions and Personal Responsibility can play some role in reducing it, but if there is little to no consequence to transmitting an infection, then I can assure you it will in practice almost always persist without a universally available and affordable vaccine.

    If you want real results then you have to be willing to consider compulsion. Case in point, Cuba has the lowest incidence of HIV in the world. This was achieved by testing the entire population and permanently quarantining those who were infected (in quite comfortable conditions as I understand it). Nonetheless, imprisonment is an extreme form of compulsion.

    In the US by contrast we have a persistent reasonably low level of infection, with minorities disproportionately affected. Washington DC has something like 12% infection rate among African Americans. People are presumed to have special civil rights guaranteeing them rights to coexist in society whilst being infectious with complete privacy. It is considered illegal to infect another once having tested positive, but testing is not mandatory and most people dont want to know.

    Personal responsibility would in theory solve this problem with no one having sex until testing themselves and their partners for HIV, but in practice enough people choose to be ignorant and irresponsible.

    In Africa, HIV is so prevalent that in some parts 25% + of the population is infected. Do the civil rights of those with a deadly infection supersede the long term safety and health of an entire population? Would not segregating the infected from the non-infected save the whole society a great deal of needless suffering in the long run?

    HIV is just one example and obviously the issue applies more generally and in different ways depending on the infectiousness and virulence of a particular disease.

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