A lesson in how not to – 1/3

Source: ‘Preparedness for a High-Impact Respiratory Pathogen Pandemic’,  Johns Hopkins Center for Health Security,  September 2019 


NPI: Non-Pharmaceutical Interventions

(Extracts below are from this report which is 84-page long. I have gone through it).

(1) Box 8 (p.56) defines NPI: Travel Restrictions, Movement Restrictions, quarantine, Social Distancing  

(2) While the economic impact of pandemics, epidemics, and outbreaks depends, in part, on the severity of the health effects of these events, the actions that countries take in an attempt to control the spread of disease can also exacerbate its tolls. (p.16)

(3) Respiratory pathogens can be particularly difficult to contain. Their tendency to have short incubation periods and their potential for asymptomatic spread can mean very small windows are available for interrupting transmission. (p.18)

(4) Central involvement of the security sector, the possibility that countries may be less likely to share information during a deliberate event, and the potential for major societal fissures are just some of the elements that would complicate or interfere with current international response frameworks in ways that would make them less effective in addressing the response to a major deliberate event (p.31)

(5) In order to be as useful as possible, modeling capabilities should be implemented in advance of an emergency and closely integrated with the public health decision-making team to facilitate rapid analyses and decision-making cycles. Decision makers also must be informed in advance about the expected limitations of modeling approaches and how uncertainties about existing data may affect model predictions. (p.42)

[My comment: Experts committed one of the worst crimes in not giving politicians the full picture and they made their predictions sound so deterministic.]

From the Executive Summary (p. 13):

(6) WHO and other public health authorities should have the capacity to provide risk/benefit analysis to national governments, driven by scientific evidence where it exists, before NPIs are initiated in a crisis. [Emphasis mine]

(7) In some cases, implementation of some NPIs, such as travel restrictions and quarantine, might be pursued for social or political purposes by political leaders, rather than pursued because of public health evidence. WHO should rapidly and clearly articulate its opposition to inappropriate NPIs, especially when they threaten public health response activities. (p.73)

(8) It is important to communicate to political leaders the absence of evidence surrounding many NPI interventions and the adverse consequences that may follow them. (p.58)

(9) Quarantine efforts could be highly disruptive to societies and economies if they are implemented for prolonged periods.121 (p.58)

(10) Quarantine measures will be least effective for pathogens that are highly transmissible, have short incubation periods, and spread through true airborne mechanisms, as opposed to droplets. As with travel restrictions, quarantine appears to delay the introduction of highly transmissible diseases but not prevent their spread entirely. (p.57)

(11) In the context of a high-impact respiratory pathogen, quarantine may be the least likely NPI to be effective in controlling the spread due to high transmissibility. (p.57)

(12) For example, studies have found that travel restrictions would be less effective once a disease has spread to multiple geographic areas or been introduced to large cities. (p.57)

(13) In determining whether and how to implement NPIs, countries must assess each proposed measure on the following dimensions:

1. Epidemiologic assessment: Do available data or experience suggest a specific NPI will work to prevent or slow transmission in a meaningful way?

2. Logistical assessment: Is the particular NPI measure feasible given available resources?

3. Social, economic, and political assessment: What are the possible unintended adverse societal consequences of a particular NPI? (p.56)

What has been done by many countries are the antithesis of this report prepared in less noisy, less contentious and less politically charged times.

Why were its suggestions ignored at all?

Why did experts not do what the reports exhort them to do? Advise politicians of uncertainties and the limitations of their model?

Why did WHO not warn countries of the limited efficacy or unknown efficacy and the substantial other costs of the ‘Non-Pharmaceutical Interventions’? – quarantine, social distancing, travel restrictions and movement restrictions?

What were the reasons?

If it was only about defeating President Trump, then, may be, now is the time to relax the obsession with lockdowns and masks?

Was the virus more lethal than they let on?

Did they know more about it than they told us? Or, were there other considerations?

Is this part of a ‘Great Reset’? [Link]

Or, was it simply an astounding and unbelievable case of the Hanlon’s razor and is still being persisted with, into the winter months?

It seems appropriate to conclude with this quote from Carl Sagan:

“We’ve arranged a global civilization in which most crucial elements profoundly depend on science and technology. We have also arranged things so that almost no one understands science and technology. This is a prescription for disaster. We might get away with it for a while, but sooner or later this combustible mixture of ignorance and power is going to blow up in our faces.” [ht: Tim Price – see here]

by Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark.

The fine art of dentistry

“A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings.” [Link]

This is in Switzerland! nearly 30% of the sample have recommended unnecessary treatment!

An article worth reading, even if a bit worrisome. Good to be alert. With dentists, it looks like you cannot stop with a second opinion. You need a third and a fourth, no matter which part of the world you live in.

The complex case for rejecting AND using plastics and wearing cotton AND silk, leather and fur

A fascinating article on why the ban on plastics is not necessarily, if its overall impact on the environment is understood correctly, an unalloyed good thing as is being made out to be. An eye-opener just as the article on cotton vs. synthetic clothing was. The law of unintended consequences never ceases to fascinate me.

University of Sydney economist Rebecca Taylor started studying bag regulations because it seemed as though every time she moved for a new job — from Washington, D.C., to California to Australia — bag restrictions were implemented shortly after. “Yeah, these policies might be following me,” she jokes. Taylor recently published a study of bag regulations in California. It’s a classic tale of unintended consequences. …

….. People in the cities with the bans used fewer plastic bags, which led to about 40 million fewer pounds of plastic trash per year. But people …. still needed bags. …..This was particularly the case for small, 4-gallon bags, which saw a 120 percent increase in sales after bans went into effect. [Link]


…. Trash bags are thick and use more plastic than typical shopping bags. “So about 30 percent of the plastic that was eliminated by the ban comes back in the form of thicker garbage bags,” Taylor says. On top of that, cities that banned plastic bags saw a surge in the use of paper bags, which she estimates resulted in about 80 million pounds of extra paper trash per year……

….. A bunch of studies find that paper bags are actually worse for the environment. They require cutting down and processing trees, which involves lots of water, toxic chemicals, fuel and heavy machinery. While paper is biodegradable and avoids some of the problems of plastic, ….. …. the huge increase of paper, together with the uptick in plastic trash bags, means banning plastic shopping bags increases greenhouse gas emissions. That said, these bans do reduce nonbiodegradable litter. [Link]

You can read the rest in the original itself. But, you have got more than a gist of it.

Now, let us turn to cotton vs. fur and leather. There was this great article in Quartz in February 2019. I thought I had blogged on it but I had not. The author of the article, Ephrat Livni begins the piece well:

Being “good” isn’t as easy as it might first seem. In theory, it’s as simple as minimizing the harm you cause. This is the line of thinking that often prompts people to make decisions like giving up meat, or, in the case of clothing, refusing to wear any materials made from animals—specifically leather, fur, silk, pearls, wool, and feathers.

But in reality, we live in a big, complex, connected world, and the consequences for our actions and decisions aren’t always easy to assess. Sadly, the possible ways that we can cause harm are seemingly infinite, and the chances of our doing so practically inescapable. And sometimes what seems like the simplest or most correct approach, when examined closely, is actually just another tricky thicket of moral quandaries. [Link]

Look at how ethically difficult it gets to choose to wear cotton and synthetics than silk:

In 2010, the majority of textiles produced in the world, 85%, were woven from cotton and polyester. Neither of these fabrics uses any animals—one is natural, and the other synthetic. “Both are responsible for widespread pollution of waterways, soils, and air,” Kwasny writes. “Both consume enormous amounts of resources.” ….

…. Cotton, for example, is the world’s most profitable nonfood crop, and 11% of pesticides used worldwide are sprayed on these plants. …. nearly all the water in Pakistan’s Indus River—97% of it—is devoted to growing cotton. It takes about 5,300 gallons of water to make a cotton t-shirt and a pair of jeans, …. Every time we wash a polyester item, we’re releasing plastics into the world’s waterways and ultimately leading to the death of flora and fauna.  …..

………. to spin enough silk for a kimono requires thousands of silkworms, and that sericulturalists kill these worms once they’ve spun a cocoon around themselves. But the work of farming silk involves a deep interaction with the natural world. …….. Nothing went to waste, and throughout the silk-creation process, farmers and artisans acknowledged that their lives were intertwined with those of the worms.

Similarly, when Kwasny visits a mink fur farm in Denmark, she remarks on the astounding care the creatures receive. ….. she notes that the mink farmers are much closer to nature than most people. They know their minks and check in on them from morning until night, feeding them, cleaning up their spaces, ensuring that the animals are healthy and getting along. During mating season, the humans look in on the minks every 20 minutes to make sure males and females are happy. They raise the puppies whose mothers die in childbirth and they get to know them. And the farmers themselves don’t gloss over the darker parts of their profession; they admit that each creature they raise has an individual character, that sometimes they grow attached to the animals, and that the nature of their work is bloody. [Link]

What are the lessons?

(1) At a policymaking level, one has to be patient and consider ALL evidence, all costs and benefits and exercise judgement even as one is acutely aware of how little one knows and might have missed out a lot. That would definitely make for better policy with appropriate and essential mitigation for the costs. Then, be humble about the policy choice taken and that also gives us the mindset to be open to new evidence and change course, without associating it with losing face.

(2) At the individual level, Melissa Kwasny, the author of the work, ‘Putting on the dog: the animal origins of what we wear’ has many lessons:

(a) In order to have a reciprocal relationship with the world, then, we have to be aware that it’s impossible to be ethically pure. It’s pleasant to think of oneself as a kind and gentle person, but it’s better to be brutally honest and understand that the best any of us can do is be “goodish.”

(b) Instead, it’s better to accommodate complexity and reject blanket answers that are convenient but untrue, and avoid insisting upon a foolish consistency, which as Ralph Waldo Emerson famously said, is the “hobgoblin of little minds.” Emphasis are mine.

In other words, the absolutism of the ‘do gooders’ is a bigger threat than we realise.

(c) This is the gem:

In a reciprocal relationship, you take only what you need, rather than as much as possible. …. Reciprocity begins with awareness. It is guided by respect and restraint. It always involves an expression of gratefulness.

Taking according to one’s need IS NOT the same as giving according to need. That is central planning and communism combined. This is individual, voluntary restraint.

Distilling it further:

  • Awareness (of the limitations of our knowledge and) of complexity and avoidance of absolutism – i.e., awareness that one can only be ‘goodish’ and not GOOD
  • Restraint (taking for need instead of pandering to greed) AND
  • Respect for nature borne out of recognition of interdependence

The techypocrisy

The wheel has come back a full circle or is on its way – or so it seems. See two recent NYT articles here and here. The digital gap is not what you thought or think it is and that technology deprivation is no deprivation but a blessing!

Of course, I am not sure extreme answers are the right ones or that they would be effective with all children. To each children, each parent. In fact, I am wary of fundamentalist or extreme views with respect to technology – utopia vs. dystopia. But, evidence points to a compelling case that modern technology is shaping a dystopian world.

But, what psychologists working for tech. companies do and how tech. company executives themselves have discouraged their own children from taking up ‘screen’ habits are extremely illuminating and insightful. Of course, without mincing words or sentiment, they are most troubling and leave us fulminating, angry and helpless, all at the same time.

[On a related and unrelated note, read this piece about the forked tongues of tech. leaders.]

The march of progress be damned and perhaps, named something more appropriately for what it is.

These developments are consistent with ‘More is preferred to less’ axiom of neo-classical economics. That is why we have frequent updates to hardware, software and also so many clickbaits with man apps.

I would also recommend the 4-part (each approximately one hour) documentary on ‘The Century of the Self’. I have watched two parts. Very, very insightful.

https://topdocumentaryfilms.co m/the-century-of-the-self/ (This is the link to the complete 4-hour video)

Those who teach consumer marketing should find it useful as to how it all began. You may draw your own conclusions as to the morality (or, lack thereof) of it all. On my part, I am clear. Consumer marketing – for most products (fast foods, soda, entertainment electronics, to name just a few) – sails close to the wind on ethics and morality or beyond it.

Food Inc. and ethics in business

Morgan Housel’s twitter handle took me to a NYT article on a Mexico village that is drowning in coke because they have no water! From there, I read articles about Colombia’s fight against the soda industry , Chile’s fight against obesity, etc.

The article on Malaysia where nutritionists take money from food giants opens up interesting questions on ethics vs. prgmatism.

All the articles are brilliant fodder for B-Schools, for students of pubic policy and for the food industry practitioners.

Many questions arise in my head:

Precisely, who are the food industry leaders trying to benefit? The managers themselves? The shareholders? Who are these shareholders? Mutual Funds? Asset Management Companies? Pension Funds or managers themselves again, as shareholders?

Don’t they have children and grandchildren and do they feed them soda, burgers and sugar, regularly?

How would they like to be remembered by posterity?

What should a laissez faire government do?

Should it let the food industry do what it does while it runs educational campaigns against sugar, soda and fat? Is that feasible? Will the government do it? Are governments somehow insulated from capture, coercion and co-dependencies with the industry? In some of the cases above, even educational campaigns have been muzzled, campaigners threatened or the campaign diluted.

Do these staid campaigns run by government departments stand a chance against cartoons, animations that lure children to consume unhealthy foods?

In the world where information is available at the touch of a few key strokes or punching of buttons in the phone, can parents not do a better job of informing themselve and their children? Or, am I underestimating the seduction of ‘sins’ in these times?

What is the moral equivalent of tempting children to consumer sugar, fat and soda and luring them to smoke? I am watching the 4-hour ‘Century of the Self’ documentary that aired on BBC. I have watched two episodes. Ed Barnays, the nephew of Sigmund Freud, came up with the tactic to get women to smoke, calling it the ‘torch of freedom’! More on that later and in a separate post.

These issues and conflicts open up dilemmas for management education and educators. Multinationals and big domestic companies fund these institutions. Students there learn business ethics. They go and work for these companies too. Look how fiendishly complex all these become?

Is it possible at all for someone to reform these institutions from inside and is there a win-win solution that exists? If it does, is it grasp-able within a horizon that is relevant, meaningful and profitable for management and managers to personally gain from it? Otherwise, they have no incentive to pursue them.

Even activists who come to office promising to reform such practices and make society more humane immediately realise the gravity of the challenges and their internal contradictions. They depend on these companies for employment generation – direct and ancillary. How does one arrive at a meaningful costs and benefits? Costs are immediate – when these businesses threaten to and do close down  but benefits in terms of better health for children and citizens are more diffuse and long-term and hard to measure.

Even in Chile, where the battle appears to have been won, notice the possiblity of a reversal after the elections. Where and when does one declare victory? Or is it ephemeral? Or, are these initiatives doomed to failure and that martyrdom is the only glory? Am I being too pessimistic? Or, that some children and some parents will have irrversibly lerant their lessons for the better and they will carry on the torch and that the message will slowly diffuse? May be, it will.

Amidst all this, is the nutritionist in Malaysia, the most pragmtic where idealism might not produce results but will produce news-stories and secure martyrdom but not much else beyond that?

For his part, Dr. Tee said the obesity risk in Malaysia would be worse without companies’ help, and he couldn’t accomplish his goals without their support.

“There are some people who say that we should not accept money for projects, for research studies. I’m aware of that,” Dr. Tee said. “I have two choices: Either I don’t do anything or I work with companies.” [Link]