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June 23rd, 2008

_Fatal Misconception_, Matthew Connelly

Subtitle: The Struggle to Control World Population

I picked this up at Toadstool. If I'd seen the online reviews, it's hard to say for sure I would have bought it. I had sort of been wondering why population control rhetoric had not returned with the massive climate change push by environmentalists. The last book I had on the topic was _Critical Masses_, which I enjoyed, but found somewhat flawed when I first read it about a decade ago, and find even more deeply flawed now (and that was _before_ reading this one!). I should take that back; there was another, highly technical book about demography that I found very difficult to wade through, but it had much less an emphasis on population control methods, IIRC.

Connelly's book is really about the population control _movement_, starting with eugenics near the beginning of the 20th century, really hitting its stride in the 3rd quarter of the century with massive panic about resources (food, commodities, fuel, etc. -- sound familiiar? This is kind of why I was expecting the return of this rhetoric), and getting hammered during Reagan's second term by the pro-life crowd latching onto China's One Child Policy as like the best anti-PR ever. Which it was.

The man dug. He went through archives. This is Really and Truly History: someone talking to the players, reading their letters and papers, wading through conference proceedings, you name it. It would be pretty easy for a doctrinaire pro-choice/person-worried-about-population-effects-on-the-environment to read Connelly through a lens that says, dude, you are attacking My People and I am Blind to Their Faults and You Must Be Crypto-Pro-Life, like intelligent design is code for creationism. It would be less easy, but still possible, for a doctrinaire pro-lifer to say, aha! Finally, someone willing to tell The Truth! All this pro-choice stuff is just rhetoric to cover an agenda to commit genocide against poor/brown/southern/whatever people. It is, as a result, a difficult book to read. It's not easy to trust the guy. Is he twisting the evidence, or really presenting fairly What Really Happened?

If you don't read the conclusion, in fact, his _actual_ agenda would remain pretty murky. But in the conclusion, it is quite clear that he welcomed the sea change that happened to the population control movement. Getting the US money that was sloshing around gone. Getting the patriarchal bureaucrats who were sexually harassing women (in the US and overseas) gone. Ending coercive programs, whether "incentives" or literally forcing sterilization/abortion/etc. on those who did not want. He _particularly_ welcomes the dramatic increase in representation and control by women of the new movement for reproductive rights.

He is also a passionate historian: if you don't know what happened, you're going to be fighting a lot of pointless, wasteful, losing battles, and fail to learn crucial lessons. If you are too focused on what might be to the exclusion of learning from the past, the range of evil you might engage in is breathtaking. And if you try to run other people's lives for them without listening to them and answering to them, you are going to fuck up. Badly.

He's even sympathetic to the compromises made by minority participants in the population control movement -- he recognizes they were doing the best they could with what they had available at the time.

What's not to love? Compassionate. Intelligent. Informed. Pretty much what you want from an author on any topic, but especially one this hot.

AT 384 pages of dense text, think a little while before committing to reading this. It would be sad if you started it and didn't finish it. It really works best as a whole.

And I say that as an inveterate sampler and reader of last chapters before reading the rest of the book -- so this is a tradeoff I'm accustomed to judging.

book selection heuristics

I have a lot of them. Many of them have been heavily mocked over the years, but honestly, they're really good.

And I have a new one: don't read books about how People Make Bad Decisions: Here's How They Do It, Why They Should Stop, and What They Should Do Instead.

I mean, it's a _great_ topic. Unfortunately, it seems to bring out the worst in people.

p. 19 in _Worst-Case Scenarios_ by Cass Sunstein:

"Many people refuse to go to doctors and ignore incipient medical problems because they fear the worst-case scenario. Indeed, an active debate about how often people should be tested for cancer has been fueled by evidence that such testing produces real anxiety, which itself can lead to health problems. 3"

When you scramble wildly to look at 3, because, like me, you've read Welch's excellent book, _Should I Be Tested for Cancer?_ and recognize that this description is, at the very least, wildly misleading, and you really want to know where the heck Sunstein got this bizarre idea, you find ... Welch's excellent book cited with no additional notes.

???!!!???

There's actually an interpretation here that makes Sunstein Not Wrong: ambiguous test results cause anxiety on the part of health care professionals who then press their customers to undergo more, invasive testing. Further, many tests predict with poor accuracy a bad outcome which is unlikely to really do a person in before they die of some other cause (for example, PSA tests and prostate cancer) leading to treatment with an enormously high probability of some other bad outcome (incontinence, impotence).

Is that what _you_ think of when you read Sunstein's sentence above? A doctor -- an entire medical community -- experiencing anxiety relieved only by invasive and dangerous treatments, as a result of a test?

And honestly, that's not even a worst-case scenario.

IUDs

Probably everyone's heard of the Dalkon Shield, its recall, the lawsuits that ended the company that created it, blah, blah, blah.

Probably most readers know about IUDs since the Dalkon Shield, which continue to be a contraceptive option around the world, including in the United States. For a wide variety of reasons (breastfeeding and hormonal birth control immediately after having a baby are not particularly compatible; people tend to be inconsistent with condoms, at least in part because they don't like them; people _really_ don't like diaphragms, etc.), IUDs have been recommended to and used by several women friends/relatives of mine.

Uniformly, they volunteered that this wasn't like the Bad IUDs of the past, that it didn't have the complications/risks, etc. And here are the outcomes I've encountered in a very small (count 'em on one hand) number of women I know who've used an IUD in the last decade:

(1) Disappeared. This was discovered when she was going to "start" trying to get pregnant a second time.
(2) Persistent bleeding that continued for a year. Complained after a few months; health care provider convinced her to try just a little bit longer.
(3) Failed, that is, got pregnant. Arguably, this could be lumped in with (1), because the IUD was never found.

I don't know anyone who developed an infection/PID.

But ya gotta admit -- that's a bad set of outcomes for such a small number of users. But I have taken a statistics class and, honestly, I'm apparently still really naive and optimistic; I chalked this up to what can happen when you have a small data set.

Prior to the Dalkon Shield, a massive variety of designs of IUD were tried around the world over a period of years. And guess what? 40% failure rates were absolutely typical (either pain or bleeding leading to the woman insisting it be removed and/or spontaneous ejection/disappearance of the IUD) within the first two years. Infection/PID/uterine puncture are much, much rarer.

But don't you think that 40% would have been worth mentioning to the women who are having one inserted _now_? Given the design variations tried, it's hard to imagine that a new version is going to behave that differently. And my small sample size indicates that past trend is playing out in the here and now. So why are health care providers telling my friends/relatives that Things Have Changed and This Version is Better?

As a little further commentary on the whole IUD thing, Connelly describes how many of these were inserted in various years in India and China and around the world. He also describes how the Population Control/"Family Planning" crowd of those years was willing to take money away from public health/operate in advance of the ability of the local medical industry. The justification was that pregnancy and childbirth was a larger threat to the health of women than the "small" risk associated with IUDs, sterilization, etc. Let's sit with that idea, and contemplate, literally, MILLIONS of IUD insertions in some years in one of those two countries. Which implies tens of thousands of cases of PID, uterine rupture, bleeding, etc. On top of this, the devices used to insert the IUDs had to be sterilized between each use (this didn't happen even with sterilizations on men, and there were tetanus epidemics that resulted from mass vasectomies -- that's gonna really encourage the local populace to sign up the next time the "family planners" are in town, hunh?) because it was considered to expensive to ship single use, pre-sterilized kits. Anyone who has read about the transmission of Ebola and similar recognizes this is how hospitals wind up amplifying/creating epidemics of diseases that are otherwise very difficult to transmit.

No medical professionals were involved in implementing these insertions, in many cases (just like what would happen with Depo, years later), policy was _not_ to take medical history because it would just slow the process down. Etc. All in the name of, the bad cases are going to be rare, the outcome is Really Important and We Know Better Than You Do.

Don't even get me started on the connection between X-raying women's pelvises to determine a baby's position when she was in labor, and how when they finally stopped doing that the childhood leukemia rate took a dive off a cliff.
I bought this, IIRC, at University Bookstore in Seattle while I was visiting in May. As I have noted in earlier posts, I'm increasingly disillusioned with books on this kind of subject (why people make bad decisions, essentially). I read books on this kind of subject for two reasons. (1) People mystify me. I mean, seriously. And I'm always hoping that this kind of book might explain what other people are thinking. They do not do a good job. Either I'm not getting the explanation (possible) or they're just flat out wrong. (2) I make mistakes in my reasoning, and am interested in alternative approaches for possible (modified) adoption.

I was pretty disturbed by what can, at best, be considered a severely misleading citation of a book I have a _lot_ of respect for (Welch's _Should I Be Tested for Cancer?_) on page 19. However, between the recommendation by Bazerman (I enjoyed his _Predictable Surprises_) and the concluding pages endorsement of the idea of intergenererational neutrality (basically, you can discount future dollars, but you can't discount future lives), I was prepared to cut Sunstein a lot of slack. As of page 135 he has exhausted all of it.

Let me count the ways:

(1) Misrepresentation of the Precautionary Principle. And when I say misrepresentation, it's so breathtaking it's difficult to convey in a short sentence or two, but read on.

(2) Conflation of the Precautionary Principle (which is, basically, if you're doing something, and there is consensus that that thing might have some really bad effects, you are supposed to mitigate those effects and waiting for absolute scientific agreement/proof is no excuse for not taking those measures now) with what Sunstein describes as Cheney's One Percent Principle (which is, basically, if there's a one percent chance that something-to-do-with-terrorism, we have to treat that as a hundred percent chance of something-to-do-with-terrorism). Really not the same. See (1) for breathtaking.

(3) Treating sins of commission (say, polluting) as interchangeable with sins of omission (say, failing to allow the marketing of a new drug that might save lives) and categorizing everyone who separates these two as engaging in a basic fallacy.

(4) Acting like DDT is the only effective way to deal with malaria (because, after all, eliminating open water and supplying bed nets to the sick, pregnant, nursing, infant, aged, can't _possibly_ reduce virulence).

(5) Identifying 1970s fears of mercury in tuna as one of a series of "widely publicized 'hazards'" that turned out not to pose a serious threat to public health.

(6) His treatment of California, the West Coast in general, the mayors' in general, etc. and their efforts to reduce their production of greenhouse gases. As far as he is concerned, this costs them money and has no meaningful impact. And apparently does not counter his assertion that Americans don't much care about greenhouse gases/global warming/climate change. Oh, and they must be making some dumb calculations. He does list some additional alternative explanations, but at no point does it occur to him that California adapting in a timely fashion might serve California well in terms of being able to supply experts and technology to the rest of the world when crash programs are implemented later.

There's a level at which I feel guilty for buying this. It violates several heuristics (all male names on the reviews, author is from U Chic, that conflation of the one percent principle with the precautionary principle first appears in the introduction). I _am_ guilty for buying this. I figured since he didn't seem to be a bad guy, it would turn out okay. I was wrong. He's an apologist for some seriously bad people, whether he recognizes that they're bad people or not. And he's reactionary, whether he realizes it or not.

Learn from my mistake: don't waste your time on this one.

ETA: Want a quick summary? Sunstein is a tool.
(1) A given society is made up of age-cohorts which will tend to think and act a lot like each other, with some identifiable subgroups. A given age-cohort will _not_ behave like the cohort ahead of or behind it, with some identifiable trends across multiple age-cohorts.

Ex. Depending on what decade you were born in, your base attitude towards credit and savings will fall within certain parameters.

(2) People have a lot of difficulty learning something that does not fit into their pre-existing set of
ideas about how things work. They first resist perceiving it, then resist believing it, and ultimately drag their heels about acting on it.

Ex. Free marketers are constantly surprised that regulations (a) do anything (b) useful. Pro-regulatory types tend to be surprised when regulations have net negative effects.

(3) People would rather believe it's someone else's fault, and therefore someone else's responsibility to make a change/pay damages/etc.

Ex. Pretty easy to go after smokestacks. Pretty hard to go after SUVs. Virtually impossible to return to walking everywhere/subsistence farming.

(4) The detailed, nitty-gritty circumstances of a life predict most (but not all) of a person's opinions in contentious debate.

Ex. If you live on the first floor, the falling leaves are a PITA to sweep. If you live on the second floor, the leaves are pretty, no work, and stop people looking in your windows. You don't have a view, so you don't lose anything. If you live on the third or fourth floor, the leaves interfere with your view, and you want those fuckers cut down or at least massively trimmed _now_. If you live across the street, you don't have to sweep the leaves, you like that the trees contribute to the aesthetics of your neighborhood, and you're very resistant to cutting the trees down and possibly replacing them. If you're the city arborist, you want to have nothing to do with this dispute. If you're on the board, you're tempted to put copper nails in the trunks to kill them without blame attaching to you specifically, because you're tired of hearing your neighbors argue. BUT any given person in the building might take any given view, independent of which floor they are on, especially if you're flat out opposed to killing trees under any circumstances, or really upset about what the roots are doing to the sidewalk in terms of increased trip hazard.

(5) What information people have available defines the possible conclusions they can come to. People can seek out information if it occurs to them to do so. They can interpolate from what they know, if they are inclined to do so (know how and make a habit of doing so). They can take in information which is presented to them. A large group of people with a lot on their collective minds are the natural prey of people who control the information passively presented to the group. Similarly, a large group of people with a lot of time on their hands are really, really, really hard to lead down the garden path. The passage of time can go either way.

Ex. La Leche League's creation and successful reintroduction of breastfeeding in mainstream US society.

(6) The treatment a person experienced early in life tends to set their expectations as to how people can be/are/should be treated. They can choose to counter this effect on their speech and actions, but that early treatment will color their feelings and thoughts, and an unexpected situation may trigger that past programming.

Ex. Going home for Thanksgiving dinner.

(7) The relatively recent past seems like the Dark Ages. Anything more distant than that is inconceivable.

Ex. No one can seriously discuss/plan reducing our fossil fuel consumption to 1970s levels.

There's so much more. But these are the one's I'd like to see covered.