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June 25th, 2008

Bezos on the Conversation

Of course I love this man. Duh. Like I would have done what I did for 2.5 years if I hadn't thought this man was worth following around; I don't put that kind of time and emotional energy into much of anything.

But this is great. What's the mission for the kindle? Improving long-form reading (as opposed to information snacking, which most recent technology has encouraged). What's not to love!

ETA: 15-year-old Tabitha (with a trace southern accent, maybe North Carolina) called in to ask when the Kindle would have textbooks on it. Tabitha had her numbers down: she knew what backpacks and her schools weighed and what the kids carrying them weighed. She knew what the MDs recommend for backpack/body weight ratio. She rattled those numbers off as quickly, articulately and professionally as anyone I've ever heard on the topic. Bezos response was non-committal but indicated he had already been thinking along similar lines. Yay! I didn't hear anyone bring up the Kindle-for-library for large print books, but I gotta believe the kindle team is thinking about this, too.

And I hope Tabitha has a long and productive career at whatever she chooses to pursue. Smart young woman.

Elizabeth Pisani, _The Wisdom of Whores_

Pisani is a really fascinating person, judging by this book. And given how much of her heart and soul flows through her writing, I figure this book is a reasonable way to assess Pisani.

First, she's a communicator. She says she loves to chat. In several languages. She was a reporter, before going back to grad school in epidemiology. And she's the author of every length of writing, for every imaginable audience. In several languages.

Second, she can deal with numbers and science. She can understand them. She can produce them. She can _spin_ them -- and she knows when she _is_ spinning them.

Third, she's a people person, which brings us back to the chatting, but also back to the spinning the numbers, trying to find ways to motivate people.

Ordinarily, you're lucky if you're good at _one_ of these things. The world is lucky when someone is good at two of them (or really, really unlucky, depending on one's perspective as to that person's agenda). To get all three in one package would have struck me -- prior to reading this book -- as flat out impossible. I cannot think of any other author that brings this particular package to the page.

So what is Pisani writing _about_ and what is her goal, in a book with this title? She latched onto AIDS as a recently graduated epidemiologist, as a consultant for the UN. Over time, she morphed into a field person -- going from writing cookbooks for how to do surveillance on the disease to actually mapping where the sex workers were, chatting them up, collecting bodily fluids, getting them off to be tested, massaging the resulting data into a model of what was happening with the disease, etc. That's what she's writing about, and all by itself, that's an incredibly fascinating story worth reading. Her own agenda changed over time, but overwhelmingly, it's apparent that Pisani wants to save lives, and she doesn't much care if that life is currently being lived just for another hit, and whether that's an educated life or whatever. She just wants to save lives, knowing full well we're all going to die eventually, but she especially wants to keep people from contracting a terminal illness when they're at a point in their life when they're doing really dangerous stuff. With the drugs, it's apparent that she's betting most of these people _are_ going to outgrow injecting drugs. With the sex workers, it's apparently she'd like to make sure that people who already have a pretty awful life don't suffer additionally -- and that they don't amplify a disease into the general population.

Secondarily -- and this is perhaps the best thing about Pisani, that this comes _second_ -- she wants to see all this money washing around through the system (and there _will_ be a later post comparing this book to Connelly's) to be spent wisely. Not necessarily the way it was promised to be spent, either. She wants that money to be spent where it will do real good, and comparative good. She's not interested in saving one life for a year if she could save a thousand lives for decades for the same amount of money, and this pretty much makes it impossible for her to be a career person at the UN or any similar place.

Great book. Hard to imagine how to oversell this book. I can imagine that there are people out there who will be offended by this book and the language within it (hey, you _did_ see that title, right?). I can imagine there are even more people out there who think "children" should be protected from the information in this book. I think you should work through that shock and sense of obscenity and read it anyway, if you are an adult. There probably is an age which is too young to read this book; I don't think I'd give it to someone who hadn't yet hit puberty, for example, but trying to protect a 15 or 16 year old from what's in here is doing not only them, but our society, a disservice. If more people encountered this level of thought, experience and analysis at a formative and suggestible age, there really is no problem we couldn't make huge progress on.
That's a couple books in a row now that I've read books about really big problems (Population Control, AIDS) and what People Have Done About Them. Pisani mentions (obliquely and not favorably, through references to Contraception Safaris) some of what Connelly covers, which makes sense because there was surely overlap between her years of reporting in Asia and what Suharto and etc. got up to in an effort to stop people from having (as many) children. By the time she returned as an epidemiologist and field worker, the Population Control stuff had morphed (the money had washed out of the system and gone elsewhere).

The books are, obviously, very different. Connelly is a historian/digger through archives. Pisani is a scientist/active participant. Connelly can look at the full arc. Pisani is right in the middle of it, altho she perceives the end and predicts what will come next (and I'm betting she's right, too -- global warming is where the crazy money will next wash through, attracting more oinkers at the trough). There are several differences. The Population Control movement was a late gasp of colonialism (including people who had actually been running the colonies until they got run off), obviously white, obviously male. The AIDS movement, from the beginning, was inclusive in a way that Population Control wasn't until after the money ebbed: racially, including people with AIDS, including sex workers, and I'm not sure how to say this, but not only was it not a single gender thing, it wasn't just a two gender thing, either.

Some of the inclusiveness is truly built into the bureaucracy from the top down, in a way that Pisani at times ridicules (since people are included repping countries that _have_ no AIDS, for example). And misguided exclusivity still needs to be ferreted out. This sort of surprised me when Pisani talked about writing surveillance cookbooks that treated "sex workers" as separate from "drug injectors". For that matter, treated "people who buy sex" as separate from "people who sell sex". I read _My Secret Life_ by Walter and enough about molly culture in England to know that if you've got a category, you've got people who are violating the category. And that's in a culture that's readily relatable to our own. Move ten thousand plus miles away and introduce a whole other history/social structure/religious environment? Forget it.

I've read a variety of similar things lately, as an aside. There was a NYT article about stream restoration that included several things that just went thud for me: removing the logs from a Pacific Northwest stream to improve flow?!? And then being surprised that you just wiped out fish habitat and have to restore it. Have you ever _seen_ water in the Pacific Northwest? Better still, "discovering" that streams near Lancaster, PA had a century or two worth of pond-sediment, as opposed to stream sediment. Duh. Look, it was Pennsylvania in the 18th and 19th centuries. Don't you _think_ it had to look like Western Europe from slightly earlier, i.e. every fucking waterway in sight has been channelized, with a dam, a pond, and a mill? Before the Europeans got to it, those "streams" were braided is-that-a-water-ways. And that's what's going to come back if you try to "restore" it. This is right up there with my neighbors here complaining that their streams are turning into swamps. Well, duh! This is New England. It would _all_ be either swamp (bog, whatever) or rock if left to itself. And then meadow and then forest. If you want something different, be prepared to kill a _lot_ of animals, and do a lot to make the water do something different.

To return to the topic at hand. Connelly and Pisani share a sort of appalled shock at how bureaucrats in "development" tend to get very focused on how "efficient" they are at spending the money coming in -- an efficiency defined NOT in terms related to actually addressing the problem at hand. And agencies which can spend money fast, get more money to spend than agencies who spend money slowly, without regard to, say, actually addressing the problem at hand. Also, preconceived ideas drive how the money can be spent and often those preconceived ideas are driven by politics very distant from the problem at hand and are remarkably impervious to attempts to change them (Bush and abstinence, IUDs and Population Control, etc.).

Connelly and Pisani also perceive that their particular subject was getting a disproportionate amount of money/resources -- there were a lot of places that desperately needed something different than more IUDs or ARVs or whatever. Connelly, it seemed to me, really bought the idea that more money should be going to "development" (women's rights and education, say) rather than supplying more contraception. Pisani's perspective is a little different, but related. She thinks you can do a lot quickly to slow or halt the spread of AIDS more cheaply than doing general "development" and betting on that stopping the spread of AIDS.

Obviously, Connelly's conclusion with population control leads directly to what Pisani was experiencing. The Population Control folks thought they could ignore (or sap!) development issues/funding in favor of contraception. They got hammered partly because they were distributing bad contraception inefficiently and inadequately and partly because (this is the bad part) they were creating huge medical problems (dead/dying/bleeding women and to a lesser degree men) because of the kind of contraception they were pushing (sterilization and IUDs, generally delivered by non-medical personnel with minimal training in an unsafe context -- Pisani's Contraception Safaris).

The AIDS, crowd, by contrast, isn't doing near the harm that the Population Control crowd was: passing out condoms, lube and clean needles are highly unlikely to do any harm and often help (until they run out). Pushing abstinence isn't going to help anyone particularly, but at least it doesn't (directly) create a tetanus epidemic (like at least one contraception safari -- and this was vasectomies). There's a level on which, after reading Connelly, I want to take Pisani and say, damn, girl, this is _so much better_ than a decade or so earlier! Even when she's complaining about the Chinese ignoring their AIDS problem until a weird blood collection program amplified a small number of cases I kept thinking, better that than the kind of intrusiveness that characterized the first decades of the One Child policy.

I have no hope that future Serious Issues will be addressed effectively and efficiently by bureaucracies (of any sort), whatever those issues might be. There's no indication whatsoever that net progress has been made between the two campaigns, at least, not from these two books. Pisani makes it clear that NGOs don't save any money, and often have little to no real impact; governments can accomplish a lot more, much more cheaply, if they have an effective action to take and can target it appropriately. But NGOs are often the source of the effective action -- they're good at figuring out what does and doesn't work, sort of like a prototyper (altho she doesn't use that term). Yet it does seem like there has been some inefficient but effective work done, which makes me wonder if all that money sloshing around (which Connelly and Pisani are both dismayed by) might be a necessary part of the lifecycle of Fixing a Problem. There's going to be some waste, maybe too much research, too little research, the wrong research, a solution that doesn't work at all, a solution that causes too many other problems, a solution that works but is targeted inappropriately, etc.

I wasn't looking to read about this kind of thing when I picked up these books. _Wisdom of Whores_ was a great title and I love me some great title. Also, she was clearly a nerd which is just hugely wonderful. Connelly was presenting a detailed, well-researched history of a movement I was curious not to have heard much from lately. It never dawned on me these two might be related.

I pulled _Mainstreaming Midwives_ off the shelf. One wonders if this, too, is somehow connected. Certainly, _The Ask_ is. ;-)

Reading List so Far: _The Wisdom of Whores_, by Elisabeth Pisani and _Fatal Mis-Conceptions_ by Matthew Connelly
Recently, I posted about what a good book about decision theory needs to explain. (Virtually) The entire list can be summed up under the heading: People Will Do the Easy Thing. They'll take in information passively, rather than seek it out. They'll do what people around them are doing, rather than something different. They'll operate from their personal point-of-view, rather than take on the perspectives of those around them. Etc.

A lot of Policy is driven by a thorough understanding of this principle. And I mean, thorough. Unfortunately, People Will Do the Easy Thing is discouraging in that it does not lead to the desired outcome. Here are some examples:

(1) Fitting a diaphragm requires skill for it to be effective. Using a diaphragm effectively requires effort and skill. People will do the easy thing. They won't use a diaphragm. Try something else. Condoms require less skill, but some effort, and there is a cost (time/resources to have them available, some cost in sensation, some transaction cost in getting partner to use them). People will do the easy thing, etc. Down this path lie IUDs. Unfortunately, turning the IUD into something that requires little skill increases the hazard. And it turns out they just aren't that effective over populations.

One of the problems with going the Easy route is that you might choose something dangerous (and blind yourself to the risks) or that doesn't get you what you want, because it is easy. Bureaucrats are people. They choose the Easy thing, too.

(2) It's hard to convince people who do not buy or sell sex and who do not inject drugs that it is worth spending money on people who do buy or sell sex and who do inject drugs. If they are in jail, it's even harder. It's a lot easier to convince people to spend money on "innocent"/"good" people. This is why you wind up down the spend-money-on-development path and/or focusing AIDS awareness on the not-sleeping-around spouses of the Wicked Injector/John. Unfortunately, while it is very easy for a scientist to make the argument that this is a stupid waste of money, the scientist, after a decade, will learn that people are better able to memorize the argument for/against focusing on the innocent *rather than actually doing the Right Thing*. Scientists are people. They do the easy thing, too, which is keep saying, hey, this works, that doesn't. Knock off what you are doing and do it this way instead.

One of the waria Pisani talks to says Men are Lazy. They won't go buy a condom and bring it with them to the waria when they are going to buy sex, because they are too Lazy. But if the waria is saying put this on after the man is all hot and bothered and ready to play, the man is too Lazy to argue. He'll wear it.

What Policy needs to do is identify the people who are motivated enough to _not_ be Lazy, who are willing to do something _other_than the Easy thing and/or whose calculation of what is Easy turns out to also be the right intervention. And then figure out a way to replicate that. That, however, is Not Easy. Pisani has brilliant examples of this, for example, making it the brothel-owners responsibility for the people in the brothel to use protection, and create a reasonable enforcement mechanism (e.g. clinics that treat STDs find out where the johns have been buying sex; test sex workers, etc. -- shut down brothels that are transmitting disease). Unfortunately, I don't think you can "cookbook" this kind of Policy -- it is all very situational.