Tag: Book-Blogging

Book-Blogging – A Problem From Hell, by Samantha Power

A_Problem_from_Hell_(book_cover)Samantha Power’s masterful book, A Problem from Hell: America and the Age of Genocide, will make you want to do one of two things: drop everything and go work with her from the inside, to embolden our institutions and ennoble our leaders; or rage from the outside about the myriad failures of conscience and the fostering of cowardice that have consistently stymied the better angels of America’s nature.* It’s hard to see much middle ground.

In this thoroughly researched and thoughtful book, Power provides a remarkable history of modern-day genocide. She brings the reader to the death marches of Armenians in the gloaming of the Ottoman Empire to the wanton destruction of male Muslims in Bosnia and Kosovo, all the while cataloging the all-too-familiar costs of all-too-familiar inaction on the part of world leaders – saving her sharpest critiques for her adopted homeland, America. This is a book that could profoundly change the way you view the international system, and those at the top of it.

From the mid-17th century, when the Peace of Westphalia ended the Thirty Years’ War to the mid-20th century, nations were assumed sovereign over their land and their citizens (summed up best in Millennial-speak as “you do you”). Certainly, there were land wars and civil wars, insurrection and imperialism, but nations didn’t question how other nations treated their people.

And then in the early 1900s, the Ottoman Empire began massacring its minority Christian Armenian population. This is important for two reasons: it stoked the passions of an American ambassador, Henry Morgenthau, and caused him to speak out against a sovereign nation’s actions towards its people; and it inspired Raphael Lemkin to change the world.

Generally, the Great Man of History theory – the cum hoc ergo propter hoc fallacy that assumes, for example, that everything good or bad that happens during Barack Obama’s presidency is his doing – is just that: a fallacy. But Raphael Lemkin, a passionate Polish lawyer who eschewed decorum and tact in his zeal to codify genocide (his word) as a crime against humanity, was a Great Man of History. He is one of the the but fors of this story; but for Lemkin, it’s hard to see how the United Nations would ever have adopted the Genocide Convention, in December, 1948 or thereafter.**

The other but for of this story is darker and more deeply depressing: but for America’s reticence to enter the fray diplomatically or militarily, again and again, untold lives could have been saved. Power uses the taxonomy of inaction outlined by Albert Hirschman to underline the stated reasoning against action:

“Economist Albert Hirschman observed that those who do not want to act cite the futility, perversity, and jeopardy of proposed measures.”

Each category is pretty self-explanatory. Futility is the sense that nothing could help; perversity that an action could make things worse; and jeopardy a sense that American lives/interests would be harmed by action.

Power is at her best when presenting her unflinching criticism of the cowardice exemplified by America’s leaders each time they invoked the futility, perversity, and jeopardy of action. Facing genocide, or even the prospect of genocide, leaders cowed to interest groups and genocidal leaders, rather than stand up for the ideals they continually cited – nothing more or less than vague platitudes:

U.S. officials spin themselves (as well as the American public) about the nature of the violence in question and the likely impact of an American intervention. They render the bloodshed two-sided and inevitable, not genocidal. They insist that any proposed U.S. response will be futile. Indeed, it may even do more harm than good, bringing perverse consequences to the victims and jeopardizing other precious American moral or strategic interests. They brand as “emotional” those U.S. officials who urge intervention and who make moral arguments in a system that speaks principally in the cold language of interests. They avoid use of the word “genocide.” Thus, they can in good conscience favor stopping genocide in the abstract, while simultaneously opposing American involvement in the moment.

This book won the Pulitzer Prize in 2003, and for good reason; it is thoughtful, unsparing, and scathing. Reading it and thinking about it helped clarify the way I think about America’s role in the world. From the perspectives of morality and pragmatism, we have an obligation to be better; anything less than our best – the officially sanctioned torture in Abu Gharib, the deaths of innocents in misguided drone strikes, the idiocy of using a public health campaign as a front for espionage – invites bad actors to use those same methods. And inaction in the face of injustice and terror is nothing if not a green light for its continuance.

Power, now the United States Ambassador to the United Nations, has walked back some of her more forceful critiques of American action and inaction of the past, saying at her confirmation hearing that “Serving in the executive branch is very different than sounding off from an academic perch.” Activists worry that she has lost her zeal.

This strikes me as unlikely. While it is certainly true that she speaks more carefully now than she wrote before, it seems obvious that she is brilliant, passionate, and willing to do what it takes to effect the change she earnestly argues for in A Problem From Hell and elsewhere – even if that means softening her speech while sharpening her knives.

After reading this book, I’d drop what I’m doing in a heartbreak to work with her from the inside, which should be all that you need to know to go pick it up.


*Full disclosure: while I am temperamentally much more comfortable in the latter group – of realists and cynics, agitators and disruptors – in this case I think it’d be really dumb to do anything but side with Power.

**Lemkin is also a good reminder that Great Men of History aren’t always viewed that way during their lifetime: “Lemkin had coined the word ‘genocide.’ He had helped draft a treaty designed to outlaw it. And he had seen the law rejected by the world’s most powerful nation. Seven people attended Lemkin’s funeral.”

Book-Blogging – Scarcity, by Sendhil Mullainathan and Eldar Shafir

Scarcity coverAs I’m writing this, it’s the middle of the holiday season, which means that you’re probably a little dumber right now. A bit more scatterbrained. Likely reaching for that extra holiday cookie or for one more egg nog than you really need.

Upon reflection, you’d probably admit that this is at least partly because you have a lot on your mind; more last-minute gifts to wrap than time; and, after purchasing a plane ticket home, buying gifts, and (over-)indulging with friends, a much thinner wallet. You’re stressed out.

In the parlance of Sendhil Mullainathan and Eldar Shafir, you’re experiencing “scarcity” – you’re “bandwidth-taxed.” In their excellent read, Scarcity, the authors seamlessly weave real-world examples with clarifying experiments to show just how pernicious scarcity can be. I highly recommend picking up the book; it will change the way you look at your finances and your time. And hopefully it will change the way you think about how poorly-aligned our society’s understanding of individuals in poverty is; how a reimagining of anti-poverty policy could make everyone – but especially the poor – better off.

As Mullainathan and Shafir point out, scarcity isn’t all bad; as anyone who has written a last-minute paper or crammed for a test knows, a time constraint provides a useful “focus dividend” – it gets you to get stuff done[1].

But the costs of scarcity often outweigh its benefits. A packed schedule or a bank account near zero (or below) cause tunneling: focusing on the most pressing issue, often at the cost of the long term. You take out a payday loan to pay the late bill, even if it leads to usurious interest rates you’ll have an even harder time paying off next month; all your meetings start 10 minutes late, and none of them are all that productive; you choke on that first date you really wanted to go well.

It’s not just your free time or wallet that are depleted, though; it’s your bandwidth – a wonky way of describing “brainpower.” The correct understanding of bandwidth, Mullainathan and Shafir argue, is akin to a gas tank; you use it up over time, and when you’re working on a thoughtful task, you use it up faster than when you’re doing something mindless[2].

And when your bandwidth is taxed, you are dumber. Literally. In one of Mullainathan’s and Shafir’s studies, mall-goers –some well off, others poorer – were asked about a hypothetical decision to spend either $150 or $1,500 to fix some short-term car trouble, and then were given a test of Raven’s Progressive Matrices to judge fluid intelligence.[3] When given the $150 hypothetical, the rich and poor looked equally intelligent; when given the $1,500 hypothetical, the poor did significantly worse. As the authors note, this was significant both in the statistical sense and in the real-world sense:

 Our study revealed that simply raising monetary concerns for the poor erodes cognitive performance even more than being seriously sleep deprived… our effects correspond to between 13 and 14 IQ points. By most commonly used descriptive classifications of IQ, 13 points can move you from the category of “average” to one labeled “superior” intelligence.

Thinking about money issues temporarily made people less intelligent, by nearly an entire standard deviation. Mullainathan and Shafir found similar effects to executive control:

 The same farmer fared worse on fluid intelligence and executive control when he was poor (preharvest) than when he was rich (postharvest). Much like the subjects at the mall, the same person looked less intelligent and more impulsive when he was poor… The postharvest farmers got about 25 percent more items correct on Raven’s. Put in IQ terms, as in the earlier mall study, this would correspond to about 9 or 10 IQ points

This is why, the authors note, “scarcity creates its own trap.” Tunneling, and the juggling it forces, distorts decision-making:

Scarcity, and tunneling in particular, leads you to put off important but not urgent things—cleaning your office, getting a colonoscopy, writing a will—that are easy to neglect. Their costs are immediate, loom large, and are easy to defer, and their benefits fall outside the tunnel. So they await a time when all urgent things are done. You fail to make these small investments even when the future benefits can be substantial.

You make dumb long-term decisions because you only think about the most immediate and pressing things to do.

A proper understanding of, and reckoning with, these ideas leads to significant individual, social, and political changes.

For individuals, it may mean scheduling high-bandwidth tasks earlier in the day, or at least not scheduling all high-bandwidth tasks back-to-back; perhaps you should put mindless tasks – doing expenses, maybe, or clicking through low-priority emails – after something that requires your full attention.  And it means trying to turn all of the hard, repetitive decisions you have to make into one-time decisions; you can either have to say no to the chocolate bar every time you open the pantry, or just say no to it once at the grocery store. Same deal with habits: if you go on a run or to the gym on a consistent basis, choosing to go today will be, well, less of a choice.

As a society, these ideas should lead us away from viewing the poverty problem as a moral one – thinking that those in poverty are lazy or dumb or what have you – to a practical one. We know – or, more accurately, have a strong factual basis to believe – that a bandwidth-taxed individual is liable to make worse decisions, and that those in poverty are, by definition, bandwidth-taxed individuals. Properly considered, the research should lead to a greater level of empathy; we all know what it feels like to be bandwidth taxed – but most of us are fortunate enough to not feel like that all the time. Many aren’t, though.

If you view poverty through this lens, it’s easy to see how specific policy changes could help increase bandwidth and reduce scarcity. One stark example: payday loans[4]. Mullainathan and Shafir put it better than I can:

Many workers, as we saw in chapter 5, resort to payday loans. Yet it’s worth observing that a payday loan is often simply a loan against work that has already been done. The worker who takes a payday loan halfway through the pay cycle has already earned half her paycheck. The need for a loan is largely due to the fact that payment happens with a delay. Why should an employer have workers taking these loans, potentially falling into scarcity traps, taxing bandwidth, and resulting in lower productivity, especially when the employer can himself give pay advances at low cost? How valuable would it be for employers to improve productivity by offering the right financial products and creating bandwidth?

This is a pretty nonideological solution to a politically-fraught issue. There are costs to it, sure, but as the authors point out, it’s easy to see how they could be outweighed by productivity benefits.

Finally, policymakers and policy wonks need to learn how to craft programs that take the already-limited bandwidth of the poor into account:

We treat education as if it were the least invasive solution, an unadulterated good. But with limited bandwidth, this is just not true. While education is undoubtedly a good thing, we treat it as if it comes with no price tag for the poor. But in fact, bandwidth comes at a high cost: either the person will not focus, and our effort will have been in vain, or he will focus, but then there is a bandwidth tax to pay. When the person actually focuses on the training or the incentives, what is he not focusing on? Is that added class really worth what little quality time he managed to spend reading or with his children? There are hidden costs to taxing bandwidth.[5]

Scarcity is a problem we all face, in one form or another. And we face it together, too, as a society. Read this book and you’ll have a much better understanding of it.

[1] Though, in those cases, neither the paper nor the studying is as good as it would be sans procrastination

[2] You may recognize this idea as “ego depletion,” Roy Baumeister’s model for how willpower is reduced when people are faced with difficult decisions. In this model, willpower is a muscle that can be used, depleted, replenished (with a sugary treat, say), and strengthened over time

[3] You know – and likely loathe – these:

Screen Shot 2014-12-23 at 9.56.48 PM 








[4] Speaking of which, the John Oliver segment on payday loans is excellent

[5] As an aside, if you’ve worked in international development in any sector, you recognize how difficult education/”sensitization” (for those in east Africa) is. Add bandwidth to the long list of reasons why.

Book-Blogging: Making of the Atomic Bomb, by Richard Rhodes

The_Making_of_the_Atomic_BombRichard Rhodes’s Making of the Atomic Bomb is not for everyone.

For starters, it’s long – really, really long.  It’s also fantastically dense, serving as not only a history of the atomic bomb but also as a history of nuclear science, anti-Semitism in eastern Europe, and of World War II. And it can be a slog – at times, a hard read and a boring one to boot.

But it is the book to read if you want to learn about, well, the making of the atomic bomb and the Manhattan Project.

For that reason, writing a review of it is pretty much unnecessary: either you’re the type of person to read this book, or you’re not. If you are, I highly recommend it; if not, I don’t think you’ll like it.

Instead, after the jump I’ll list a few of the sections I highlighted while reading on the Kindle, mostly because I thought they were interesting or provided a unique perspective or thought.

Book-Blogging: All of Sam Kean’s Books

disappearing spoon

A nagging running injury has kept me elliptical-bound for the better part of six weeks, so lately I’ve been Hoovering books on my Kindle.

You’ve probably never heard of Sam Kean (he doesn’t have a Wikipedia page). If you know the name, it’s probably because you know the voice from Radiolab, where he’s talked about everything from a man who invented technology that has saved and killed a remarkable number of people (that’s Fritz Haber, of the Haber process for producing nitrogen and the “Father of Chemical Warfare” Haber) to the man who survived both atomic bombings, Tsutomu Yamaguchi.

If there’s anything I’m evangelical about, it’s Radiolab, and I liked the way Kean told these stories, so I picked up Kean’s first book, The Disappearing Spoon. And then I read it. Quickly. And then I quickly picked up his next two: The Violinist’s Thumb and The Tale of the Dueling Neurosurgeons.

Each deals with a separate science topic – elements, genetics, and neurology, respectively – and is driven by historical anecdotes followed by in-depth explanation. Each is a delightful read.

And that’s more impressive than it sounds. It’s not easy to make the periodic table (in and of itself) all that interesting; genetics is a difficult topic to truly understand, and so is neurology. Kean combines genuinely fascinating stories (see: Haber and Yamaguchi) with a writing style that’s colloquial without attempting “Talk Hip With the Kids” and lucid without being shallow.  (To wit, from The Disappearing Spoon: “As a metal, polonium is useless. It decays so quickly it might have been a mocking metaphor for Poland itself.” Which, if you know anything about the history of Poland, is both funny and sadly true.)TDN

VTScientists have an undeserved reputation as boring, stodgy, and all-around uninteresting. This could not be further from the truth – it seems like every major invention has a major backstory full of backstabbing, deceit, indifference, and cunning – and it is Kean’s obvious affection for these scientists and their stories that gives otherwise dense material the padding to flourish.

The books are goldmines of interesting tales and facts; I picked a random paragraph in my book notes  of The Disappearing Spoon and this is what came up:

 But the taste buds for sweet and sour are easy to fleece. Beryllium tricks them, as does a special protein in the berries of some species of plants. Aptly named miraculin, this protein strips out the unpleasant sourness in foods without altering the overtones of their taste, so that apple cider vinegar tastes like apple cider, or Tabasco sauce like marinara. Miraculin does this both by muting the taste buds for sour and by bonding to the taste buds for sweet and putting them on hair-trigger alert for the stray hydrogen ions (H+) that acids produce.

Which is pretty interesting. Each of the books is a wealth of factlets like that, without devolving into a book of anecdotes. Not easy to do.

I could go through each book individually, but really they’re all excellent, and you should just start with whichever topic you think you’d find most interesting.

Book-Blogging: The Great Escape, by Angus Deaton


The past two hundred years have borne awesome changes to the world (in the definitional sense of the word): world population has septupled – septupled! – and, looking at the way lives are lived now, anyone living in 1814 would likely conclude (not wholly incorrectly) that we are Sorcerers Practicing Black Magick. Technologically, socially, and economically, the past 200 years have been vastly different than the preceding 200. Or 1,000, for that matter.

How did a few nations break thousands of years of (relative) constancy and become significantly wealthier and healthier than ever before? Why didn’t, and haven’t, others? What’s happening now, and what can we expect to happen in the future?

Angus Deaton, a professor at Princeton University, wrote a masterclass of a book, The Great Escape, dissecting these questions. I can’t recommend it highly enough to anyone interested in health and wealth; medicine and economics; the past and the future.

The book isn’t actually a book; it’s more like a book and a chapter-length op-ed, and it’s worth reviewing each separately. The book, Chapters 1-6, is the most complete accounting of the recent changes in health and wealth in the world that I’ve read. The op-ed makes the case that foreign aid weakens recipient governments – especially in Sub-Saharan Africa, where in many countries it approaches three-quarters of government expenditures – and as a result harms the people it putatively tries to help (though “tries to help” does a lot of work in that sentence, and Deaton argues it often isn’t about helping them but us).

The first few chapters walk through the truly shocking increases in health many wealthy societies have witnessed during the past few generations. This “aging of death,” as Deaton delightfully calls it, started around the 1850s in Western countries and eventually filtered down to less-developed regions in the 1950s and thereafter; it continues to this day.

As Deaton points out, life expectancy is a confusing metric, and kind of a bad one at that. Take the fictional country of Macronesia: because of a genetic defect, half of its population dies at birth, and half lives to be 100 years old. It’s average life expectancy is, therefore, 50 years – but no one lives to be just 50, and those that make it past their first day have 100 years of life left. 50 is, in this context, a meaningless number. But it’s Macronesia’s life expectancy just the same.

And so it is with many real countries that have intolerably and unconsciously high infant and child mortality rates. Think America at the turn of the 19th century, when life expectancy was something like 40 (a generous, speculative figure that is almost certainly on the high side). But that’s because so many kids died. To pull a few (admittedly non-random) examples of lifespans we would consider long today, George Washington wasn’t 40 when he died; he was 67. Benjamin Franklin, John Adams, and Thomas Jefferson were 84, 83, and 90, respectively.

(Because I just have to: in one of history’s great coincidences, Adams and Jefferson – one-time sworn political enemies who nevertheless developed a long, deep correspondence by pen in the gloaming of their post-presidential lives – died on the same day in 1826 – the Fourth of July. The 50th anniversary of the official signing of the Declaration of Independence. Because of course.)

Another problem with life expectancy: as an American white male, my life expectancy at birth in 1987 was 72.1 years – but that was an outdated figure almost as soon as the ink dried on that year’s actuarial table. Changes in medicine, technology, and policy over my lifetime will almost certainly mean that my (American, white, male) peers and I will live, on average, far longer – even past 100.

Though he (rightfully) questions the use of life expectancy as a metric in and of itself, the massive uptick in it is because far, far fewer children are dying than before, and that this is because of public health measures:

The major credit for the decrease in child mortality and the resultant increase in life expectancy must go to the control of disease through public health measures.

Because of public health measures, when we talk about countries, we no longer talk about neonatal and child deaths per 1,000 live births; we talk about them in numbers greater than that by two orders of magnitude: 100,000.

As a result, in America, life expectancy increased from 47.3 in 1900 to 77.9 in 2006. He puts it more colorfully than I could:

One way in which the transition is sometimes summarized is to say that diseases move out of the bowels and chests of infants into the arteries of the elderly.

The second half of the book describes the unprecedented economic growth that began in the 1800s and continues today. I won’t get into it much (if there’s any story here you already know, it’s this one), and only will make a few points about measurement.

Deaton convincingly argues that defining and measuring poverty across countries is much more difficult than most casual observers realize. A dollar goes further in India than in the states, and even the calculation to account for this – the wonkily-named “Purchasing Power Parity” – is flawed in obvious and predictable ways. Defining poverty is also difficult in America itself; the poverty line was first chosen then rationalized, and has always been politically fraught.

Gross Domestic Product, or GDP, is a problematic measure, too (and a recent one, as Planet Money helpfully discussed on a recent podcast episode). As Robert F. Kennedy pointed out, it measures much of what we don’t necessarily want, and little of the important, ephemeral things in life.

(Deaton doesn’t even dive into the difficulties about figuring out the GDP of a country – especially a poor country – a monster of a problem in itself).

At times during the book part of the book, Deaton is a bit of a broken record – mentioning too many times to count that “escapes leave people behind, and luck favors some and not others”– but this is a minor sin easily overlooked.

The op-ed at the end is, to put it mildly, polarizing. Deaton is an intellectual monster in the field of development economics, so his firmly planting a foot in the “anti” camp made waves. I won’t get into the arguments much – there’s simply too much to cover – but will give a short summary and a note of admiration.

USAID Food Bag

His argument basically rests on the idea that foreign aid – even the 100% benign, apolitical aid, if it exists (though there’s reason to believe it doesn’t) – necessarily distorts the policies and actions of recipient governments. Governments that are strong don’t need the aid, he argues, while governments that aren’t strong (read: corrupt, authoritarian, or both) will be hurt by the aid. In other words, think of it like the Halstedian “radical mastectomy” of aid: it’s used when it either can’t help anyway or isn’t needed in the first place, and causes severe trauma either way.

(For more on radical mastectomies and cancer, read The Emperor of All Maladies, a wonderful book that I reviewed here).

Deaton does mildly argue that aid directed towards the provision of certain types of health care (safe water, sanitation, pest control) can be, on net, a capital-G Good thing. And he voices approval for certain types of indirect aid: funding research into Neglected Tropical Diseases; advocacy for policy changes that promote migration and trade; removing harmful rent-seeking subsidies; et cetera But overall, he’s quite skeptical of direct-to-consumer aid.

Deaton’s op-ed chapter is admirable for its bluntness and for its acceptance of a hard truth: getting rid of aid may be normatively the best for the long-term fate of low-income countries, but in the short-term this is both impossible – does anyone really think USAID and the World Bank are just going to disappear? – and has serious immediate consequences (people will die). But he argues for it anyway, and kudos to him for having the bravery to do so.

This book – and its accompanying op-ed – is fantastic. Full stop. Buy it now.

Book-Blogging: Every Day is For The Thief, by Teju Cole

EVIFTTShort book recommendation: pick up Teju Cole’s Every Day is For The Thief. It’s excellent and, though specific to Nigeria, the anecdotes and sights conjured up in a series of essays about a (fictional character’s) return trip to the country have the whiff of universality, at least in east Africa. The swaggering touts. The relentless, numbing generators.

The book is short and is self-recommending, so I won’t write a full review. Instead, here are a few excerpts I highlighted:

Touting is not a job. It is a way of being in the world, a distillate of pure attitude: the chest puffed out, the body limber, the jaw set to brook no opposition. There is in every tout the same no-nonsense attitude, the quick temper, the willingness to get into a fight over any and all conflicts. There is a strut they do, a swagger. These are the original wiseguys of Lagos; some of them are as young as fourteen. They do not go home in the evening and stop being touts. The thing is bound to their souls.

The informal economy is the livelihood of many Lagosians. But corruption, in the form of piracy or of graft, also means that most people remain on the margins. The systems that could lift the majority out of poverty are undercut at every turn. Precisely because everyone takes a shortcut, nothing works and, for this reason, the only way to get anything done is to take another shortcut. The advantage in these situations goes to the highest bidders, those individuals most willing to pay money or to test the limits of the law.

The energies of Lagos life—creative, malevolent, ambiguous—converge at the bus stops. There is no better place to make an inquiry into what it was I longed for all those times I longed for home.

But also, there is much sorrow, not only of the dramatic kind but also in the way that difficult economic circumstances wear people down, eroding them, preying on their weaknesses, until they do things that they themselves find hateful, until they are shadows of their best selves. The problem used to only be the leadership. But now, when you step out into the city, your oppressor is likely to be your fellow citizen, his ethics eroded by years of suffering and life at the cusp of desperation. There is venality in abundance here, and the general air of surrender, of helplessness, is the most heartbreaking thing about it.

Book-Blogging: The Idealist: Jeffrey Sachs and the Quest to End Poverty, by Nina Munk

The IdealistThe only off piece of Nina Munk’s must-read book, The Idealist, is the title.

Which is not to say that Dr. Jeffrey Sachs – the former wunderkind Harvard professor and world-renowned economist whom Bono calls his personal personal “guru” – isn’t an idealist; he certainly appears to be.

But above all, Jeffrey Sachs is The Believer – in Jeffrey Sachs.

When his prescription for economic transformation, shock therapy, led to a massive transfer of Soviet wealth to corrupt Russian oligarchs, Dr. Sachs decried the politicians who screwed up his plan, not the plan itself.  When global health and development experts argued that his bednet proposal would cripple Tanzanian industry, Dr. Sachs called them “absurd,” “disreputable,” and even “economically ignorant.”

And when the Millennium Villages Project (MVP) – Dr. Sachs’s Big Idea to End Poverty Forever – has had setbacks and outright failures, it’s because of a lack of donor support and “artifact” disturbances beyond the project’s control, and not the project’s innate flaws. (Munk’s retort to this is excellent, and telling: “But why in the world were drought and violence and hostage taking unexpected in sub-Saharan Africa?”)

It seems that in Dr. Sachs’s world, you’re either with him, or you’re wrong.

After all, the man is uniquely smart. He is genuinely brilliant. “I’m a good economist!” Munk captures him yelling at one point;  “sometimes, I wonder why I need a PhD for this,” he says at another. Everyone else – similarly brilliant development experts included – just doesn’t get it.

But, at least when it comes to the MVP, Dr. Sachs is not a good economist – he’s an advocate. An eloquent, brilliant, effective, biased, good advocate. The project is his brainchild and his baby — he’s inextricably tied to it and will be judged by its success or failure — which makes true, dispassionate economic analysis difficult, if not impossible.

The origins of the MVP are relatively well-known; as Munk explains,

The stumbling block, [Sachs] concluded, was a “poverty trap”: an overwhelming, interconnected burden of disease, illiteracy, high fertility rates, dismal agricultural productivity, lack of capital, weak or nonexistent infrastructure, debt, hunger, drought, malnutrition.… Tackling one problem at a time, piecemeal, was pointless, he concluded. The way out of extreme poverty depended on a “big push” in foreign aid—a massive, coordinated investment designed to lift countries up and out of poverty, once and for all.

The idea is compelling in its simplicity: $120 per person per year for five years (later, ten – a “course correction,” according to the MVP), and poverty would be history. A few MVP sites piloted in 2005, with the expectation that success would show the world how easy (a word Dr. Sachs uses quite a bit in Munk’s book and his own, The End of Poverty) it is to get poor communities on the ladder of development. Billions would be pledged and the project would scale to every poor village in Sub-Saharan Africa. Easy.

As Munk documents from Ruhiira, Uganda, and Dertu, Kenya, the two MVP villages she spends the most time in, villagers’ lives certainly seemed to improve: farm yields increased; deserted hospitals came to life; garbage – a sure sign that things were being bought – piled up.

But $120 per person per year is a lot of money in southwestern Uganda and eastern Kenya – of course the villagers would be better off in the short term. The more important question: were they “on the ladder” of development, too? Once the money dried up, would they be able to lift themselves out of poverty?

Maybe. Maybe not. We don’t know. For starters, it’s still much too early to say.

But more importantly, the project wasn’t set up to conclusively “prove” anything – possibly its most significant failure. As development economists Michael Clemens and Gabriel Demombynes have outlined in detail (along with others), the MVP didn’t start with randomized and controlled villages, so no true rigorous testing to assess efficacy of the intervention is possible (at least from its outset). The data is contaminated, flawed.

Munk un-wonks this for readers:

Yes, in Sachs’s villages, the prevalence of malaria had dropped, more women were giving birth with the help of trained birth attendants, child mortality was down, and generally speaking, people were better nourished. At the same time, those and other similar improvements were happening all across sub-Saharan Africa, not only in the Millennium villages… Between 2000 and 2010, for example, deaths from malaria fell by a third in Africa. Infant mortality rates dropped sharply. More African children than ever attended primary school. More Africans had access to safe drinking water….

Is Ruhiira better off than neighboring villages because it’s a MVP village? Probably (again, at least until the money dries up). But how much better off, and in what ways, and for how long? Was the MVP structure (and cost) necessary for those improvements, or could the results have been achieved at lower cost? There’s no way to know.

Dr. Sach’s response to this empirical, data-driven critique of the MVP? “I don’t think they’re on target, I don’t think they’re good science, and I don’t think they’re apropos.” (There’s more here, if you’re interested in diving into the wreck of the debate).

Basically: don’t trust the science. Trust me! I’m a good economist!

Munk’s book is an invaluable dissection of how policies developed in New York City from the top down are liable to fail on the ground in Sub-Saharan Africa — when they’re subjected to political, social, and cultural realities that are hard to predict from afar. She spends time with the villages in a way that Sachs simply cannot, as an observer and not The Great Professor (as the Dertu MVP lead refers to Dr. Sachs). She watches maize rot in Ruhiira because there’s nowhere to put the surplus (and because the villagers would rather eat matooke than posho – as anyone that has had both would in a heartbeat). She sees things fall apart.

I would love to see the MVP be wildly successful in Ruhiira, Dertu, and every other small village in Sub-Saharan Africa. I would love it if aid could actually end (extreme) poverty, once and for all.* I would love to see the whole world – wealthy and not – rally around the results and the effort: a global moonshot to end poverty forever.

But it’s far from clear that foreign aid is capable of doing that, and it’s far from clear the MVP will dramatically change this. It does seem clear that scaling up the MVP, at this point, would be an irresponsible use of limited funds that could otherwise go to targeted (read: cheaper) interventions. (Dr. Sachs has indicated that July 1st, 2016, is the drop date for the final evaluation of MVP pilot villages)

This isn’t a discussion about whether “aid works” or not. That argument, which recently flared up again on Twitter and elsewhere, is a completely parochial, utterly vacuous disagreement without meaning.

Some multilateral/government aid, used in the right way (often in the health sector) clearly is effective at saving lives and improving quality of life. Other aid, used in the wrong way, is a waste of money at best, and often actively harmful.

I find it hard to believe that a reasonable person would disagree with that last paragraph (Brett Keller makes a similar point here).

It’s time we all move on from such staleness; there are too many smart, hard-working people working in this space to continue it. Let’s discuss what can be done, and in what ways, to maximize whatever good we find ourselves able to do. This may be traditional aid, but it also could be a social enterprise, or a totally-for-profit business. Or a check, given directly to a family, to allow it to put an iron roof on its home.

Near the end of the book, with criticisms mounting and the success of the MVP in doubt, Munk notes that Dr. Sachs

 had distanced himself from his ongoing African experiment. His impassioned articles and speeches and interviews and tweets now centered on income inequality in the United States, climate change, the collapse of Greece, tax reforms, greed on Wall Street, the decline of moral standards, chaos in the euro zone, gun control, and the political vacuum in Washington. He was all over the place.

His latest book is on John F. Kennedy.


Related Links:

*Bill Gates made overtures to this point in his eagerly-awaited Annual Letter, which is worth reading, though skeptically


Book-Blogging: Polio, an American Story, by David Oshinsky

David Oshinsky’s Polio: An American Story is a really interesting read and I highly recommend it, especially for those interested in the history of medicine and global health.

Rather than give a full review, I’ll just bullet point a few thoughts I had while reading and some of the themes that resonated with me most.

  • Polio : 20th century America :: Cholera : 19th century Europe. Its presentation was terrifyingly quick – minor symptoms one day, paralysis the next; mercurial – no one knew where it came from, leading to isolated summers; visceral, with permanently crippled (white) children – but hardly the most deadly or problematic disease of the time, in terms of total morbidity and mortality
  • The National Foundation of Infant Paralysis, or NFIP (which posterity will know best through the March of Dimes), was a remarkable organization. It completely upended the philanthropic regime of the day, by asking everyday people to give what they could – a dime, a dollar, whatever. It also used the influence of the radio and prominent public figures (e.g., actor Edie Cantor, Franklin Delano Roosevelt) to drive attention and monetary support to the disease – things that sound trivially obvious now but were novel then
  • Tying together the two bullets above: in 1954, NFIP absorbed $66.9 million of the $140 million given to health charities in America – an amazing amount when considering the number of polio cases that same year: 100,000. The other organizations were upset about this, finding it unfair and a poor allocation of resources. The argument continues in a similar vein today; $1 billion is spent on polio eradication each year, which siphons critical resources (not just money, but also technical, human capital, and supply chain, to name a few) away from the prevention and treatment of other diseases and social ills that cause a much higher burden
  • Oshinsky does his part to dispel the Great Man Theory of Scientific Discovery in this book, highlighting the dozens of scientists and researchers who were involved in the hunt for a workable vaccine, including Albert Sabin (who developed the live oral vaccine that did the heavy lifting in ridding most of the world of polo); Isabel Morgan (had she not taken maternity leave and left the lab, she very well could have developed the first workable vaccine against polio); and Hilary Koprowski* (who tested a live oral polio vaccine on humans years before Sabin did). It seems that Jonas Salk’s most useful skills were his pliability and his sense of urgency – both of which NFIP liked
  • Hear this famous quote from Salk before? “There is no patent. Could you patent the sun?” Turns out, NFIP looked into it, decided that, like the sun, it would be unable to legally patent its vaccine (prior art). Salk was being more literal than moral**
  • The rollout of the Salk and Sabin vaccines in America goes a long way towards showing why other massive public health campaigns are so hard; Salk/Sabin had much that future campaigns would not: an ample supply of physicians and nurses (who have comfortable enough lives to be able to volunteer their time and expertise freely for “the cause”); across-the-board literacy and “medical sensitization” (i.e., people used to interacting with the medical system); a society that viewed new science and technology positively, and thus willing to take a chance
  • Polio inadvertently gave us one of the first cases of machine-assisted artificially-lengthened life: Fred Snite., Jr., a young man struck with polio in 1936, lived in an iron lung for 18 years, a time during which he married, had kids, and attended his alma mater’s football games with regularity


*Koprowski’s name would come up in the 1990s, as accusations mounted that his live OPV trials in Belgian Congo in the 1950s caused Simian Immunodeficiency Virus (SIV) to spillover into humans; in other words, that he caused HIV and, subsequently, the deaths of tens of millions of people. This was shown, again and again, to be inaccurate.

**Decades later, Salk would create an AIDS vaccine, and, as Oshinsky put it, “there was no talk of giving it to the world as a gift – no illusions about patenting the sun.” Salk co-founded a company, the Immune Response Corporation, and assigned the rights to it, then profited immensely when the company went public. The vaccine didn’t work.

Book-Blogging: The Emperor of All Maladies, by Siddhartha Mukherjee

(For this book review, I used Grammarly’s plagiarism checker because I wanted to ensure I didn’t steal words like this guy – from Florida, naturally – stole bulldogs. Explanation/Disclaimer/Disclosure below. UPDATE: The organization asked me to remove the link; something about Google’s Webmaster Guidelines not allowing sponsored links…)

Before I go on a bit of a tangent, I don’t want to bury the lede: if you haven’t read The Emperor of All Maladies, you should – it is an excellent “biography” of cancer, a group of diseases that has been with us since there was an us to be with. The author, Siddhartha Mukherjee, does an awesome job in the definitional sense: his ability to walk the reader through the complicated, difficult history of the disease with such ease and readability should inspire awe.

For the vast majority of modern history*, humans had more reason to fear the nameless, ever-present Grim Reaper outside of them than the rarely violent, relatively quiet one waiting on the inside.

They often worried about being on the wrong end of an Act of God, as when God plagued the Philistines with a pestilence (now thought to have been the bubonic plague) as divine retribution for stealing the Ark of the Covenant from his favored people, the Children of Israel (or so the Children of Israel believed).

They feared the air, sometimes more than they feared the wrath of God; it could be full of poisonous, deadly effluvia – and there would little they could do about it (it was thought). Everyone — scientists and laypeople alike — believed that decaying matter aerosolized and infected populations with malaria (old Italian for ‘bad air,’ actually), cholera, yellow fever, typhus, and most of the other major diseases they faced.

But then a lot changed, all at once. In the 100 years between 1850 and 1950, they figured out how to beat Death in life, sometimes. Though they were wrong about Miasma Theory and its omnipresent effluvia, the fear manifested itself in relentless bouts of cleaning and sanitizing, which inadvertently protected them from the real killers.

Robert Koch, Louis Pasteur, Joseph Lister, and others convinced them – agonizingly slowly – that Death came from unseen beings, and, properly convinced, they began searching for the “magic bullets” that would rid the world of infectious disease. Paul Ehrlich (who coined the terms “magic bullet” and “chemotherapy”) discovered an arsenic-based compound, Salvarsan, that was effective against syphilis; Walter Reed wiped out yellow fever near the Panama Canal; Alexander Fleming found “Mould Juice” in a messy laboratory. The world changed, fast.

It was as if the Grim Reaper outside lost his scythe. We died less from infectious diseases, and we lived longer; the Reaper was something to fear, but not to acquiese to as quickly as before**.

But we have other things to fear, often inside us; more often, the Grim Reaper attacks calmly, silently, and with remarkable patience.

Of the things we fear inside of us – heart disease, congestive heart failure, diabetes – nothing brings the worry that a small lump on the breast or an enlarged lymph node does. It’s cancer that keeps us up at night.

Cancer, as Mukherjee points out, has always been with us; five thousand years ago, the Egyptians wrote about it in detail (“there is no treatment”). Though never in the history of mankind has it mattered more than it does now.

Mukherjee chose to style his book as a “biography” of cancer, and it works. The prose is clear, illuminating, and, at times, intimate; a practicing physician, he’s able to describe the disease through his very real patients in a moving way.

A physician-researcher-writer-teacher in the vein of Atul Gawande, Mukherjee calmly and lucidly walks lay readers through the complicated science of cancer – no simple task. He describes the history of cancer as a grisly recounting of painful, debilitating treatments: from William Halsted’s radical mastectomies to Sidney Farber’s near-death aminopterin chemotherapy to today’s “modern” drugs aimed only at our genes and not our tissues (certainly less grisly, possibly less painful).

The book is an excellent history of the politics of cancer, and the way medicine, advocacy, and politics intersect. It’s not an accident, for example, that we speak of cancer as an adversary, something to “beat” in a “war” – it was a calculated decision by Mary Lasker, an early and powerful advocate for cancer research (and therefore the funding for it). There are drawbacks to using that language – how many patients would have been better off “accepting defeat” by going the palliative route? – but it has given strength to millions of cancer patients and affected family members.

The Emperor of All Maladies is totally fascinating, and it’s a shame it took me four years to get to it. Read it.

*Loosely defined as post-hunter-gatherer

**Which is not to say that we’ve defeated infectious disease. Obviously that isn’t the case. Antibiotic-resistant bacteria are quickly leading us towards the horrifying prospect of a post-antibiotics future, for one thing. For another, knowing how to cure tuberculosis hasn’t rid the world of tuberculosis – it’s as much about the science of delivery as the science of bacteriology. And each time society breathes a sigh of relief, a new disease emerges that humbles it once again (see: Spanish flu, SARS, HIV, avian/swine flu, etc. etc.)[G7]

Grammarly Explanation/Disclaimer/Disclosure – Grammarly, a San Francisco-based company that offers grammar and plagiarism analysis software, reached out to me about trying out its software, and offered a small incentive to link to it on a future post. The organization gave me free trial access (subscription is typically $29.95/month or $139.95/year), which I used for this post, and for placing that sentence/link at the top of this blog offered me a $50 Amazon gift card – which I hope is enough to interest me in trying out their software but not enough to incent me to promote a product I don’t like.

Fortunately, that’s not an issue; I like the software – it’s simple, smart, and a useful way to catch typical grammar issues. It seems to be able to show trends over time, too, so that, theoretically, I could analyze batches of posts to discover that I often use passive voice or consistently abuse long sentences (like this one…). I think using it consistently would make me a better writer.

I haven’t yet decided if I’ll purchase an annual subscription to the software. After playing around with it for two more weeks, I’ll be in a better position to decide.


Book-Blogging: The Life You Can Save

Recently, I read, and responded to, Dylan Matthews’s great article on Millennials “earning to give” – taking high-paying jobs at Google and hedge funds in order to maximize the amount of money given to worthy causes. Part of their rationale to do so seemed to come from Peter Singer’s book The Life You Can Save, which I hadn’t read.

200px-TheLifeYouCanSaveSo I picked it up on my Kindle for a long, jostling ride through west Uganda’s dirt roads and impenetrable forests. It’s a quick read that will stick with you; I highly recommend reading it, especially to folks our age who are (hopefully) beginning to make a non-zero amount of money.

It’s a book that asks an uncomfortable question: why don’t you give more to those mired in extreme poverty?

The answer is tied up in human evolution and behavioral economics. Anyone who has taken an entry-level philosophy course is no doubt familiar with the example Singer poses to start the book: how many would jump in a pond to save a child who will otherwise drown? Most of us would, it turns out; we’re heavily inclined to help the “identifiable victim,” and “we will spend far more to rescue an identifiable victim than we will to save a “statistical life.”

This shows up in experiments that looked at giving patterns of participants confronted with either emotional, individual stories (that of Rokia, a desperately poor Malawian girl), or statistics about poverty in Malawi. Participants gave more than twice as much when confronted with Rokia’s story than when confronted with faceless statistics; emotions, and individuals, matter[1].

Knowing why people choose not to give, Singer argues that the morally appropriate response is to donate – a lot:

“So you must keep cutting back on unnecessary spending, and donating what you save, until you have reduced yourself to the point where if you give any more, you will be sacrificing something nearly as important as a child’s life—like giving so much that you can no longer afford to give your children an adequate education.” (emphasis mine)

Give to the point where the marginal utility of that dollar is the same for you and Rokia. Anything less is immoral[2].

He recognizes that the likelihood of this happening approaches zero, so advocates a more tenable position: an implicit, voluntary “donation tax” on the wealthiest Americans of at least 5%. He convincingly argues that someone making $100,000 per year should be able to part with $5,000 without any damage to their finances or standard of living.

It’s a fascinating book that’s worth reading, no matter your preconceptions of donating, aid, and worldwide poverty. If you are already inclined to support his view, you’ll have more ammunition for friendly debates with others; if you disagree with him at the outset, it’ll at least make you think.

The one quibble I had with the book is Singer’s clumsy use of data to support his assertion that aid is effective at reducing extreme poverty. He cites a 2009 UNICEF report that documents the fall in extreme poverty over the last 50 years: from 20 million people in 1950, to 10 million in 2007, to 8.8 million in 2009. Given that the world population has nearly tripled in the same time period, it’s a remarkable reduction.

But Singer, perhaps being driven by confirmation bias, attributes this significant drop to aid:

“The lack of attention given to the UNICEF data makes it difficult to inform the public that we are making progress and that aid, especially aid directed to improving the health of children, is a big part of that progress…In the last two years, we have saved a million children. In the coming years, if we all give substantially more, we can save the entire 8.8 million.”

I think it’s highly probable that a portion of this reduction is directly caused by aid focused on health, sanitation, water, bednets, and other initiatives designed to reduce child mortality. But I think it’s more likely that economic growth had a lot more to do with the precipitous fall, especially in China, India, South Korea, Brazil, and other countries with high growth over the time period.

To me, Singer’s on the right side of the “does aid work” argument – it probably does, at least when it comes to health – but it is sloppy polemics to overlook something as simple as economic growth when coming to that conclusion; his argument would be significantly improved by acknowledging other causal factors. The rhetoric of “we have saved a million children” is good rhetoric but grounded more in emotional appeal than fact[3].

Sloppy section aside, though, this is a perfect book for Millennials who question if donating any of their (often meager) incomes is worth it. It’s $1 on the Kindle; buy it.

[1] There’s a much larger discussion here about “poverty porn” and its use to compel these donations, which Singer doesn’t discuss. I don’t want to, either, but do want to acknowledge it exists

[2] The obvious rebuttal is to call out Singer for not doing so, but it’s a cheap, trite one. A more interesting question would be to ask how future earnings potential is included in the moral calculus; if I was to give to the point where my marginal utility of a dollar is the same as Rokia’s, I wouldn’t be able to earn money the way I used to. Singer wouldn’t be able to write another book – and even if he did, the publisher wouldn’t have a printing press, etc. etc. It’s myopic to not consider this, but I haven’t seen anything about it from Singer or others

[3] Yes, I know, emotional arguments work much better than empirical ones; Singer spends a good portion of the book discussing this. But I doubt he’d argue that skewing the emotional arguments away from the truth when it’s convenient is appropriate