Month: January 2015

A reader writes:

I am surprised how few of my fellow gay men are unwilling to consider the other side of this issue: the rights and interests of the recipients of donated blood.  The most fundamental oath doctors take is to do no harm and, for blood transfusions, that means ensuring that the risk of giving a patient contaminated blood is as low as humanly possible.  So, in altering the policy, we have to weigh our benefit from ending a stigma against the increased risk of transmitting HIV to a patient.  Put another way, how many additional people per year getting HIV is acceptable for us to feel better about ourselves?

Some (very) rough math to demonstrate this point:

About 50% of the country is male and about 5% of them have sex with men.  About 10% of MSM [men who have sex with men] have HIV and, of those, only about half know.  I am going to assume men who know they have HIV won’t donate, but the effects of shifting the stigma from gay men to HIV-positive men might not be that straightforward.  That means, in the absence of a ban, about 0.125% of all donated blood will be contaminated with HIV due to MSM (for simplicity, I assumed all HIV-negative people are equally likely to be donors).

However, as is pointed out, all blood is tested for HIV.  Even if we put in place controls that would increase the chance of catching new infections, no test is perfect.  Most modern HIV tests are weighted more towards false positives than false negatives (for obvious reasons), but still about 3 out of 10,000 tests of HIV-positive individuals will turn out negative.  That means, in the absence of a ban, an additional 0.0000375% of donated blood that reaches patients will be HIV-positive.  Put in other terms, an additional 1 in every 2.5 million blood transfusions would involve transmitting HIV contaminated blood.

That number might seem acceptably small, until you consider that in the US alone, there are about 5 million blood transfusions each year.  That means the absence of a ban could result in an additional two Americans every year being given HIV accidentally simply for going to the hospital.  That seems unacceptably high to me.

Now, most people do not support overturning the ban altogether.  That said, no one I’ve read has articulated what an acceptable increase in the risk would look like and whether their preferred policy meets that threshold. But that is precisely the issue that the FDA is grappling with and all the sanctimony in the world won’t change that.

In a profile of Francis Fukuyama, the political scientist reveals that his latest book, Political Order and Political Decay, is being translated by the Communist Party in China for circulation among its senior members. His take on why they turned to the text:

“They understand that their system needs fundamental political reform,” Fukuyama says of the Chinese. “But they don’t know how far they can go. They won’t do what Gorbachev did, which was take the lid off and see what happens. But whether it will be possible to spread a rule of law to constrain state power at a pace that will satisfy the growing demands of the rising middle class is also unclear. There are 300 to 400 million Chinese in the middle class; that number will rise to 600 million in a decade. I had a debate a few years ago with an apologist for the regime.

I pointed out that in many regions of the world when you develop a sufficiently large middle class, the pressure for increased political participation becomes irresistible. And the big question for China is whether there will be a point at which its people will push for greater participation, and he said: ‘No, we’re just culturally different.’”

It was, in effect, a rehash of the old “Asian values” argument concerning the hierarchical and deferential social ethic that goes by the name of Confucianism in east Asia – allegedly the reason that Asians lacked the impulse to individual self-assertion that resulted in the demand for self-government in other parts of the world. The democratic transitions in South Korea and Indonesia put an end to that argument decades ago, Fukuyama says, just as the Arab spring debunked a parallel claim regarding Arabs. This is the part of Fukuyama’s argument about the end of history that he still stands behind without reservation or qualification – the Hegelian philosophical anthropology that saw history as the working out of the struggle between masters and slaves for recognition. “I really believe that the desire for recognition of one’s dignity and worth is a human characteristic. You can see manifestations of this in all aspects of human behaviour cross-culturally and through time.”

Previous Dish on Fukuyama’s work here.

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In a lengthy exploration of life aboard the International Space Station, Charles Fishman ponders the future of humanity in space:

We may eventually need resources from asteroids or the moon, depending on how we manage the resources we’ve got here on Earth. We may eventually need to become a multiplanet species—either because we literally outgrow the Earth, or because we damage it. Or we may simply want to become a multiplanet species: one day, some people may prefer the empty black silence of the moon, or the uncrowded red beauty of Mars, just as they preferred Oklahoma to Philadelphia in the 1890s.

These are long-horizon ideas—centuries-long. Even so, what’s missing from them is a sense of how hard living, working, and traveling in space still is, and how long we may need in order to change that.

We’re still at the beginning of the space age. More people can fit on a single commercial passenger jet, the Airbus A380, than have been in orbit. The Space Station’s most important purpose may turn out to be teaching us how to begin to make life in space more practical and less dangerous.

Almost anyone you talk with about the value of the Space Station eventually starts talking about Mars. When they do, it’s clear that we don’t yet have a very grown-up space program. The folks we send to space still don’t have any real autonomy, because no one was imagining having to “practice” autonomy when the station was designed and built. On a trip to Mars, the distances are so great that a single voice or e‑mail exchange would involve a 30-minute round-trip. That one change, among the thousand others that going to Mars would require, would alter the whole dynamic of life in space. The astronauts would have to handle things themselves.

(Vine video via NASA astronaut Terry W. Virts)

In his new guide to writing fiction, Beyond the First Draft, the novelist John Casey doles out advice to “the writer with a lump of a story or novel who doesn’t know what to do next to get it into shape”:

Beware of dogma, he warns. The first essay ventures a sage review of old writing-school edicts: Write what you know. Tell your story in the fewest words possible. Tell the truth. Conventional narrative is boring—you must experiment. Casey comes not to abolish the law but to tweak it, spirit over letter. Write what you know is good advice for a neophyte who falls on his face spinning a yarn about Mayan warriors—yet Tolstoy, while still on his feet, could imagine vividly the death vision of Ivan Ilych.

On sparing words, Casey recalls that his agent and his editor both judged a 604-page novel he’d sent them as much too long, so for several months he reworked it, cutting 100 pages but adding a few in the process. When he sent it back, now 640 pages, the agent and editor wrote him, separately, “Good. It’s much shorter.”

Whether Culture is local has risen from aphorism to dogma is debatable, but Casey says it has. Its propounder, in any case, was William Carlos Williams, the physician-poet who seldom set foot outside northern New Jersey. Against Williams, Casey sets Ezra Pound, who decamped to Europe, picked up Italian and Provençal, and set himself to studying Chinese poetry. Is it better for the writer to stay at home, thereby knowing better what he knows, or, in search of the novel (in both senses), to hit the road? Casey stakes out the agnostic middle ground, finding himself one day at the National Theatre in Washington, where a tile beneath his feet is inscribed “Washington—neither Rome nor home.” It happens that Casey has Washington roots: “I don’t think there’s a really good novel set in Washington,” he says, and he seems content to leave it at that.