Comments on: Lashed to the Rack, or the Ideology of Incremental Improvement

By: Timothy Burke

Timothy Burke — Mon, 30 Sep 2013 22:41:54 +0000

Right, but even there you’re not going to make progress against them if you treat them as incremental obstacles. There’s something big and complex lying in your way: 1% fewer vaccine deniers next year is not what’s going to get you into a real scrum with that kind of resistance.

By: Fred Bush

Fred Bush — Mon, 30 Sep 2013 21:07:35 +0000

I disagree that agency and freedom and diversity are the core values when it comes to public health issues. That’s where the Christian Scientists who won’t treat their kids and the vaccine deniers are coming from, and those are super pernicious belief systems which cause a lot of harm to others.

By: Timothy Burke

Timothy Burke — Mon, 30 Sep 2013 18:54:29 +0000

You’re assuming that the long tail of the student who won’t take their medicine can be affected by a game or by anything else.

Once you’re in that long tail you’re dealing with highly idiosyncratic, personal reasons why the medicine is not being taken. So it’ll be more than the game that’s needed if you want to close the gap–and I also think the gap is fundamentally impossible to close completely.

But more importantly, chasing those last few students incrementally is keeping anybody from asking, “Is there some value at risk in chasing universal compliance to a sensible rule?” The big picture concerns about agency and freedom and diversity and even the importance of error and fallibility become inexpressible as long as incrementalism is the only possible response.

By: J. Otto Pohl

J. Otto Pohl — Mon, 30 Sep 2013 18:52:18 +0000

The prophylactics don’t prevent you from getting malaria. They just make sure you don’t die when you first get it. But, eventually if you live in equatorial Africa you get malaria. I have had malaria four times now. The first time I got it after being on the prophylactics for about a year. I went off of them shortly afterwards. I don’t think malaria is worse than flu and unlike flu there is a cure that is effective in only three days. The US hysteria portraying malaria as being worse than cancer and AIDs combined is ludicrous. Almost all deaths from malaria in Ghana are either very young children or people with compromised immune systems who do not live in close to proximity of a pharmacy. I have never met an indigenous African or long term Obruni here who has not had malaria. It is not that big of deal if you are not a small child and don’t have TB or some other worse disease already.

By: Fred Bush

Fred Bush — Mon, 30 Sep 2013 18:39:05 +0000

While your larger point is well taken, I’m not sure about your analysis of the cost/benefit of the specific situation here. Let’s say the game cost $50k to make. How much is the value of avoiding malaria? Let’s ballpark it at $10k for these wealthy western students. So you’d only need to prevent >5 wealthy kids from getting malaria to make it worthwhile, which seems… achievable?

Of course, there would be better uses of the money, but the value of this game may be >0.

By: chris london

chris london — Mon, 30 Sep 2013 17:16:08 +0000

Great post. I especially like the analogy to Taylorism. The fetish in non-profit circles, but especially from the foundations and financiers who have the cash, for “scaling up.” Along with “scaling up” comes “innovation” and “metrics.” This all presumes that positive socio-economic change is necessarily reproducible in the same way that widgets can be mass produced on an assembly line. This fetish ultimately leads to a drastic narrowing of what is considered worth doing (i.e., worth funding) because it doesn’t allow for complexity, that maybe change needs to happy on multiple fronts simultaneously for any of it to take hold and lead to people have more control over the character and direction of their lives.