1. One way to judge a debate is by how much ground the other party concedes. With that in mind, Derbyshire began by saying this:
The subsidizing of expensive medications (the biggest part of our AIDS-relief effort, though not all of it) in fact has long-term consequences more likely to be negative than positive. The high incidence of AIDS in sub-Saharan Africa is caused by customary practices there. What is needed is for people to change those customary practices. Instead, at a cost of billions to the U.S. taxpayer, we have made it possible for Africans to continue in their unhealthy, disease-spreading habits.
He is now saying this:
“22 countries in Africa have had a greater than 25 percent decline in infections in the past 10 years.” Possibly so; but does this have anything to do with PEPFAR, which is the subject under discussion?
So Derbyshire has shifted from saying that thanks to the generous efforts of America, Africans are “continu[ing] in their unhealthy, disease-spreading habits,” to conceding that, as UNAIDS reports, HIV infections have significantly declined in the past decade. Derbyshire is now arguing whether PEPFAR deserves credit for the decline. That’s progress of a sort, I suppose.
(For those interested in the most relevant findings of the UNAIDS report, I would recommend page 11 [Figure 1.3], which shows drops in people aged 15–25 years who had sex before age 15 years and who had multiple partners in the past 12 months; page 22, which shows AIDS-related deaths by region, 1990-2009; page 27 [Figure 2.8], which shows the number of people newly infected with HIV as well as adult and child deaths due to AIDS; and page 28, which reports, “With an estimated 5.6 million … people living with HIV in 2009, South Africa’s epidemic remains the largest in the world. New indications show a slowing of HIV incidence amid some signs of a shift towards safer sex among young people. The annual HIV incidence among 18-year-olds declined sharply from 1.8% in 2005 to 0.8% in 2008, and among women 15–24 years old it dropped from 5.5% in 2003–2005 to 2.2% in 2005–2008.”)
So did PEPFAR have measurable effects? Drs. Eran Bendavid and Jayanta Bhattacharya evaluated the program’s outcomes in the Annals of Internal Medicine last year. They found that the program was responsible for a decrease of more than 10 percent in “deaths due to HIV or AIDS.” Millions of lives were saved thanks to “improved treatment and care of HIV-infected persons,” especially “the greater availability of highly active antiretroviral therapy,” which was an important focus of the program.
Admittedly, the prevalence of HIV infection in the population did not decline — precisely because people who would have died because of the virus were instead still living thanks to the drugs they received. But in the long run (as Drs. Julio Montaner, Viviane Lima, and Brian Williams note, also in the Annals), there is good reason to believe that “expanded antiretroviral therapy coverage may play a significant role in curbing the spread of HIV.”
More research will be necessary to fully determine the effects of PEPFAR, especially over the long term. But surveying the scientific literature to date, we can now reasonably conclude, I think, that while PEPFAR certainly isn’t solely responsible for the positive changes we’ve seen in Africa, it has contributed to them. And it has certainly not, as Derbyshire originally contended, made things worse.
2. Mr. Derbyshire writes:
There is then some argument that PEPFAR helps promote orderliness in poor nations. On this, I don’t have anything to add to what I said in my December 2 post. Mr. Wehner’s remarks are anyway just a chain of unjustified, unreferenced assertions. Some of them are contradicted by the much more knowledgeable Princeton N. Lyman and Stephen B. Wittels in the Foreign Affairs paper that was the hinge of my original post.
Mr. Wehner has nothing to say about that paper.
I thought my original piece was plenty long enough, but since Derbyshire insists on raising the topic: I have indeed read the essay by Lyman and Wittels that Derbyshire calls the “hinge” of his original post. The authors argue that, among other things, the U.S.’s commitment to helping treat HIV patients is limiting Washington’s leverage over recipient countries. But what I will tell you, which Derbyshire does not, is that Lyman and Wittels strongly support PEPFAR. But let them speak for themselves:
None of these issues [raised in the essay] should be allowed to undermine the commitment to treat all HIV/AIDS patients. This undertaking [PEPFAR and associated international programs] is one of the greatest humanitarian gestures in history and a statement by the developed countries that they refuse to deny life-saving treatments readily available in rich states to the millions elsewhere who need them. But the full implications of this commitment need to be addressed before they become a more serious problem.
Messrs. Lyman and Wittels are in fact offering steps that will “help sustain this major undertaking.” So the very essay on which Derbyshire rests his anti-PEPFAR case describes PEPFAR as “one of the greatest humanitarian gestures in history.” How inconvenient for Derbyshire.
3. Derbyshire writes, “If [Wehner] has read [the Lyman and Wittels essay] he will know how spurious is his comparison of PEPFAR — an ever-increasing permanent welfare commitment — to the 2004 tsunami relief effort, a one-off rescue mission.”
Actually, my comparison is not at all spurious. Remember, in his original post, Derbyshire wrote, “There is, however, no virtue in a government official spending your money and mine unless for some reason demonstrably connected to our national interest.”
My point is a simple one: even if you don’t believe that helping the victims of the tsunami was in the “national interest,” it still might be a good thing to do. Derbyshire’s argument, taken literally, denies such a thing. But when pressed on this, Derbyshire backs away from his original position. In fact, he now seems to favor “one-off disaster relief efforts in remote places.” Again, this is progress of a sort.
4. Derbyshire can’t seem to comprehend why I quoted Lincoln. Let me see if I can help him out. The quote articulates Lincoln’s view about the inherent dignity of all human beings, a belief that is relevant to this discussion since it touches on why we should care about people from other continents and other cultures — a sentiment that Derbyshire’s writings are arrestingly free of. Speaking of which: in reaction to my citing his 2006 comment that “I don’t care about Egyptians,” made after learning that around 1,000 Egyptians had perished in a tragic ferry accident at sea, Derbyshire writes this:
The rest is just more low ad hominem sneering. Goodness, how the man does sneer! He says that I am “eager to celebrate [my] callousness,” and quotes in support something I wrote in early 2006. Since I write roughly a hundred thousand words of fugitive journalism a year, that is around half a million words ago. I don’t see much “eagerness” there. If I were to mention, say, Brussels sprouts once every five years, would Mr. Wehner accuse me of being obsessed with that vegetable?
Let’s set aside the obvious irony — obvious to everyone but Derbyshire, that is — of having Derbyshire lecture anyone about sneering. I never said Derbyshire was “obsessed” with this matter — but clearly he was eager to express his views about his utter indifference to the death of many innocent people. Derbyshire now implies that his lack of compassion for Egyptians was because citizens like him were “so busy working for a living, caring for their families and friends, and worrying about the condition of their country that they have nothing to spare for the misfortunes of people in remote, unimportant places.”
Of course he was. Derbyshire’s empathy and mercy tank is empty; there is nothing to spare. Compassion fatigue takes a toll on us all.
5. Then there’s the matter of the Derbyshire put-downs like (but not limited to) this one:
Then there are some impertinent speculations concerning what I do and do not care about. I shall surrender here to the temptation that always comes over me when I am the target of sanctimonious bullying by self-congratulating prigs: Bite me, pal.
Perhaps at some point, Derbyshire will learn to distinguish crude, adolescent insults from witty ones. I would simply point out that Kathryn Lopez, Derbyshire’s colleague at National Review Online, rendered this carefully understated verdict on Derbyshire’s pieces: “I think the thread on President Bush, AIDS, and Africa took another unfortunate and unnecessary tonal turn this morning.”
John Derbyshire seems to have settled on a pattern. He makes bad arguments in callous ways and calls it conservatism. There are many things that might explain why Derbyshire says what he says; conservatism is not one of them.