Thanks for getting me up off my ass, simplicio. I just donated (a long over-due) $30 to SIAI and set up a monthly reminder to keep donating (if I have disposable income that month). And I’ll be keeping an eye out here for other pro-rationality suggestions.
A small criticism:
Make an appointment to give blood.
The United States and the European Union currently have unscientific and discriminatory policies that forbid gay and bisexual men from donating. Giving blood is definitely an ethical Good Thing, but it may not be something we would want to push as specifically associated with rationality.
Pardon my ignorance, but how the hell is this even enforced? “Have you had sex with another man?” “Um … no, no, of course not!” “Oh, okay then! Right this way! Make a fist...”
People who want to can walk right past such a ban, can’t they? (IIRC, some pro-gay-rights group even considered doing that.)
So what, then? Do they watch for men holding hands in the line to give blood? For guys in leather and big ’staches?
Okay, but even then, are they supposed to ignore evidence, so long the donor denies it on the form? Like, what if two flamboyantly dressed gay dudes get in line to donate while holding hands and making out, and then claim not to have had MSM sex. Does the technician have to say, “oh, well, guess they must be eligible”?
I asked about this at the blood clinic once. The answer I got was that the questionnaires are really secondary to blood testing, which is done on every donation.
The questionnaires simply
(a) weed out the people who are ineligible and honest about it (and there’s no salient incentive here for people to lie*);
(b) provide extra “risk factor” information on top of the tests.
Note that being gay, or having lived in Africa, are risk factors, but are not considered dealbreakers. Probably both in combination would be a dealbreaker though.
(*The only real incentive to lie here is social pressure, e.g., your whole office is donating and you don’t want your AIDS to be known about, which is controlled by allowing the donor to privately put a “No” barcode sticker on their sign-in form, which blindly disqualifies their blood without identifying them by name to any staff or patients present.)
I can believe such a ban would be ineffective if it was trying to keep people from something they were trying to get.
However, this is about banning people who are trying to give something, and who are presumably concerned with actually helping.
It wouldn’t surprise me if some men who’ve done MSM give blood anyway if they have good reason to think they aren’t infected and especially if they have rare blood types.
However, at least some people are habitually rule-abiding.
This is all hypothetical, though. I don’t know how reliably people obey the rules for blood donation, or how important all the rules are. The whole thing is on the honor system, and there are a lot of restrictions.
Did you evaluate inequivality P(D|NG)<=P(D|NO), where D=blood transmitted decease, N=blood test negative, G=gay+bisexual, O=others? What are the figures?
It seems pretty safe to guess that the inequality is reversed. But probabilities are not enough to answer the question. One must weigh expected costs and benefits.
A crude method, not of estimating any probabilities, but directly assessing the final decision, is to look at the existence of countries with different systems. That they have different waiting periods shows that the decision is not blindingly obvious. Moreover, since governments tend to be more sensitive to the publicity of concentrated harm, I would expect them to err in the direction of exclusion. That I have not heard of a recent Brazilian getting HIV from blood transfusion suggests that not only is their policy better, but that P(D|N) is unmeasureably low.
That just addresses the issue of HIV, which is what these policies that mention 1977 are about. One might worry that future diseases will appear first among gays. For this, it is much harder to determine the probabilities.
The United States and the European Union currently have unscientific and discriminatory policies that forbid gay and bisexual men from donating. Giving blood is definitely an ethical Good Thing, but it may not be something we would want to push as specifically associated with rationality.
What’s “unscientific” about a policy of not accepting blood donations from gay and bisexual men? Do you have a precise meaning of “unscientific” in mind?
If someone did a double-blind randomized study comparing disease incidence in countries that did or did not accept blood from game men, I’d very much like to hear about it.
The reasons given for the policy seem quite reasonable to me, and though of course I don’t know the ins and the out of medical risks associated with blood transmission and details on testing, I don’t see why it shouldn’t be associated with rationality (Apart from wedrifid’s comment on how these issues aren’t really about rationality, with which I agree).
Do you have a precise meaning of “unscientific” in mind?
I mean that they maintain practices, justified on scientific grounds, that are blatantly illogical.
If someone did a double-blind randomized study comparing disease incidence in countries that did or did not accept blood from game men, I’d very much like to hear about it.
Laying aside that blinding and randomization aren’t really necessary for statistical studies, I’d much rather see a study that compared the relative amounts of blood contaminated with sexually transmitted diseases across several countries with similar demographics and cultural trends, some of which refused to accept blood from gay men.
But we don’t always get the evidence we want, sadly, and so we must make do with what we have, much as the U.S. Department of Health and Human Services must.
Or, we can ignore the evidence entirely and look at whether HHS is even being consistent, which is an easier question to answer definitively. The current policy is that any man who has had sex with another man since 1977 is banned from donating blood for life. It is also current policy that any woman who has had sex with such a man is banned from donating blood for the next year.
I will leave identifying this failure of rationality as an exercise for the reader.
‘Giving blood’ and ‘the way blood donation is managed’ are very different things, and there’s only weak reason AFAICS to expect their rationality-values (in the rather different senses of ‘rational’ that apply to individual actions and to institutional processes) to be correlated.
Indeed. If a hypothetical blood boycott protesting these rules would do more harm, on balance, than alternative means of promoting public health policy reform, then giving blood is good thing to do, and our community should endorse giving blood — even though we might gnash our teeth at the apparent endorsement of discrimination or irrationality. We can clear our collective conscience, if need be, by explicitly noting that we think giving blood is a good idea even though there are problems with the way it is collected.
Similarly, if you want to donate a little money to a school in a poor community, and the only existing school teaches silly religious stuff in addition to valuable skills, you should probably still want to donate to that school.
Agreed. I would not propose a blood boycott, and I would likewise endorse giving blood, with no teeth-gnashing involved. I would even (reluctantly) endorse the current FDA standards if doing so could be expected to increase the amount of blood donated in a non-trivial way. What I would not do is endorse the current FDA standards as rational, especially in the context of a discussion about doing rational things.
If my objective is to promote rationality (and achieving ends I value ethically is also a consideration), I would want to instead endorse some activity or organization that is approximately as fuzzy but lacks current controversy over its willingness to adhere to scientific standards, noting that said controversy is still bad (given this particular objective) regardless of whether it is warranted. If I am concerned about the public perception and adoption of rationality, I should maximize for that value.
That the controversy centers around a standard that is both sub-optimal and needlessly discriminatory is merely gravy.
So, just to check, you’re concerned that endorsement of giving blood will inevitably blend over into, or be equivocated with, endorsement of the way blood donation works. Is that a fair description?
I agree that HHS’s policy is nonsensical. However:
The current policy is that any man who has had sex with another man since 1977 is banned from donating blood for life. It is also current policy that any woman who has had sex with such a man is banned from donating blood for the next year.
Just having different waiting periods isn’t inconsistent by itself. Adding another step in the epidemiological chain will decrease the likelihood of infection and thus may justify a shorter waiting period.
Adding another step in the epidemiological chain will decrease the likelihood of infection and thus may justify a shorter waiting period.
True, but not quite applicable. In the case of an MSM, the epidemiological chain begins when he has sex with an MSM. In the case of a woman, the epidemiological chain begins when she has sex with an MSM.
The criteria for joining those excluded groups are identically rigorous, and yet the rules for each are quite different.
True, but not quite applicable. In the case of an MSM, the epidemiological chain begins when he has sex with an MSM. In the case of a woman, the epidemiological chain begins when she has sex with an MSM.
Yes, but not all sorts of sexual acts have the same probability of HIV transmission. Those typically practiced within a heterosexual intercourse are far less likely (at least by an order of magnitude, perhaps even two) to result in transmission than those associated (at least stereotypically; not sure how often in actual practice) with sex between men.
(This is not meant to imply any overall judgment on the whole issue, merely to point out that different treatment of MSMs and women who have had sex with one does not by itself imply a logical inconsistency.)
Yes, but not all forms of sexual acts have the same probability of HIV transmission.
This statement is both true and the heart of the issue. It points out that talking about MSM in the first place is entirely unnecessary. If you look at the criteria for blood donation on the FDA’s website, you’ll see that three of the four listed prohibitions ban people who have engaged in certain activities like travelling or using potentially unsafe needles, whereas the fourth criterion bans a type of person: MSM.
Now, the only screening process for these factors relies on self-identification, as Silas Barta has incredulously highlighted. So, that self-identification screening process could include questions about specific risky sexual activities instead of sexual orientation, and those questions would have at least as much discriminating power as the current standard; if there are any women or straight men who also engage in those same risky sexual activities (anal sex, unprotected sex, anonymous partners, or whatever else), and there are, then such an activity-based screening procedure would be more effective than the one that screens for MSM.
There’s also another benefit to an activity-based policy: it would mean not discriminating against an already oppressed group. Discriminatory policies should be a last resort because of the possibility that they will have negative social effects (and it seems that this FDA policy reaffirms the common but incorrect belief that HIV is only a gay problem), not the first resort.
Rational processes don’t create or support standards that ae both needlessly discriminatory and inferior to obvious alternatives.
Now, the only screening process for these factors relies on self-identification, as Silas Barta has incredulously highlighted. So, that self-identification screening process could include questions about specific risky sexual activities instead of sexual orientation
And with a sane screening process, people might be more likely to answer the questions honestly, and thus the screening itself would be more accurate.
True, but not quite applicable. In the case of an MSM, the epidemiological chain begins when he has sex with an MSM. In the case of a woman, the epidemiological chain begins when she has sex with an MSM.
The criteria for joining those excluded groups are identically rigorous, and yet the rules for each are quite different.
There could be a difference, if on average, out of the population of people who have been with a MSM at least once, men on average have been with more MSM than women. The populations of exclusive MSM, and MSM who also sleep with women, may have different levels of risk.
Do you have a precise meaning of “unscientific” in mind?
I mean that they maintain practices, justified on scientific grounds, that are blatantly illogical.
I don’t see what’s unscientific, and I don’t see what’s illogical either. At best, they can be criticized for excessive caution, or a bad consideration of risks and benefits—but it’s no slamdunk.
This is an issue that I would very much like to work at, does anyone know of any particular venues for protesting these policies? Maybe directly e-mailing the red cross? The chance of changing these policies seems low and I wouldn’t be able to determine the value; but it seems like it would be a big plus for rationality in society.
The Red Cross doesn’t set that policy, and has actually suggested changing it. They seem to catch a lot of the blame for it, though, which I suppose isn’t surprising considering that they handle pretty much all blood donations in the country.
As Blueberry pointed out below, it’s a governmental policy problem.
Hah! There’s an idea for a major rationalist project: attempting to increase the extent to which governmental regulators of scientific practice are themselves scientific.
Thanks for getting me up off my ass, simplicio. I just donated (a long over-due) $30 to SIAI and set up a monthly reminder...
Glad to hear it!
The United States and the European Union currently have unscientific and discriminatory policies that forbid gay and bisexual men from donating.
Interesting… Here they ask you (if you’re male) if you were sexually active with other men in a certain timeframe, but I don’t think even a “Yes” answer to that totally disqualifies you.
Thanks for getting me up off my ass, simplicio. I just donated (a long over-due) $30 to SIAI and set up a monthly reminder to keep donating (if I have disposable income that month). And I’ll be keeping an eye out here for other pro-rationality suggestions.
A small criticism:
The United States and the European Union currently have unscientific and discriminatory policies that forbid gay and bisexual men from donating. Giving blood is definitely an ethical Good Thing, but it may not be something we would want to push as specifically associated with rationality.
Pardon my ignorance, but how the hell is this even enforced? “Have you had sex with another man?” “Um … no, no, of course not!” “Oh, okay then! Right this way! Make a fist...”
People who want to can walk right past such a ban, can’t they? (IIRC, some pro-gay-rights group even considered doing that.)
So what, then? Do they watch for men holding hands in the line to give blood? For guys in leather and big ’staches?
It’s self-enforced. You fill out a questionnaire and are asked to be honest. Yes, of course people who want to can walk past the ban.
Okay, but even then, are they supposed to ignore evidence, so long the donor denies it on the form? Like, what if two flamboyantly dressed gay dudes get in line to donate while holding hands and making out, and then claim not to have had MSM sex. Does the technician have to say, “oh, well, guess they must be eligible”?
I would be surprised if any organization had an official policy on this. It’s not frequently seen at blood donation sites.
Because it’s so easy for people who’ve MSMed to evade the ban. Which makes me wonder why epidemiologists dream it’s so effective.
I asked about this at the blood clinic once. The answer I got was that the questionnaires are really secondary to blood testing, which is done on every donation.
The questionnaires simply
(a) weed out the people who are ineligible and honest about it (and there’s no salient incentive here for people to lie*);
(b) provide extra “risk factor” information on top of the tests.
Note that being gay, or having lived in Africa, are risk factors, but are not considered dealbreakers. Probably both in combination would be a dealbreaker though.
(*The only real incentive to lie here is social pressure, e.g., your whole office is donating and you don’t want your AIDS to be known about, which is controlled by allowing the donor to privately put a “No” barcode sticker on their sign-in form, which blindly disqualifies their blood without identifying them by name to any staff or patients present.)
Thanks for the explanation!
I can believe such a ban would be ineffective if it was trying to keep people from something they were trying to get.
However, this is about banning people who are trying to give something, and who are presumably concerned with actually helping.
It wouldn’t surprise me if some men who’ve done MSM give blood anyway if they have good reason to think they aren’t infected and especially if they have rare blood types.
However, at least some people are habitually rule-abiding.
This is all hypothetical, though. I don’t know how reliably people obey the rules for blood donation, or how important all the rules are. The whole thing is on the honor system, and there are a lot of restrictions.
Did you evaluate inequivality P(D|NG)<=P(D|NO), where D=blood transmitted decease, N=blood test negative, G=gay+bisexual, O=others? What are the figures?
It seems pretty safe to guess that the inequality is reversed. But probabilities are not enough to answer the question. One must weigh expected costs and benefits.
A crude method, not of estimating any probabilities, but directly assessing the final decision, is to look at the existence of countries with different systems. That they have different waiting periods shows that the decision is not blindingly obvious. Moreover, since governments tend to be more sensitive to the publicity of concentrated harm, I would expect them to err in the direction of exclusion. That I have not heard of a recent Brazilian getting HIV from blood transfusion suggests that not only is their policy better, but that P(D|N) is unmeasureably low.
That just addresses the issue of HIV, which is what these policies that mention 1977 are about. One might worry that future diseases will appear first among gays. For this, it is much harder to determine the probabilities.
What’s “unscientific” about a policy of not accepting blood donations from gay and bisexual men? Do you have a precise meaning of “unscientific” in mind?
If someone did a double-blind randomized study comparing disease incidence in countries that did or did not accept blood from game men, I’d very much like to hear about it.
The reasons given for the policy seem quite reasonable to me, and though of course I don’t know the ins and the out of medical risks associated with blood transmission and details on testing, I don’t see why it shouldn’t be associated with rationality (Apart from wedrifid’s comment on how these issues aren’t really about rationality, with which I agree).
I mean that they maintain practices, justified on scientific grounds, that are blatantly illogical.
Laying aside that blinding and randomization aren’t really necessary for statistical studies, I’d much rather see a study that compared the relative amounts of blood contaminated with sexually transmitted diseases across several countries with similar demographics and cultural trends, some of which refused to accept blood from gay men.
But we don’t always get the evidence we want, sadly, and so we must make do with what we have, much as the U.S. Department of Health and Human Services must.
Or, we can ignore the evidence entirely and look at whether HHS is even being consistent, which is an easier question to answer definitively. The current policy is that any man who has had sex with another man since 1977 is banned from donating blood for life. It is also current policy that any woman who has had sex with such a man is banned from donating blood for the next year.
I will leave identifying this failure of rationality as an exercise for the reader.
If you refuse to participate in or associate with any activity that your government has illogical rules about, not much will be left.
I’m not proposing a boycott of blood drives. Just that they may not be something a community of rationalists should endorse as rational.
‘Giving blood’ and ‘the way blood donation is managed’ are very different things, and there’s only weak reason AFAICS to expect their rationality-values (in the rather different senses of ‘rational’ that apply to individual actions and to institutional processes) to be correlated.
Indeed. If a hypothetical blood boycott protesting these rules would do more harm, on balance, than alternative means of promoting public health policy reform, then giving blood is good thing to do, and our community should endorse giving blood — even though we might gnash our teeth at the apparent endorsement of discrimination or irrationality. We can clear our collective conscience, if need be, by explicitly noting that we think giving blood is a good idea even though there are problems with the way it is collected.
Similarly, if you want to donate a little money to a school in a poor community, and the only existing school teaches silly religious stuff in addition to valuable skills, you should probably still want to donate to that school.
See also: Your Price for Joining
Agreed. I would not propose a blood boycott, and I would likewise endorse giving blood, with no teeth-gnashing involved. I would even (reluctantly) endorse the current FDA standards if doing so could be expected to increase the amount of blood donated in a non-trivial way. What I would not do is endorse the current FDA standards as rational, especially in the context of a discussion about doing rational things.
If my objective is to promote rationality (and achieving ends I value ethically is also a consideration), I would want to instead endorse some activity or organization that is approximately as fuzzy but lacks current controversy over its willingness to adhere to scientific standards, noting that said controversy is still bad (given this particular objective) regardless of whether it is warranted. If I am concerned about the public perception and adoption of rationality, I should maximize for that value.
That the controversy centers around a standard that is both sub-optimal and needlessly discriminatory is merely gravy.
So, just to check, you’re concerned that endorsement of giving blood will inevitably blend over into, or be equivocated with, endorsement of the way blood donation works. Is that a fair description?
That’s nothing like what WrongBot said.
It’s not something I’ve specifically said, but I don’t think it’s an unreasonable inference from my stated position. It is also mostly true.
Yes, with the nitpick that I would say “likely” instead of “inevitably.” In terms of expected outcome, the two are similar.
I agree that HHS’s policy is nonsensical. However:
Just having different waiting periods isn’t inconsistent by itself. Adding another step in the epidemiological chain will decrease the likelihood of infection and thus may justify a shorter waiting period.
True, but not quite applicable. In the case of an MSM, the epidemiological chain begins when he has sex with an MSM. In the case of a woman, the epidemiological chain begins when she has sex with an MSM.
The criteria for joining those excluded groups are identically rigorous, and yet the rules for each are quite different.
WrongBot:
Yes, but not all sorts of sexual acts have the same probability of HIV transmission. Those typically practiced within a heterosexual intercourse are far less likely (at least by an order of magnitude, perhaps even two) to result in transmission than those associated (at least stereotypically; not sure how often in actual practice) with sex between men.
(This is not meant to imply any overall judgment on the whole issue, merely to point out that different treatment of MSMs and women who have had sex with one does not by itself imply a logical inconsistency.)
This statement is both true and the heart of the issue. It points out that talking about MSM in the first place is entirely unnecessary. If you look at the criteria for blood donation on the FDA’s website, you’ll see that three of the four listed prohibitions ban people who have engaged in certain activities like travelling or using potentially unsafe needles, whereas the fourth criterion bans a type of person: MSM.
Now, the only screening process for these factors relies on self-identification, as Silas Barta has incredulously highlighted. So, that self-identification screening process could include questions about specific risky sexual activities instead of sexual orientation, and those questions would have at least as much discriminating power as the current standard; if there are any women or straight men who also engage in those same risky sexual activities (anal sex, unprotected sex, anonymous partners, or whatever else), and there are, then such an activity-based screening procedure would be more effective than the one that screens for MSM.
There’s also another benefit to an activity-based policy: it would mean not discriminating against an already oppressed group. Discriminatory policies should be a last resort because of the possibility that they will have negative social effects (and it seems that this FDA policy reaffirms the common but incorrect belief that HIV is only a gay problem), not the first resort.
Rational processes don’t create or support standards that ae both needlessly discriminatory and inferior to obvious alternatives.
Yes, but I think his point was that the specific policy in question isn’t self-contradictory, not that it’s a good policy.
And with a sane screening process, people might be more likely to answer the questions honestly, and thus the screening itself would be more accurate.
There could be a difference, if on average, out of the population of people who have been with a MSM at least once, men on average have been with more MSM than women. The populations of exclusive MSM, and MSM who also sleep with women, may have different levels of risk.
I don’t see what’s unscientific, and I don’t see what’s illogical either. At best, they can be criticized for excessive caution, or a bad consideration of risks and benefits—but it’s no slamdunk.
This is an issue that I would very much like to work at, does anyone know of any particular venues for protesting these policies? Maybe directly e-mailing the red cross? The chance of changing these policies seems low and I wouldn’t be able to determine the value; but it seems like it would be a big plus for rationality in society.
The US Department of Health and Human Services just declined to change the policy this month.
Voted up for informative links!
The Red Cross doesn’t set that policy, and has actually suggested changing it. They seem to catch a lot of the blame for it, though, which I suppose isn’t surprising considering that they handle pretty much all blood donations in the country.
As Blueberry pointed out below, it’s a governmental policy problem.
Hah! There’s an idea for a major rationalist project: attempting to increase the extent to which governmental regulators of scientific practice are themselves scientific.
Glad to hear it!
Interesting… Here they ask you (if you’re male) if you were sexually active with other men in a certain timeframe, but I don’t think even a “Yes” answer to that totally disqualifies you.