A World in Shadow I

The New York Times recently ran a series, titled “Diseases on the Brink“, that surveyed five diseases – polio, measles, dracunculiasis (also known as guinea worm), blinding trachoma and lymphatic filariasis – that it may be possible to eradicate, if the political will of the world community is up to the task. All these diseases can be treated with relatively simple measures, and have been wiped out or nearly so in industrialized nations thanks to improved sanitation and vaccination, but remain endemic in the Third World. All of them are also notable for their effects, which can include lifelong debility, disfigurement, or both.

While polio and measles will likely be familiar to readers, the other three may not be. Guinea worm was discussed in the Ebon Musings essay “All Possible Worlds“, to which I direct interested readers (although a strong stomach is advisable).

The other two are equally revolting in their effects. Blinding trachoma is an eye infection caused by the same microorganism that causes chlamydia, Chlamydia trachomatis. Spread from person to person by flies or by contact with infected individuals, the disease causes the sufferer’s eyelid to turn inwards, painfully scraping the eyelashes over the surface of the eyeball with each blink. If not treated, the corneal scarring this causes eventually leads to total blindness. The World Health Organization estimates that 70 million people worldwide are infected with trachoma, with infection rates as high as 86% in countries such as Ethiopia, and as many as 5 million suffer from the late-stage trachoma that ultimately causes blindness.

The Times’ description of how the disease is spread:

Swarming Musca sorbens flies play an ignominious role in spreading the disease. They crave eye discharge and pick up chlamydia as they burrow greedily, maddeningly into infected eyes.

recalls Mark Twain’s description in the essay Thoughts of God, where he imagines God giving the fly its marching orders:

“Depart into the uttermost corners of the earth, and diligently do your appointed work. Persecute the sick child; settle upon its eyes, its face, its hands, and gnaw and pester and sting; worry and fret and madden the worn and tired mother who watches by the child, and who humbly prays for mercy and relief with the pathetic faith of the deceived and the unteachable. Settle upon the soldier’s festering wounds in field and hospital and drive him frantic while he also prays, and betweentimes curses, with none to listen but you, Fly… Harry and persecute the forlorn and forsaken wretch who is perishing of the plague, and in his terror and despair praying; bite, sting, feed upon his ulcers, dabble your feet in his rotten blood, gum them thick with plague-germs… carry this freight to a hundred tables, among the just and the unjust, the high and the low, and walk over the food and gaum it with filth and death. Visit all; allow no man peace till he get it in the grave; visit and afflict the hard-worked and unoffending horse, mule, ox, ass, pester the patient cow, and all the kindly animals that labor without fair reward here and perish without hope of it hereafter; spare no creature, wild or tame; but wheresoever you find one, make his life a misery, treat him as the innocent deserve; and so please Me and increase My glory Who made the fly.”

Filariasis, by contrast, is caused by parasitic worms whose larvae are spread by mosquito bites. Inside the body, the worms grow to adult form, up to four inches long and as thin as hairs, and take up residence in the lymph nodes. They obstruct the vessels that allow lymphatic fluid to flow properly, causing it to pool in the body’s lower extremities – the legs, feet, and for men, the scrotum – and producing a grotesque swelling called elephantiasis. (The scrotum of an infected man can swell to the size of a basketball.) Even besides the pain and humiliation this condition causes all by itself, it can lead to fevers, sores and infected ulcers of the skin. Victims can be left literally unable to walk. The worst part is that, even if the parasite is killed by anti-worm medications, the swelling is permanent, because the overstretched lymph nodes do not shrink to their former size.

The suffering caused by these diseases is beyond description. Why, then, do theists praise the goodness of the God whom they believe created them? If a human had created one of these pathogens and released it into the wild, he would be reviled as one of history’s greatest villains. But when God is held to be the cause, believers sing hymns of praise to his name and proclaim his infinite goodness. Few of them even seem aware of the discrepancy, and those that are aware typically appeal to patently unsatisfactory evasions such as proclaiming it a “mystery”.

An atheist, on the other hand, faces no difficulty in explaining these pathogens. As with every other species, they came about through evolution, which like all natural processes is neither morally good nor morally bad and does not take human needs into account. These species have adapted to prey on human beings, and so long as they continue to gain reproductive advantage by doing so, they will continue to torment us. If we ever want to eradicate them, we must use our faculties of reasoning, themselves the product of evolution, to better understand how nature works so that we may control it to our benefit.

But more than that, we must come together and work for the outcome we desire to see. The most effective cure in the world is nothing if there are not people willing to distribute it. Prayer and other appeals to the supernatural are worse than useless, in that not only do they achieve nothing in and of themselves, they draw time, effort and attention that could otherwise have been spent on useful tasks such as vaccinating another child or treating another contaminated pond. Witness the abject and pitiful superstition some families turn to in lieu of effective treatment, quoted from the measles article:

The swami, Grishm Giri, 82, his long white beard hanging halfway down his stained tunic, explained that last year had brought twice the usual number of measles cases. He waved a staff of peacock feathers over each child and chanted prayers, collecting about 12 cents from each family.

His assistant, Niraj Giri, a middle-aged man in a saffron-colored shirt, measured the distance from the children’s navels to their nipples with a string. “We try to find out if the center of the navel is in the right place,” the assistant said. “If it is not, we correct it.” He explained that this displacement of the center is the real cause of disease, a problem that can be fixed through the nerves by hitting the bottoms of a person’s feet.

Among those waiting for help was Ram Pukar, a rickshaw driver, holding his 6-year-old daughter, Sujita, who was so sick her head lolled from side to side. Her long black hair hung like a matted screen across her face.

(Note that 12 cents is almost exactly the cost of the measles vaccine. What good could that money have done for this poor family, rather than being wasted on the ignorant posturings of a charlatan?)

Worse, sometimes superstition directly interferes with the genuinely effective efforts. The article on guinea worm discusses a rural village that refused to let international workers treat its contaminated pond with a mild pesticide that kills the worm’s larvae, because the pond is “sacred” to them. Similarly, the polio vaccination program has run into intense difficulties because some Muslims believe the vaccine is part of a Western plot to sterilize them, or because Muslim families refuse to let male strangers enter the household if the husband is away.

If we are ever to wipe out these scourges, we need to overcome the distracting and stubborn superstitions that stand in the way of true cooperation. It can be tempting to let people who refuse effective help in favor of superstition suffer the consequences of their folly, but compassion demands a higher standard – if for no other reason, then for the sake of the children and other innocents who do not deserve to suffer for the irrational beliefs of others, and who have a chance to grow up into a future free of diseases both of the body and of the mind. For the time being, this is still a world very much in shadow, but if the human community can truly come together to work for what is good, then we have a chance at inheriting a future full of happiness and light.

Other posts in this series:

About Adam Lee

Adam Lee is an atheist writer and speaker living in New York City. His new novel, Broken Ring, is available in paperback and e-book. Read his full bio, or follow him on Twitter.

  • Quath

    Interesting as always. I often wonder if we should force our will upon others to accept our morality. In some ways I think we should (such as forced vaccinations) but I worry because forced morality (or safety) can be an abused power (Inquisition).

  • Philip Thomas

    The test is whether or not we are doing harm to others by refusing to force our will upon someone: forced vaccination is accepatable because of the danger to this and future generations if the disease persists. Harm to others must be thought of in strictly this world terms: any theories about the afterlife are not relevant. (The Inquisition was based on the theory that its victims would go to hell if they were not made to recant).

    As for God (if he exists), if he could have made the world so that there was less suffering, he would have.

  • http://www.patheos.com/blogs/daylightatheism/ Ebonmuse

    In theory, I agree that whatever harm may be caused by mandating vaccination is less significant than the potential consequences of not doing so. However, as a practical matter, it just isn’t possible to force vaccination on large groups of people who don’t want it done to their children – the resources are barely there even if we assume full consent by everyone. If we hope to wipe out these diseases, we have to convince people that it’s for the good, even if this means, as it tragically does, that more children may suffer and die because of their parents’ superstitious beliefs.

  • SpeirM

    Most people hold to at least a few moral precepts that they think are so important that others should be forced to go along. Naturally, they have the good of the whole at heart. (At least, some of them genuinely do.) As has been mentioned, the Inquisition was an especially egregious example of this. That’s why this kind of talk rattles me a little, even when I happen to agree with the moral principles in question. The reason is simple: while I don’t have faith in God, I don’t have faith in my own infallibility, either.

  • Azkyroth

    That’s why this kind of talk rattles me a little, even when I happen to agree with the moral principles in question. The reason is simple: while I don’t have faith in God, I don’t have faith in my own infallibility, either.

  • Azkyroth

    Where did the rest of my comment go, I wonder? *blinkblink*

    Back buttons are your friend.

    The principle here is that unnecessary suffering should be prevented. This being a fundamental element of compassion and empathy and hence of human psychology, to the point where it’s trivially self-evident at an intuitive level, it seems like a pretty safe bet…

    Note that unlike the principles on which the Inquisition operates, the factual components of this principle are readily verifiable (humans react in certain ways to certain types of stimuli, we call these ways “suffering,” we don’t wish to experience suffering ourselves if at all possible, other humans are “like us” in a relevant way).

  • SpeirM

    I couldn’t agree more that it’s self-evident.

    Even so, it isn’t evident to everyone. It never will be. Some people sincerely believe there are considerations that transcend human suffering. To us that’s an outrage. They’re outraged that we’re outraged. So we should force our morals on them?

    Actually, maybe. But we need to realize what we’re really doing is forcing our beliefs on them. We don’t like to think that way, but it’s true. No matter how learned, no matter how bright, there will always be things that lie just beyond the horizon for us. The Earth is warming, but I have to take somebody’s word for it. I can look at their data, but what assures me it’s not all made up to some nefarious end? Because I’m not a scientist, global warming can never be more than an article of faith for me. Same with evolution. From what I’ve seen, the evidence for it is overwhelming. But, again, I’ve never handled the fossils, and wouldn’t know how to interpret them if I could. The supporting findings of allied fields also throw evidence at me that I can’t verify firsthand. So, I have to take evolution largely on faith.

    More than we’d like to admit, we believe rather than know. It’s a survival mechanism. We have to assume certain things so we can plan ahead. For some of those things it’s important to our survival as a race that we form a consensus. And yet, the race as a whole will never agree about things that lie just outside our grasp. (How often have I seen heated debates right here over topics lying closer at hand? Clearly, reason doesn’t assure consensus.)

    Now, maybe we should enforce medical treatment that has been shown to work. But we must take into consideration that we’re likely trampling on the rights and beliefs of some people. Unless we want to become the tyrants many believers suspect we would become given the chance, we’d better step lightly.

  • Gathercole

    I agree with Adam that there is a great temptation to say “fuck you” to people suffering because of their ignorant bullheadedness. But how should we convince them? Are there ANY reliable ways to deconvert even a single person, much less an entire community? In most cases, it may turn out to be a dilemma of forced vaccination or nothing. If the risk to us is great enough, we absolutely should engage in forced vaccination, however rude people may believe it to be. Eliminating suffering trumps politeness.

  • Philip Thomas

    Unescessary suffering by others, yes. If it is merely a question of the individual suffering whom you are considering whether to force, then we should respect their free will, assuming they are capable of exercising such (not insane, for example).

    The Inquisition has now ceased to operate…

  • Azkyroth

    I believe Adam addressed this, tangentially, in his “Rule the World” essay. Basically, yes, religious people should be allowed to refuse vaccines for themselves. They should not be allowed to refuse vaccines for their children. As I’ve argued elsewhere, appealing to freedom of conscience and freedom of religious belief no more protects allowing one’s children to die or suffer horribly from completely treatable conditions than it protects human sacrifice.

  • SpeirM

    “…appealing to freedom of conscience and freedom of religious belief no more protects allowing one’s children to die or suffer horribly from completely treatable conditions than it protects human sacrifice.”

    I agree with that. So do our laws, and for good reason.

    I just see a lot of allied issues where the same rule of thumb could be applied with less favorable consequences. For instance, many in the atheist/agnostic/whatever community see all religion as a great evil, just another kind of disease. Aren’t we agreed the world would be a better place without it? Are we justified in preventing parents from inculcating their children with this evil? Would we if we had the power? Given plenary power, what steps would we take to prevent it; indeed, to stamp out religion altogether? Some could easily justify atrocity this way. (And have, by the way.) That was my point about bringing up faith and making decisions for others based upon it: not only religionists function that way.

    Yes, I know I’m talking about a slippery slope. But we worry about such things because, in common experience, slopes do indeed become slippery. It’s not always a fallacy.

    We’ve got to draw the line very clearly and resolve not to cross it. Even then I’d worry for the simple reason that someone would eventually come along who would not respect that line.

  • andrea

    IMO, it comes down to would you let an ignorant child burn themselves on a hot flame that *you* know will burn them? It’s very much the same as letting idiots refuse vaccines. You would swat their hand, or ignore their beliefs, for the greater good.

    There was a story in a Smithsonian Magazine a few months back. The Amish have all sorts of genetic diseases since they are such an inbred culture, some which are ameliorated with early detection. They’ve finally gotten a small clue and are now allowing genetic testing. However, would you force this testing on a population that didn’t want it, even if it saves the lives and suffering of children? How far does a “right” to believe in nonsense go? It’s not a belief that the vaccines, blood transfusions, etc work, it’s a fact, no matter if you did the research yourself or not.

    And religion isn’t a disease. It’s a tool. And in many hands, it’s misused. But it has done some good.

  • Philip Thomas

    When someone refuses a vaccine, he increases the danger to all (depending on the nature of the disease) When someone persists in a wrong opinion, he is not (necessarily) increasing the danger to others- certainly the case is less clear cut. Actually the most recent example of contentious vaccines I can think of is not religous: here in the UK the MMR Vaccine (Measles, Mumps, Rubella), is given to children under 5. However, there were some scare stories that children who had been vaccinated were developing autism, and so some parents refused the vaccine for their child: in some parts of London this took place on such a scale that Measles is now once again a serious threat…

  • EnigmaOfSteel

    I think it is important to consider how vaccinations function in groups, what the risks are for the group in which you belong, as well as the potential side effects of a particular vaccine, before arriving at a decision to inoculate oneself or child. For this reason, I do not support a mandated vaccination scheme, at least not in the USA as things now stand. Although I can envision a situation where this could be supported.

    Vaccinations protect groups by preventing contact through spreading in populations. Most vaccines are not 100% effective at preventing the disease, but by inoculating a certain percentage of the population, the disease is prevented from spreading. Some in the group can still get the disease, whether or not they are vaccinated, but the likelihood is severely reduced, since contact is diminished. This is why if some in a group are not vaccinated, the risk can be negligible. Although at a certain point the risk does become significant, as we have seen in some countries where vaccination rates have fallen below a certain percentage of the population, allowing the disease to spread.

    So from a risk point of view, the case cannot be made that every person needs to be vaccinated from all diseases, only that a large percentage of a group should be vaccinated from targeted diseases. One then needs to decide who should be vaccinated, and from what disease the person should be vaccinated. For example, some people have a family history that indicates negative reaction to certain vaccinations, one reason the doctor usually asks about this prior to inoculation – or should. There may be a case where a particular vaccination should not be given to a child. Depending on the group and vaccination level, the risk is negligible, and in fact the risk of giving the child the vaccination could be worse than not giving it.

    There is a reason why we are not all vaccinated for the many diseases that exist in parts of Africa. We are not part of that group, unless we live in or become part of that group through travel in that population. Then we usually get inoculated. We have to look at the particular group and then determine the risk of vaccination. For example, given the polio risk in the USA seven years ago, when the live vaccine was still in use, I would not have vaccinated my child with that vaccine. This is because the risk of getting polio from that vaccine was greater than getting it from that particular population.

    It should be evident that the issue is not simply one of vaccinating everyone, but of looking at groups and assessing risks. We vaccinate based on our risk group, taking into account that not all need to be vaccinated to protect the group, and that at the individual level some may have a valid reason not to be vaccinated.

  • SpeirM

    “And religion isn’t a disease. It’s a tool. And in many hands, it’s misused. But it has done some good.”

    Believe it or not, I tend to agree. My comments were directed toward a common attitude among atheists, et al. We all know religion can be very, very bad. (It can put disease to shame sometimes for the harm it does.) But, like you say, it’s done a lot of good. It might even be averred that’s it’s done good that nothing else could have accomplished.

    In fact, I sometimes get on the nerves of the unbelieving community by suggesting that not only is religion unavoidable, it’s probably necessary. Some of my comments about faith among non-religionists above were toward this end. There’s got to be something that unites us in a common cause. We have to be able to form consensuses about some things that aren’t empirically provable. There are times when we just have to say, “This is the truth,” even if we can’t support it to everyone’s satisfaction. Call it something else if it suits you, but, by definition, that’s faith; or, rather, faith is required to accept it. Thus, at some point we return to something very like religion, theistic or not.

  • lpetrich

    Here is a good candidate for eradication: sexually transmitted diseases. Almost all of them have no nonhuman hosts, so they would be vulnerable in the way that smallpox is. The bacterial ones can be cured with already-existing antibiotics, but the viral ones would require vaccines. There is a vaccine in the works for Human Papilloma Virus, but it has been obstructed by those who feel that it would allow people to get away with their sexual sins.

    Which makes me wonder if certain people would have similar objections to other large-scale efforts to control STD’s — and if certain people would mourn the success of such efforts.

    I’m reminded of

    In America the earthquake of 1755 was widely ascribed, especially in Massachusetts, to Franklin’s rod. The Rev. Thomas Prince, pastor of the Old South Church, published a sermon on the subject, and in the appendix expressed the opinion that the frequency of earthquakes may be due to the erection of “iron points invented by the sagacious Mr. Franklin.” He goes on to argue that “in Boston are more erected than anywhere else in New England, and Boston seems to be more dreadfully shaken. Oh! there is no getting out of the mighty hand of God.”

    The full story: Andrew Dickson White on Ben Franklin’s Lightning Rod

    ADW mentioned elsewhere in that book that it used to be common to believe that various diseases were God’s punishment for people’s sins, and that to try to cure or prevent them was thwarting God.

  • lpetrich

    SpeirM’s position on religion is to me, at least, the royal-lie theory of religion, after the advocacy of that position in Plato’s dialogue Republic. Plato advocated banning his society’s official religion, Hellenic paganism, from his Republic, because to him it was full of bad examples like heroes lamenting and gods laughing. And in its place was an official religion, which he called a “royal lie”, a religion which was carefully designed to make that Republic’s citizens accept the legitimacy of that Republic’s rulers.

    I would not want to dismiss the royal-lie theory of religion out of hand, but I think that one ought to be honest about it, as Plato had been.

  • Philip Thomas

    Well, what SpeirM is suggesting isn’t necessarily false, you know. Maybe there is some sort of Universal Moral Code which people should be told about. Adam certainly seems to think so…and one of the truths of the code is that you should accept the legitimacy of your rulers, where this is compatible with the rest of the code. Now I grant you that doesn’t sound very religous, but give it five minutes exposure to the world and it will acquire religous connotations soon enough.

  • SpeirM

    Unless I’m mistaken, Plato was talking about a deliberately contrived religion. Those tend not to work. (Coming immediately to mind are the French religion of the Revolution and Communism, which was, at least, a religion stand-in.)

    No, unless a belief system grows from the ground up, it’s not likely to last long. Often there’s a Mohammad or Joseph Smith to act as a nucleus, but the pearl comes by the work of many others. It lives on because it fills a need (which, by the way, is no evidence there’s any transcendent truth in it). It shapes itself as it grows to better meet that need, such that after a few generations the founders would hardly recognize it. You really can’t impose that kind of thing from above and expect success, for the same reason you can’t say, “Believe this,” and expect people to really do so.

    But all this is getting off track as to the topic. I just us to recognize that we, too, have our beliefs. We’d better think long and hard before pressing those beliefs on people who don’t see things the same way. (Which, of course, is not to say that we never should.) I fear tyranny. I don’t don’t care whether it comes by way of Fundamentalist Christians or Muslims or Atheists. Because I’ll tell you this: I’ve run across many an atheist who would make impositions that I would find intolerable. Others speak against religion with such mad vehemence that I would as much fear them gaining power as I would theocratic Christians. If it ever came to that, expect to find me standing on the believers’ side of the road, pitchfork in hand. No, I could never be one of them, but I’d defend their right to be wrong.

  • EnigmaOfSteel

    Unless I’m mistaken, Plato was talking about a deliberately contrived religion. Those tend not to work. (Coming immediately to mind are the French religion of the Revolution and Communism, which was, at least, a religion stand-in.)

    Is there some supernatural component of communism that I am unaware? Otherwise I do not view communism as a religious stand-in. A key element of religion is that it involves people making decisions based on supposed supernatural forces. The actions of the religious can be highly problematic when they are guided by a supernatural force, because they may not be open to rational argument. By contrast, if one does not agree with the communist, one can have a rational argument of why certain aspects of that social system are wrong, without the communist justifying his/her position by invoking a supernatural force. That is a big problem with religion – how can you argue with a supernatural entity.

  • SpeirM

    “Is there some supernatural component of communism that I am unaware? Otherwise I do not view communism as a religious stand-in.”

    Well, in the first place, I don’t know that I’d say religion has to involve the supernatural.

    But I used “stand-in” deliberately. Communism served in the place of a religion. It involved central tenets to which one must hold. It required a belief that the State knew better than the individual. Thus, the State took the place of deity. Believing could get you rewards; disbelief, punishment. It had its own code of ethics. In these ways it provided the cohesion–like a religion–that motivated masses of people in one direction, toward one goal. So, yes, I see it as at least an ersatz religion.

    We always argue that atheism isn’t a religion. I agree. It’s no more a religion than is theism. Theism itself isn’t a religion, but beneath it are many religions. Likewise, although atheism itself isn’t a religion, beneath it are many belief systems that function very much like religions. Because atheism is so particulate–each of us has his own variety–we tend not to label these “religions.” Communism was (is) an exception to that general rule.

  • Azkyroth

    Not to mention the fact that many communist states (particularly the USSR and China) developed what were essentially national cults surrounding a heroic founder-figure and supreme leader, to whom superhuman moral and intellectual qualities were implicitly or explicitly ascribed. Communist ideology is often accepted and advocated in a dogmatic fashion, and in states where its adherents have gained control of the government, they have gone on to violently suppress dissent, doubt, and competing belief systems, as is the case with virtually every religion ever invented.

  • EnigmaOfSteel

    Well, in the first place, I don’t know that I’d say religion has to involve the supernatural.

    I define religion as involving the supernatural, and that does seem to be the generally accepted definition. There is usual some faith in a supernatural existence or force, usually a type of deity. How the religious practitioner chooses to act depends on the supernatural force, and the impact in this world may be slight to severe. The definition of religion simply becomes meaningless if you open it up to any kind of belief – aka I believe the earth is round based on scientific evidence, but could conceivably be wrong, maybe I am the victim of a computer experiment ala The Matrix, thus I am practicing religion. That is why I do not support your extension of belief in an attempt to equate.

    But I used “stand-in” deliberately. Communism served in the place of a religion.

    I don’t agree that communism served in place of religion as you suggest. The state did not take the place of a deity. A deity is supernatural the state is not. If a god issues an edict, it’s an argument between god and man. If the state issues an edict, it is issued by humans (who are the state) and is an argument between humans if they disagree.

    And so also I do not agree that under atheism is a belief system that functions like religion. There is a significant distinction, in that religion involves action based on a supposed existence of a supernatural force. By contrast the atheist acts based on evidences in this world. There is no supernatural mover that needs to be taken into account.

  • http://www.patheos.com/blogs/daylightatheism/ Ebonmuse

    Okay, everyone – I appreciate your contributions, but this discussion is drifting far afield from the original topic of the post, so I’m closing comments for now. Please don’t let me discourage you from continuing it via e-mail if you’re so inclined.