In the comments to the XDR-TB update post, Scott suggested that bloggers were putting too much emphasis on whether the TB patient was stupid/arrogant/self-centered/whatever, and later that "waxing indignant is pointless." I started this as a response to those comments, but thought instead it might be an interesting conversation--is it pointless? Certainly indignation about this guy's behavior won't change what's happened. Indignation about creationists' abuse of science won't make them stop. Does it have a point? My thoughts on it below the fold.
So, my thoughts. I think there certainly is a place in science for "just the facts, ma'am," without any personal spin and minimal interpretation or emotion thrown in. The ordinary scientific literature is largely a place for this--rather dry, few personal anecdotes, certainly not a lot of accusations of stupidity (or if they are, they're couched in really, really polite language). I don't think a blog is the place for this, and especially with stories like this, I don't feel that they need to be devoid of indignation.
Thing is, my writings on the TB case aren't just about the science. Because it's a public health matter, it's also about the policy--how we deal with the potential spread of this pathogen, what we do when someone like this guy doesn't care about the well-being of others and puts his own trivialities before the health of others. How do we deal with that, as scientists, as public health workers, as government officials and law enforcement agencies, as private citizens? How do we go about making a plan? This should be rooted in science--looking at history to determine the best ways to enforce quarantines, looking at epidemiology and clinical microbiology to determine how long to isolate a patient, how to determine if they're infected and infectious; relying on biochemistry and pharmacy to provide us with chemicals to kill, treat, or prevent these illnesses in the first place. But they necessarily involve a human element as well, that can't be measured simply and that isn't inherently scientific.
For people to want to take action, for people to care about things like this, I think some indignation is necessary. A patient with TB is an abstraction. something most of them have probably not thought about prior to this story. But people have loved ones, and people want to keep those loved ones safe. I think about this joker on a plane, and picture him sitting next to my kids, breathing near them, potentially spreading a highly deadly bacterium around with no regard for who he may be harming. I think of him unknowingly being near my friend's dad, still immunocompromised after chemotherapy and susceptible to all manners of infectious disease. And yes, I get indignant.
I'm not saying we should try to coerce people on matters like these, or to purposefully play to sympathy, or outrage, or other emotions. But this is a medium where we can express opinions along with the science, to show how it's relevant to one's everyday life, to show what its impact either is or could be. Science isn't done in a vacuum, and good science can--and should--underlie good policy, and a bit of indignation every now and then just may have the effect of getting someone out of their chair and up to take action.
Indignation is a perfectly good response. There are times when one HAS to travel. I had chicken pox at age 21, was far away from home, and I had to get back. But I didn't start the journey sick, and I took what care I could not to cause trouble to others.
But to deliberately inflict one's microbes on others, if you have ways to avoid it, is rude. To deleberately circumvent no-fly-lists as this guy did, is malice aforethought. Indignation is a good response, and may be more effective than arrest and confinement in the long run.
Indignation is essential in this case. Communication between human beings isn't just about "the facts" ma'am. When we feel threatened by the poor decisions of others, it must be communicated. Angry, frustrated language and posturing make those points much more clearly than the facts.
Silly humans, what's the point of expressing emotions?
I'm not saying we should try to coerce people on matters like these, or to purposefully play to sympathy, or outrage, or other emotions.
Ummm, why not? Really, when we have truth and right on our side, the thing to do is to just keep hammering it home. The mass consciousness or zeitgeist or whatever you call it, is hard to turn around or get through to. But it can and does get done. We saw this with HIV/AIDS. The message was safe sex, behavior modification, condoms and so on. And eventually it worked. AIDS is present at a low level in the USA but it is at least stable and isn't increasing any more. In countries where this hasn't happened, it is still raging out of control and spreading. Ditto, smoking tobacco. Finally this vice is dying out because of education and changes in social norms.
If one just keeps reiterating the issues, for a long time it looks like nothing is happening. But humans are social group living creatures and most are responsible and responsive to the social norms. People can be stupid, but not all people are stupid all the time. For many issues, the message is, "Never give up."
I doubt after the PR and this guy is now in federal custody, that the next XDR TB patients are going to shrug their shoulders and go on around the world vacations with their families.
In the case of creationists, it's not the science that is the most important thing for them to get right...it has nothing to do with science/creationism in many cases. I was once debating someone about creationism by email for months. At one point she said something that made me understand. I can't remember for sure what I was explaining to her (maybe something about why the Grand Canyon isn't only 4000 years old or the moon dust thing or some other claim...and this was before the Index of Creationist Claims)... She said "I find it easier to believe the way you explain it, but I don't." What! Huh! There was something more important to her. Her salvation...her eternal soul...and everything that that entailed. If she thinks that believing in anything a godless, atheistic, scientist would tell her would jeopardize her salvation, then she wont. It's as simple as that. I doesn't matter where the evidence leads, or even if it's right in front of her face...you don't play around with something as important as your eternal soul.
In the case of the American who found himself in the Republic of Georgia with XDR-TB, he believed his salvation was in the America with the American medical system.
Qui tacet consentire videtur.
What Raven said!
Indignation makes it known to other members of the public that the traveler's brand of self-absorption is not okay. It's especially important to establish the social norm now, before traveling while seriously infectious becomes something "everybody" does. I wish public health people weren't so skittish about stepping out and saying certain behaviors are flat out WRONG.
I think indignation is silly and most undignified for a scientist, pardon the pun. In fact, it may be a little pompous to assume that that CDC could be assumed to know what it was talking about to the point of freezing someone's movements with a long-distance phone call. The guy wasn't even feeling sick, some doctor found a spot on his lung. I don't know enough detail to say whether his behavior was 'irresponsible' but, as you point out, it was probably a pretty standard human reaction to his situation. I would say lighten up. If we have a TB epidemic on our hands, it isn't his fault.