A Diarrheal Parasite and the Duties of a Commercial Republic

A nation may learn much about itself not only from its parliaments and its palaces, but from its latrines. In the United States at present, an intestinal illness called cyclosporiasis has been detected in more than half of the states. Federal authorities report 843 cases of this complaint, caused by a parasite, with sufferers ranging from the very young to the very old. One state alone reports 177 cases in a single month. The disease brings not merely discomfort but dehydration, hospital visits, and lost days of work. The spectacle is undignified; the consequences, for those who live from week to week, are severe. The cost is paid in weakness and wages, not only in doctors’ bills.

We are told that outbreaks of this parasite have been associated, on various occasions, with raspberries, basil, cilantro, snow peas, lettuce. Here is the division of labour in its most appetising form and its most alarming. In my own day, when I described the pin-maker in The Wealth of Nations, I admired how many hands combined to fashion a single, simple object. Now as many hands, scattered over many fields and warehouses, combine to lay a salad upon a clerk’s plate in Ohio, or a labourer’s in Texas. The same arrangement that multiplies the plenty of the table multiplies the possible points of contamination. An extended market refines the palate; it also complicates the tracing of a parasite.

In such a system each person acts, as he always has done, from a sober regard to his own interest. The grower wishes to sell more herbs, not fewer; the merchant would rather his customers return, than be confined with nausea; the shipper prefers regular contracts to scandal. They will, therefore, listen politely to exhortations about hygiene, and then calculate. If cleanliness and testing are cheap and reputation dear, they will be diligent; if cleanliness is dear and the probability of detection low, they will be negligent. Any public health scheme which requires unusual virtue in ordinary traders is framed upon a false view of human nature; it must instead contrive that safety and gain march together.

This is where the state, in a commercial society, has work that no private undertaker can profitably perform. When I wrote in The Wealth of Nations that the sovereign owed to the people certain duties—defence, the exact administration of justice, and public works and institutions which would not repay the expense of any individual—I did not then know of microscopic parasites; yet I knew that drains, streets, and schools were not to be left to the accident of private zeal. The quiet labour of disease surveillance, the humdrum inspection of water and produce, the investigation of 843 cases scattered across 31 states, are of this nature. They are costly to maintain, invisible when they succeed, loudly blamed when they fail, and therefore ill-suited to the calculus of profit.

Yet we ought to distinguish carefully between the necessary authority of such institutions and the convenient pretensions of those who trade under their shelter. Whenever merchants or growers propose regulations in the name of safety, the most suspicious attention is required. Rules that truly protect the public will generally be open, proportionate, and no respecter of persons. Rules that require expensive certification that only the largest firms can afford, that forbid small rivals the very practices long tolerated in giants, or that close foreign competition on the pretext of a single outbreak, have the scent not of sanitation but of monopoly. People of the same trade seldom meet to discuss a parasite without discovering also some means to fatten their own profits.

The impartial spectator, that internal judge whose sentiments I tried to describe in The Theory of Moral Sentiments, would ask, in such an affair, whose suffering weighs in the balance. He would see old people and young children weakened by dehydration, workers losing wages to days in bed, overburdened nurses and physicians, all for a luxury that might have been made safer by moderate foresight. He would see, too, the temptation of some officials to declare the matter exaggerated, and of some advocates to proclaim it apocalyptic, each pursuing reputation rather than truth. He would not demand perfection—parasites, like human follies, will never be wholly banished—but he would insist that the burdens of improvement fall first on those best able to bear them, not upon the labouring poor.

There will be enthusiasts who respond to this outbreak with a grand design: the entire food system to be rearranged upon their model farms or their favourite technologies. They resemble the man of system, who imagines the people to be so many pieces upon a chess-board, and forgets that each piece moves by its own principle. We should rather seek reforms that work with these motions: liability rules that make negligence unprofitable, information that allows buyers to reward cleanliness, public laboratories that lower the cost of proper testing. These are modest contrivances, but experience suggests that modest contrivances, steadily pursued, do more for human health than magnificent projects, briefly applauded and quietly abandoned. A rich nation proves its wisdom not by the splendour of its schemes, but by the sobriety of its drains.