Bioethics, healthcare policy, and related issues.
Goldman Sachs has just issued a helpful report for the insurance industry, identifying the profit potential for them in various likely outcomes of the current healthcare access reform initiative. Their conclusion: the best thing for the insurance companies is no reform at all, followed by the weakest possible reform; the worst thing for them is real reform with universal access and a publicly-backed plan option.
In other words: the current disaster of a system is the one that provides the greatest possible profit potential to the insurance industry; any effort at increasing access to care is against that industry’s interests, and a robust and successful reform effort is the worst possible thing from an industry whose profits are entirely dependent on charging the highest possible premiums and delivering the least possible care.
The Senate Finance Committee bill, which Goldman’s analysts conclude is the version most likely to survive the legislative process, is described as the “base” scenario. Under that legislation (which did not include a public plan) the earnings per share for the top five insurers would grow an estimated five percent from 2010 through 2019. And yet, the “variance with current valuation” — essentially, what the value of the stock is on the market — is projected to drop four percent.
Things are much worse, Goldman estimates, for legislation that resembles what was considered and (to a certain extent) passed by the House of Representatives. This is, the firm deems, the “bear case” scenario — in which earnings per share for the top five insurers would decline an estimated one percent from 2010 through 2019 and the variance with current valuation is projected to be negative 36 percent.
What the firm sees as the best path forward for the private insurance industry’s bottom line is, to be blunt, inaction.
The study’s authors advise that if no reform is passed, earnings per share would grow an estimated ten percent from 2010 through 2019, and the value of the stock would rise an estimated 59 percent during that time period.
The next best thing for the insurance industry would be if the legislation passed by the Senate Finance Committee is watered down significantly.
Coincidentally, no doubt, the report arrives from Goldman Sachs – recipient of uncountable billions in public bailout dollars for their executives’ bonuses, from the Obama administration – just as the healthcare access reform plan being pursued right now by that same administration is nearing its final legislative conflict. Goldman helpfully notes in a disclaimer that the firm “does and seeks to do business with companies covered in its research reports.”
All you have to do to see how utterly repulsive the healthcare insurance industry is is to simply watch how they talk about their own business. It is impossible to be disgusted enough by an industry that – uniquely in the industrialized world – treats people’s bodies, health, and lives as saleable commodities in a free market in misery.
The AP reports that Scott Roeder, the terrorist who killed Dr. George Tiller, publicly and in cold blood, last May, has openly confessed to the crime and justified it with the usual religious-radical gibberish about “unborn children”. In the article, he explicitly equates fetuses with independently-living persons and claims that killing to prevent abortion is justified if at least one forced pregnancy results; he encourages others to perform similar terroristic murders, and states he intends to base his legal defense on an argument for a religious-political justification for murder. None of this is new, except possibly that he has stated all this on record now. It confirms what we knew about him, anyway.
The real question is whether those who are so agitated about real or imagined terrorism of other kinds (especially by Muslims), and who have been so complacently accepting of anti-woman terrorism in the US for decades, will condemn or even acknowledge an open statement of Christian religious-terrorist ideology in the case of yet another anti-choice fanatic.
Just this week we’ve seen a terrible mass murder committed by a Muslim military officer who was apparently distraught over the war in Afghanistan and his possible deployment. Literally before the bodies were cool, various right-wingers jumped in to denounce “Muslim terrorism” and to cite vague links between the suspect and Al Qaeda (he visited a mosque which was also visited by someone who knew someone who was connected with Al Qaeda); however, it is not clear that the apparent perpetrator’s motives were intended for a political end at all – as opposed to merely an outburst of personal anxiety – and there is little to suggest that it was terrorism in any reasonable sense. The murders of doctors by anti-choicers, beyond any question, are defined by the features of terrorism found in most of the commonly-used definitions: they are acts of violence committed against civilians for the purpose of inciting fear in other, third-party individuals, to promote a particular political end. We heard nothing of this at the time of Dr. Tiller’s death (nor of any of the previous murders and other acts of violence); will we hear it acknowledged now that the terrorist has so openly proclaimed his murderous religious ideology?
Anti-choice terrorism is intended to prevent women from exercising a legal and moral right involving their bodily health and autonomy, by terrorizing those women and their healthcare providers – it is violence intended not merely against its chosen (often random) targets, but to terrorize and thus paralyze a larger group, to further the religious and political ideology of the perpetrators and their vast army of supporters and admirers within the religious right. Yet it has never been acknowledged as such, and the large subculture on the right wing who have made a profession of terrorism scare-mongering have never acknowledged the persistent anti-choice terrorism ongoing in the US. (Nor has the FBI: fake anthrax attacks had been staged on almost 700 abortion clinics in the US in the days before 9/11 – not one of them resulted in an arrest, or any obvious urgency about the issue, and they were not treated as domestic terrorism. One person was charged with terrorism for fake anthrax attacks on clinics in the wake of 9/11 and the Congress anthrax mail attacks – the first and only such charge in the entire history of anti-choice terrorism. None of the anti-choice murderers, including Roeder, have been charged as terrorists.)
Now we have an admitted terrorist openly advocating further political killings to promote his religious obsessions. If Roeder were a Muslim and his targets were not women and their healthcare providers, the shrieking loons of the right would be off their heads screaming about his crime, his religious beliefs, his unrepentant stance, his advocacy and rationalization of violence, and his links to other extremists with similar religious and political beliefs. Will we see even the slightest acknowledgment of Christian anti-choice religious terrorism and its dangers in this blatant case?
At this moment, debate is proceeding on the House votes on the landmark healthcare bill. I haven’t blogged about it, because, frankly, it was overwhelming and I didn’t know what I could say that would help. (The Democrats’ stealth approach to bill-crafting, while possibly politically astute, made it hard to get a clear handle on the thing, too.) This will be, without question, one of the most important legislative events of my lifetime; if the bill passes the Senate and is finally voted into law in a reasonably intact form, it will be the most significant development in American history that I will see. More importantly, it will be – largely, though not entirely – an end to crippling insecurity and lifelong anxiety for hundreds of millions, and of irremediable pain and suffering for tens of millions who now live in the only affluent country that permits its business class to sell life itself for profit.
The bill on offer is far from optimal. It locks in the profiteering on death and misery that the vast majority of the country is burdened with, and is needlessly complicated and limited in what it offers to the rest. It deliberately cripples its own modest offering by restricting it only to those whom the profiteers have absolutely refused to serve at any price, prohibiting the rest of the country from accessing healthcare organized on any saner and more humane basis. But worst of all, the bill is being held hostage by the insane and vicious anti-choice army that infests the right wing and has wholly captured the Republican party. And, too predictably, the omnipresent contingent of grandstanding asshole Democrats is giving them exactly what they want, as they always do.
Right now, the “Stupak amendment” is being debated: an amendment that will prohibit any person enrolling in the government-backed “healthcare exchange” – which is to say, the poorest and most desperate, who are the only ones eligibel to enroll in that plan – from being offered a full range of healthcare services in cases of unwanted pregnancy. For those people, the “public options” will be forced pregnancy, death in childbirth, or an abortion that she likely can’t afford and the right-wing terrorists have likely made unavailable anyway. The Republican House caucus has already stated explicitly that they will refuse to vote for the healthcare bill in any form. But they – with their unconscionable Democratic allies – are holding up the bill to demand the anti-choice amendment in a bill they will not support even if they get it. And enough Democrats are equally indifferent to women’s lives and women’s needs to help them do it.
Democratic women are putting up a good fight – and their male allies deserve thanks, too. The Republicans have shrunk from merely legislative misogyny to outright thuggery, as they so commonly do. Michele Bachman led crowds of right wingers through the Congressional office buildings earlier today, invading offices and screaming at people to, in her words, “scare” them away from supporting women and healthcare for all. House Republicans staged an organized disruption on the floor today, systematically interrupting Democratic women as they spoke in favor of women’s interests and full healthcare coverage. The healthcare debate is being conducted the same way the Florida recount was in 2000: in the face of Republican assaults and intimidation, and without regard for the truth or significance of the actual substantive issue.
I have little to say about the whole thing. I feel helpless – particularly frustrating in the face of an issue so central to my personal and professional concerns – and am waiting as on election night for the outcome of votes that will – with great good luck – mean so much to so many, and move American one huge step closer to the decency and commitment to humanity that has been so sadly lacking in so much of our history. I can only wait and hope, like everyone else. In the meantime, there is an organized, vicious, and relentless minority that is fiercely dedicated to their own hostility to any notion of a decent regard for others, and to the freedom of others to live their own lives unconstrained by that minority’s backward and reactionary values. They are fighting – in the most literal sense – right now to keep tens of millions of people at the mercy of any illness they may suffer, to keep hundreds of millions at the mercy of an insurance system that rivals only those reactionaries themselves in its hostility to the needs of the people they nominally serve, and to keep every woman in America at the mercy of the nasty and bitter men who despise them and their bodies.
I can’t stand watching this unfold. And I can’t say, can’t express even fractionally, how much, how gut-wrenchingly much, I hate and revile these disgusting creeps.
UPDATE: Rayne at Firedoglake reports “Stupak Amendment Passes: 64 Dems Ask for Primary Opponents“. That’s exactly how I feel about it. I had already promised myself that I would contribute to the primary opponents of any misogynist Democrats; I’m saddened, and shocked, that there are so many of them. I will certainly target all that I can afford to. Read the rest of the post; it’s exactly right.
UPDATE: The final bill has passed, 220 – 215. Exactly one Republican voted in favor – 39 Democrats voted to withhold healthcare from over 40 million Americans. This is a great – but very partial – victory. There still remains the Senate bill – which will be a far tougher fight, with looser rules and a larger percentage of heartless and misogynist Democrats in the mix – followed by the conference committee and the final vote. The Republicans and reactionaries will do everything they can to destroy other people’s hopes for a decent life, and their control over their own bodies and life plans – the rioting, disruption, demagoguery and thuggery seen today are just a taste of what is coming. And this step, momentous as it is, comes bitterly. The discussion in the followup post at Firedoglake captures it perfectly; as one commenter put it: “It’s like winning a huge battle, but half of your friends were killed or wounded.”
UPDATE: I’ve added the reference to Democrats in the headline. I didn’t make it clear above that Bart Stupak, who led the charge to destroy healthcare reform for over 300 million Americans if they didn’t let him destroy autonomy for 150 million female Americans, is a Democrat. Along with 63 other misogynist traitors, he put the people’s party against 51% of the people, to indulge their personal medieval religious obsessions. Fuck him and all of them.
UPDATE: Scott Lemieux at Lawyers, Guns, and Money gets the power dynamic exactly right: “Certainly, there are many potential criticisms of how Democratic leadership has dealt with health care, although when you actually care about expanding access to health care it’s hard to negotiate with the Stupaks of the world who don’t, but want to use other people’s progressive impulses to attack women.”
A former healthcare clinic administrator in Texas today announced that she had quit her job, joined a far-right anti-healthcare group, and dedicated herself to harassing other women to prevent them from receiving surgery and other forms of “icky” healthcare, after seeing a video of an appendectomy that she didn’t like.
I just thought I can’t do this anymore, and it was just like a flash that hit me and I thought that’s it,” said Jonhson. . . .
Johnson said she was told to bring in more women who wanted [icky procedures], something the Episcopalian church goer recently became convicted about.
“I feel so pure in heart (since leaving). I don’t have this guilt, I don’t have this burden on me anymore that’s how I know this conversion was a spiritual conversion.”
Johnson reports that she is likewise convicted about gall bladder removals, most forms of cancer surgery, and liposuction, although she does not criticize the decisions several of her friends have made to have such procedures, because “that’s different”. She is semi-convicted about breast implants, believing they are the work of the Whore of Babylon but also something you could understand that a woman needs sometimes. She justifies these distinctions with random Bible quotes and references to her own idiosyncratic feelings, which she cannot coherently articulate but is happy to impose on others by law.
This otherwise trivial story about one small-town individual’s weird religious hangups was trumpeted by the religious right as a stunning victory over the right of other people to make healthcare choices they don’t like, claiming other people’s healthcare was now “in meltdown mode” and “total disarray”. Every healthcare clinic in the country, including the one that has now hired a new director, went about its business as usual.
The Huffington Post today breaks an original story on a long-running scandal at Columbia University Hospital, in New York, regarding lack of informed consent on a risky blood-volume-expander study. Heart-surgery patients were recruited into a study involving a new formulation of a volume expander that had been known to cause severe bleeding in its existing form; minimal information was provided in the consent form, some patients did not speak English, some were recruited in the ER under stressful circumstances, and the hospital IRB apparently did not adequately review the existing literature indicating the level of risk potentially involved. (Frustratingly, the story does not say what stage this experiment was conducted at, but it appears to have been a Phase I trial.)
The consequences:
At least two patients in the study died shortly after receiving the fluid and more than two dozen others required transfusions, according to documents submitted to the federal government by the hospital and obtained by the Huffington Post Investigative Fund.
There were attempts to rein in the problem as it developed:
In November 2000, two Columbia anesthesiologists – Marc Dickstein and Mark Heath- sought out the head of the institutional review board, Paul Papagni, a lawyer. They told Papagni that they had been in the operating room when a number of patients had hemorrhaged. They feared the study’s design virtually guaranteed that there would be more who would suffer hemorrhaging
However, their objections were derailed by internal politics. Columbia did later act decisively to crack down on the lead investigator, Dr. Elliott Bennett-Guerrero and report the breaches of protocol to the HHS, but they also downplayed the severity of the consequences, in part by reporting only a narrow range of outcomes from selected patients, not including the most severe adverse outcome, the bleeding that was the most important known side effect. The hospital also ignored advice from the HHS that it contact patients from the study and apprise them of the truth. Dr. Bennett-Guerrero has now been dismissed from the hospital (he landed in a Directorship and medical-school professorship at Duke – guess they’re OK with all this). Columbia has now been ordered by HHS to contact its former patients.
So, all in all, a serious problem plagued by misbehavior at every level, and an apparent partial coverup.
That’s all very worrisome, but it is the investigator’s attempted defense that particularly caught my attention:
Bennett-Guerrero . . . said in e-mails: “It is hard to imagine that an unbiased expert in cardiac surgery clinical trials could conclude that subjects were harmed in this study, since with only 50 patients per group the study was not designed or powered to prove any differences in major complications including death.”
What he’s saying is that because the sample size was so small, the statistical error in the results is necessarily mathematically too large to be able to show that the deaths or other events that resulted are clearly more numerous that would be expected by chance in such a group of patients.
There are a couple of real problems with this.
First, with a sample size of 50 and, as the article notes, varying dosages of the expander given, up to “three times the level recommended by the manufacturers”, this appears to have been a Phase I Ascending Dose trial. Phase I trials are conducted expressly for the purpose of monitoring safety and adverse side effects of the experimental treatment – they are intended to weed out unsafe treatments before they are tried on large groups of patients. In such trials, safety monitoring is paramount; the first sign of harm to patients should bring the trial to a halt. It’s true that such trial sizes are often too small for statistical significance, but the whole point is to gain confidence before exposing a larger sample size – so empirical monitoring is vital. In this trial, two patients died and numerous others suffered serious hemorrhaging – severe-enough outcomes that experienced clinicians complained directly to the IRB – but the lead investigator never reported a problem or stopped the trial.
(It is possible this was a Phase II or combined Phase I/II trial – though again the facts still seem to suggest Phase I. But if so, the sample size should have been large enough to be likely to return statistically significant results. The trial would be worthless without them.)
Another concern is that no early-Phase trial is supposed to be conducted on patients receiving conventional therapy or in lieu of conventional therapy, where such therapy exists. They are conducted on healthy volunteers. Partly this is to ensure that participation is truly voluntary (i.e., that patients are not being enticed into trials because they see it as a requirement for receiving other therapy), partly precisely to avoid this problem of contaminating apparent adverse consequences of the experiment with the patients’ underlying pathologies.
So it is difficult to see how this trial could have been appropriately designed, aside from the question of informed consent. Either it was a safety trial conducted on patients whose health was already compromised to the point that adverse effects could not be identified as the results of the experimental medication, or it was a dosage-efficacy trial conducted on a sample size too small to provide reliable results, either positive or negative. And in either case, clinical judgment seems to have been dispensed with as patients died but – because of the built-in lack of confirmatory mathematics – no suspicion was entertained about a possible link to the experiment they were participating in.
That raises questions of the investigator’s intent. At this point, I want to step away from this particular incident, and make it clear I am not making insinuations about Dr. Bennett-Guerrero or others from the Columbia trial. Clearly things went badly there but I don’t know what was going through his mind or what his intentions were. I want to use this situation to illustrate ways in which clinical trial design can be (again, I am saying nothing about this particular case) manipulated to evade ethical protections for subjects.
If a trial is deliberately designed with a sample size too small to return significant results, then by definition no negative results can ever be discerned (nor can any positive results, either, of course). At the Phase I level, where harm is the only reported result, lack of positive results is not a problem, but the impossibility of negative results means that the candidate drug will automatically pass the screening. (Since you can’t find any statistically significant negative results, there will be no statistically significant negative results to report, thus the drug can never be proven to have failed the test. And since, at Phase I, “not failing” is a good-enough result to justify further research, the lack of a robust experimental design can, paradoxically, be a very useful feature.) With a lax IRB focusing only on the mechanics of the informed consent procedure, and not the possible pathways for harm or the mathematical intricacies of the results testing, one can easily get permission to conduct a “drug test” that no drug can possibly fail.
Doing so, of course, requires that you suspend judgment as to the empirical/clinical course demonstrated by the subjects. With no mathematical test for success/failure, an ethical researcher must rely on careful clinical monitoring to detect problems with individual patients or the trial as a whole. Starting with healthy subjects makes such problems obvious, since they aren’t supposed to die at all, but conducting the trial on subjects already sick (or, in fact, pulled directly out of the ER into heart surgery) creates a ready explanation why some of them may die, if in fact they do. So, again, there is an incentive to conduct the trial in what would otherwise be a scientifically invalid manner, essentially building in negative outcomes from the beginning (if the patients already have life-threatening illnesses, you’re going to get some bad outcomes no matter what) as a screen for the negative outcomes that may arise from the experimental procedure. This makes it difficult to honestly answer the question whether the procedure harmed the subjects, but makes it easy to argue that it did not provably harm them.
Thus, for an unscrupulous researcher (and again, this part of the discussion is hypothetical; it is not aimed at a particular individual), it may be possible to design a trial that cannot deliver honest and reliable results, but which also cannot fail to provide the preferred result from the point of view of a drug manufacturer or funding source. Doing so requires conducting a trial that is both scientifically non-decisive by intention and which lacks the ability to identify clear harms to subjects. It may also require deliberately enticing patients into the trial for whom better and safer therapies are available, precisely to use their pathologies as a ready excuse for adverse clinical outcomes which the trial may produce in them. And, it necessarily requires vacating the professional obligation to use vigilance and judgment to monitor and protect patients in all circumstances, and especially the experimental environment – and to instead rationalize patients’ outcomes away in order to avoid public knowledge, and possibly self-knowledge, of the harms inflicted upon them.
Convenient rationalizations are not an acceptable mindset for those who take vulnerable others into their care. The fact that a trial design cannot determine whether its subjects have been harmed is not an acceptable exculpation of those whose obligation was to watch for, detect, and ameliorate such harms. It is a reason why such trials must not be conducted in the first place.
There is a considerable component of right-wing blather, on healthcare and other topics, that is not seriously intended from the outset. To be sure, actual right-wing policy proposals are often offensive and addle-headed – withholding healthcare from women for religious reasons, or prohibiting factual information on contraception for teens are too-familiar examples – but often enough the most outrageous statements the wingnuts make are intended only to generate controversy. The ensuing agitation inflames the right-wing base constituency and feeds their self-aggrandizing notion of themselves as “under siege”, while the attention the controversy gins up raises the wingers’ profile and generates book sales and speaking fees. Rush Limbaugh, Ann Coulter, Michael Savage, and their cretinous ilk have made a profession of making factual claims that are indefensible in morals or truth, then evading responsibility by claiming they were joking; nominally more respectable right-wing pundits are not above the tactic, either. (George Will’s incompetent blundering into the issue of global warming continued long after his lack of knowledge had been thoroughly exposed in his own paper; the incident did him no harm among his target readership, for whom truth is an incidental feature of their reading material.)
For this reason, I felt less shock than merely tired recognition at this week’s reports from the right-wing “Value Voters” conference, in particular the much-remarked insanity of anti-choice provocateur Lila Rose’s demand that abortions be “done in the public square” (“maybe then we might hear angels singing as we ponder the glory of conception”*). Of course it’s idiotic, outrageous, and unhinged; of course it’s meaningless as a serious policy proposal. But it was never intended to be otherwise. It was intended to do exactly what it did – get more attention for a serial attention-seeker whose stock in trade is saying provocative things on video so she can enjoy the reaction, as well as create yet another controversy to make anti-choice theater seem important by generating press.
But it’s worth taking a moment, not to combat this nonsense as if it was to be taken seriously, nor even to condemn the continual offensiveness and provocation of the anti-choice movement (a singularly unlikely complaint, since without that the anti-choice movement wouldn’t even exist), but to note the ways in which anti-choicers choose to offend.
What does it mean to imagine – even if only to create offense – that women should be forced to have their abortions in public? As crazed as the suggestion is, it is not as extreme, from the right-wing perspective, as it would seem from any decent point of view. Mandatory public display of intimate gynecological procedures in order to diminish the legal availability of those procedures is nothing more than the literal instantiation of the basic presuppositions of the anti-choice movement in general:
As with so much anti-choice agitation, women simply disappear from this invasive and offensive scheme as persons to be taken seriously in their own right. Healthcare is granted near-sacrosanct status as regards privacy, discretion, and the centrality of the needs and interests of the patient, but a woman seeking abortion must expose herself, legs splayed in stirrups, vagina dilated, instruments inserted, “in the public square” – her needs and interests, in fact her basic humanity as a person deserving of consideration and dignity, carry no weight against the creepy, invasive perversions of the sex-obsessive misogynists. The abortion debate is structured, logically, as a conflict between women’s autonomy and the religious imperatives of the anti-choice right wing, but here there is no recognition of autonomy interests at play in any way – women not only may not control their bodies or reproductive options, but may even be forced into invasive and degrading displays deliberately intended to undermine their own autonomy, as a condition of (temporarily) accessing such options. As always, women simply don’t count. Whatever protections and privileges the typical moral person might command in undertaking their own purposes in their own life simply vanish if that person is a woman seeking control over her reproduction.
But this familiar moral blindness is not accidental, and it is not merely the hyperbolic implication of a deliberately provocative suggestion. Stupid, crazy, and nasty as they may be, the right wing is not completely incapable of recognizing moral humanity, even in those they despise. The right wing gradually learned not to use racial slurs; today it would unthinkable for them to suggest that people of color should be paraded “in the public square” even as a tactic to undermine their rights, and wingers fall over themselves denying the racism in their racist policies. The gay-rights movement, embattled as it was, made remarkable progress in the space of about 35 years; today, the conservative position on gay rights extols accommodations (“Don’t Ask, Don’t Tell”; civil unions) that would have been grand liberal victories just a few years previously. Yet after thousands of years of patriarchy, women command no such deference. Even as a joke or a provocation, there are things that are not said about minorities and gays – things the public would reject in disgust. There seems to be nothing the right wing won’t say about women – there seem to be no abuses or humiliations that are beyond the pale, no degradations or invasions that are unthinkable, whether or not they seem likely as policy.
Vacating medical confidentiality to publicize abortions for the explicit purpose of humiliating women by generating disgust at their bodies, healthcare, and reproductive choices? The only part of that scenario the right wing objects to is the abortion. All the rest is merely the rights, interests, and choices of women. Nothing at all, really.
* I am not making this up.
Apparently, tea-baggers protesting healthcare reform have adopted the slogan “Keep your laws off my body”. This is what passes for wit on the right-wing: people who are presumably largely anti-choice have appropriated a pro-choice slogan for their own purposes.
Mind-bogglingly, they claim they are not merely poking fun by making progressive symbols retrogressive, but are adopting the tools and techniques of left-wing activism for purposes that they regard as similar in motivation and intention. Adam Brandon, press secretary for the tea-bagger organization, claimed:
If we had been alive back in the 1960s, we would have been on the freedom bus rides. It was an issue of individual liberty. We’re trying to borrow some from the civil rights movement.
Right. Freedom Riders:
But that wasn’t my main point. I wanted to note just that one slogan: “Keep your laws off my body”.
It seems undeniable that the vast majority of tea-baggers would strongly oppose the liberty that slogan advocates. Surely their Congressional enablers do. But with the characteristic ignorance and lack of shame that makes it possible for right-wingers to say any of the things they say, they’ve co-opted words they don’t believe in into a context in which they don’t even make sense.
Unlike the issue of abortion rights – wherein the same noisy faction that opposes healthcare for others also aggressively campaigns to prohibit women from controlling their own bodies, and to force them to undergo pregnancy and childbirth against their will – the proposed plan for universal healthcare access doesn’t impose any unwanted procedure on anyone’s body. The access plan incorporates no specific treatments at all – it is a funding mechanism, not a treatment regimen, still less a mandatory one.
Naturally, of course, the wingers who oppose both abortion and healthcare in general, while demanding “keep your laws off my body”, also oppose abortion funding under any healthcare plan that is passed: that’s right, they insist that the healthcare plan they oppose because it would impose laws on their body must also be crafted so as to assist them in imposing laws on other people’s bodies. But more fundamentally, it is the characteristic right-wing solipsism and sheer imperviousness to fact that makes this absurdity possible: their aversion to healthcare means other people can’t have any, and their valorization of unplanned pregnancy means other women must have them; laws that have nothing to do with actually imposing upon people’s bodies are opposed with liberal slogans regarding bodily freedom, while the liberal demand for bodily freedom is opposed by people who spout that same slogan.
As always, the interpretive question here is whether these people are simply mind-bogglingly stupid, or deliberately dishonest. And as always, it’s hard to tell the difference in their cases.
“Choice” – the exercise of the fundamental value of autonomy as it affects the most distinctive, and most embattled, aspects of women’s lives – is always under siege by the right wing and its religious foot soldiers, as much so today as at almost any time. And today, “Blog For Choice Day, 2009″, the anniversary of the Roe v. Wade decision and nearly coincident with the the New Year and the Obama Inauguration as well, it is worth taking stock, and seeing just how encroached and relentless that battle has grown, and what hope of progress arises at this time of new beginnings.
The manifold horrors of the Bush years are finally behind us, and President Obama is already taking steps to end their ravages and wipe away the stains they have left upon the United States. In the area of reproductive autonomy, he has sent encouraging signals that he will repeal the odious “Gag Rule” and “Conscience Clauses” and oppose legislative attempts to further intrude upon women’s freedom. Hopefully the discriminatory Hyde Amendment will finally bite the dust as well. But that those are salient issues is only evidence of how much has been lost in a short time.
That we have to beat back absolute absurdities, such as that hospital personnel may refuse to treat patients in need out of personal prejudice alone, or that any yahoo with an ideological grudge, down to and including pharmacy clerks and cash register tellers, can withhold products and prescription medications on the same whim, means that the first promise of the unfolding Obama administration is simply to undo some of the trespasses of recent years, restoring what, under Clinton, nobody imagined could be lost. Actual progress will have to be a follow-on goal.
So it is not merely “choice” – reproductive autonomy in the area of birth control and abortion – that is under siege, but the entire range of choices women may make regarding their healthcare, sexual and reproductive lives, and liberty in general. Not only the right to abortion has been restricted, but, as part of their war on women’s sexual health, women’s rights to make factually informed choices about their own health and treatment options, to choose, purchase, and receive medicine and healthcare products prescribed or recommended for them, to choose how to balance their sexual and healthcare needs without interference, to choose their own goals and methods in family planning without prohibition on extremist religious grounds, to choose to use scientific medical advances without arbitrary religious restriction, and to make any number of other choices regarding their health and bodily autonomy, have systematically been assaulted, hamstrung, and denied by legions of religious-extremist obstructionists inside and outside the Bush administration. The first item on the “choice” agenda must now be restoring the basic set of choices that existed before the whackos got loose; only then can we begin to extend and refine the range and accessibility of those choices.
There is good reason to be hopeful, as, barely days into the Obama Presidency, a new sense of decency emanates from Washington and the most egregious crimes of the recent past are repudiated and undone. There is little reason to be ecstatic, however - and those who value women’s autonomy know too well that women are always the first to be thrown overboard for political expediency, and that women’s bodies and lives are of little weight in the traditional political balance. It would be foolhardy to expect President Obama to be too radical a departure from business as usual in that respect, though he has been generally good on choice, and on scientific, vs. religious, policymaking. Sadly, I expect that “Blog for Choice Day” will be an annual tradition that outlasts even this administration. But this is certainly the beginning of better things to come, and the victory has never been out of sight, however hatefully it has been contested. Good days ahead!
Cardinal Egan, supremely obnoxious Catholic Archbishop of New York, has an essay up on some Web site, complete with the standard handwringing condescension and heart-tugging photos, declaiming how desperately we need to take control of women’s bodies and impose forced pregnancy as a matter of law and culture. Its contents are typical of this well-worn genre: a lame argument about whether a human fetus is a “human being”, willful elision of the difference between biological identity and moral status, sweeping moral declarations grounded on nothing but his unreflective certainty, and of course obligatory references to Hitler, Stalin, and Dred Scott.
The heart of this superficial and nonsensical (or perhaps it could be said: “a-sensical”) piece is a photograph of a 20-week fetus – a photograph which, Egan declares, proves by itself that abortion is wrong and it is utterly worthless to even consider the actual moral issues raised by the question.
Why, you might inquire, have I not delved into the opinion of philosophers and theologians about the matter? And even worse: Why have I not raised the usual questions about what a “human being” is, what a “person” is, what it means to be “living,” and such? People who write books and articles about abortion always concern themselves with these kinds of things. Even the justices of the Supreme Court who gave us “Roe v. Wade” address them. Why do I neglect philosophers and theologians? Why do I not get into defining “human being,” defining “person,” defining “living,” and the rest? Because, I respond, I am sound of mind and endowed with a fine set of eyes, into which I do not believe it is well to cast sand. I looked at the photograph, and I have no doubt about what I saw and what are the duties of a civilized society if what I saw is in danger of being killed by someone who wishes to kill it or, if you prefer, someone who “chooses” to kill it. In brief: I looked, and I know what I saw.
Why it is that the moral attack dogs of the right wing are always so eager to proclaim their own lack of comprehension I don’t know, but it is no longer surprising as a practical fact, and still less in light of the product of their “reasoning”. But ask yourself: who would take such idiocy seriously in any other context? On what moral issue would anyone seriously say “I saw a picture of an organism affected by this subject that moves me in some way, so I refuse to think about it carefully or read what the best thinkers on the subject have said, and that justifies both my unsupported, idiosyncratic religious beliefs about it and my intention to impose them on everyone else in the country!”? Who would seriously claim that not thinking about, reading about, or analyzing a serious problem could possibly produce a correct answer, or was a proper ground for imposing a solution to it as a matter of law and policy? Well, who but a religious right-winger?
Michelle Malkin now takes on the cause, and the rhetoric, of the misogynist anti-autonomy movement and its efforts to eliminate accessible reproductive healthcare.
Planned Parenthood is the largest single provider of prenatal, contraceptive, and abortion care in the US. In a country in which over 85% of all counties have no abortion services provider at all, in which health insurance plans are not required to provide contraception, and in which government-provided health programs for the poor are prohibited from providing abortion or, at times, even information about abortion, Planned Parenthood is often the only reproductive health provider available in many communities, and usually the only one available at reduced cost.
This drives the anti-woman brigade screaming crazy. There has been an organized campaign against Planned Parenthood by the sex-negative right wing for years, using a combination of smear tactics, lies, distortions, and political lobbying. Attacks range across everything from Margaret Sanger’s racism (don’t believe what you hear from hypocritical liars), Planned Parenthood’s practices of murder, malpractice, and coverup (don’t believe what you hear from anti-woman liars), and the – in Malkin’s terms – “obscene profits” Planned Parenthood makes from the lucrative business of providing subsidized healthcare to uninsured patients in poor communities (don’t believe what you hear from financially illiterate liars). The reason, of course, is that Planned Parenthood is doing what they are dead set on wiping out: making reproductive autonomy real for the most vulnerable women in America.
Michael Gerson, Bush administration tool and terminal sufferer from Conservative Comprehension Disorder, continues his pattern of getting everything exactly backwards in his Washington Post-sponsored campaign of attacks on Barack Obama. The day after April Fool’s Day (he must have missed a deadline), Gerson published another misinformed screed, this one claiming that Obama is an “extremist” on abortion for opposing laws that would have sentenced women to death. As usual with Gerson and the forced-pregnancy crowd generally, almost everything he says is factually false, and a repetition of standard right-wing myths. The column consists of nothing more than Gerson and the Post carrying water for the organized anti-woman crowd by repeating their well-worn talking points verbatim, with no pretense of originality or reportorial integrity. (more…)
“Reproductive Health Reality Check” is running an April Fool’s Day blog carnival against “Crisis Pregnancy Centers” that mislead patients seeking abortion with deliberately deceptive tactics and false information. “CPCs” are medical fraud – there is no other description for it. And they are an increasing problem as abortion services are continually targetted and women have fewer real options; currently they outnumber real, full-service reproductive health clinics 2:1.
College women are specifically targeted by these charlatans – sometimes with official support from the colleges themselves. Shockingly, not only does Georgetown University – a Catholic school – refuse to provide any form of contraception or abortion referral through its campus healthcare center or hospital, they apparently have also been blanketing the campus with anti-abortion stickers whose only pregnancy-care referral number is to a CPC, not a real health clinic. (Full disclosure: I have an MA from GU, from the early 90s, and their behavior in this regard was even more reprehensible then.) UNC Chapel Hill students have had to create their own sex-ed programs for fellow students, who mostly come from local high schools with “abstinence only” programs and literally don’t know anything about reproductive health, and then are targeted for lurid propaganda by a CPC located just off campus. Students at other schools have had to do the same.
CPCs are a threat to the larger patient population as well. Vicki Saporta of the National Abortion Federation documents many of the problems they represent, including their deceptive tactics, medical fraud, and the support they receive from the anti-choice right (including over $30 million in taxpayers’ money from the Bush administration, and more from state legislatures). Allyson Kirk reports her experience with a CPC that had deliberately located itself along the entranceway to a real health clinic; after receiving an appointment at the real clinic, she mistakenly entered the wrong door, deliberately made up to look like a pro-choice facility, and was treated as if she was the expected patient, then subjected to invasive questioning and fraudulent misinformation.
This kind of behavior would be criminal in a real health clinic. CPCs present themselves in a deliberately fraudulent manner, impersonating real clinics with trained personnel (almost invariably, nobody at a CPC is a licensed healthcare practitioner) offering appropriate healthcare services, for the deliberate purpose of manipulating patients’ decisions and foreclosing their options; they then defend themselves legally by denying that they are subject to the professional obligations of real healthcare providers. The more this is known, and the more their tactics are exposed, the safer women will be.
I don’t usually write link-only posts, but this is worthwhile and the stories some contributors have to share are appalling. Go take a look.
I have posted elsewhere on my reaction to Obama’s speech on race, and conservative reactions to it. But yesterday’s column by Michael Gerson of the Washington Post moves me to comment here specifically on the provocative remarks about AIDS that have been quoted in this controversy, and their implications for the larger questions that must be faced by this country.
As most people will be aware, the right wing has been Swift-boating Barack Obama for the past few weeks over controversial statements made at various times over several decades by the pastor of the black-identified Baptist church Obama attends in Chicago. Yeserday Obama responded with a speech on the history and role of race and racial discrimination in America – a speech that will stand within the highest ranks of American political oratory, and, I am convinced, be seen in the future as the watershed moment in race relations in this country (certainly so if Obama wins the presidency; likely so even if he does not). There is almost nothing in the speech about healthcare, and only a little about the particular statements of the Rev. Jeremiah Wright that the right wing has picked out to whip up into controversy. Rightly, Obama placed the entire controversy in the larger context of racial history; many conservative commentators, angry at seeing their manufactured controversy dismissed in favor of more important and more substantive issues, responded with criticisms that Obama did not explicitly repudiate Wright and specific statements he had made, as they had demanded. Michael Gerson, in particular, focuses on Wright’s endorsement of the far-fetched conspiracy theory about AIDS that has been circulating in the black community.
Obama’s excellent and important speech on race in America did little to address his strange tolerance for the anti-Americanism of his spiritual mentor.
Take an issue that Obama did not specifically confront yesterday. In a 2003 sermon, Wright claimed, “The government lied about inventing the HIV virus as a means of genocide against people of color.”
This accusation does not make Wright, as Obama would have it, an “occasionally fierce critic of American domestic and foreign policy.” It makes Wright a dangerous man. He has casually accused America of one of the most monstrous crimes in history, perpetrated by a conspiracy of medical Mengeles. If Wright believes what he said, he should urge the overthrow of the U.S. government, which he views as guilty of unspeakable evil. If I believed Wright were correct, I would join him in that cause.
But Wright’s accusation is batty, reflecting a sputtering, incoherent hatred for America. And his pastoral teaching may put lives at risk because the virus that causes AIDS spreads more readily in an atmosphere of denial, quack science and conspiracy theories.
Obama’s speech implied that these toxic views are somehow parallel to the stereotyping of black men by Obama’s grandmother, which Obama said made him “cringe” — both are the foibles of family. But while Grandma may have had some issues to work through, Wright is accusing the American government of trying to kill every member of a race. There is a difference.
Gerson regards holding such an opinion as beyond the pale – and anyone who would believe such things as deranged. (“This accusation . . . makes Wright a dangerous man. . . . Wright’s accusation is batty, reflecting a sputtering, incoherent hatred for America . . . .”) Gerson is obviously grossly ignorant of the history and substance of these rumors, and the historical context in which they arise. And – like other conservatives dismissive of blacks’ reactions to America’s racial history – he seems to have no sense of what that context means to the people it most closely affects.
There is a terrible tension in healthcare – medicine, especially – between the use of expert knowledge to serve and heal those in need, and its use to aggrandize those with the knowledge and to control, mold, dictate to or torture those who fall into their hands. Knowing what can help another can easily be mistaken for “knowing what is best for them”, and historically has been so mistaken throughout the entire history of medicine as a profession. Today, it’s hard to hear the phrase “Doctor knows best” without an ironic smirk – the same smirk we conjure up for the parallel slogans of wrongheaded patriarchal oppression “Father knows best” and “Trust your government”. But it was not long ago that that slogan was the entirely literal creed of the most respected profession in Western society, and the work of challenging that creed and establishing the primacy of patient values and autonomy was lengthy and hard-fought. Its path was marked by the graves – quite literally the graves – of too many martyrs.
The most entrenched redoubt of medical power (though least well-grounded in research and knowledge) was psychiatry. Not only did the head-shrinkers lay claim to the most occult knowledge of human functioning and health, but they stood against a patient population that was inherently and societally almost unable to defend itself. Members of, possibly, the most severely and unsympathetically stigmatized stratum of society, mental patients were given no credence, and often had no recognized legal standing, to assert their own values and choices in treatment. And it is true that in many cases, patients with mental illness could not in fact act for their own interests or competently manage their own treatment and caretaking. But the presumption that no such patient could have a valid opinion about their own care, coupled with the prejudice that they were unfit for “normal” society, and likely dangerous, meant that virtually anything could be done to anyone, if advocated by a doctor armed with a diagnosis of mental illness. The things that were done were in many cases almost unthinkable.
Howard Dully spent over 40 years thinking about what was done to him. It took him a full life of hardship and failure to finally understand his own fate, and to come to terms with it. That anyone could have survived, let alone found peace and stability, after having lived his story, is an amazement in itself.
Dully is the author (with a professional co-writer) of My Lobotomy: A Memoir. The subject of the book is exactly what the title suggests. The story it contains is heartbreaking.
Dully’s life is difficult to summarize, except to say that it was unremittingly harsh almost from birth. Dully was born in California in 1948; his father was a hard and unemotional man who was driven to work excruciating hours, sometimes at as many as 4 or 5 low-skill physical labor jobs at the same time, partly by the need to support his family, partly by his own obsessive work ethic. Howard grew up a big kid (he’s now 6′7″, 350 lbs) who picked on his younger brother; when he was 4 his mother died after giving birth to a baby brother with a severe neurological deformation – the baby was placed with relatives and never spoken of again within the family. Howard and his family bounced around various friends’ and relatives’ homes as his father struggled to earn a living, and Howard suffered constantly both from missing his mother and from the severe discipline he suffered in some of these homes. Things really got bad when his father married again, to a woman with two sons of her own. Dully claims that she simply resented and hated him; from reading both his own stories of his home life, and some of his doctors’ notes, it is easy to believe he is correct. Howard, in the meantime, was legitimately a handful for any parent: he was apparently flightly and unreliable to an extreme degree, was aversive to school work, discipline, and hygiene, and often fought with his brothers, though they had a generally good relationship. As he got older he began doing stupid kid pranks – shoplifting and stealing items from cars, and playing hooky. As a huge and growing boy, he was constantly hungry, but was not allowed to eat between meals and was beaten for taking snacks. His step-mother also had some sort of obsession with her furniture and household trinkets, and would beat Howard for touching anything in the house, sitting on the parlor furniture, or using the front door. His step-mother would beat him for any infraction, and for things that weren’t infractions; later his brothers confirmed that she did indeed beat him for things she did not mind when done by her own sons, and would rave at him for no reason at all. When his father got home, he would get another beating – his father made him choose a piece of firewood to be beaten with, and Howard developed the skill of picking ones that were flexible enough to hurt less but strong enough not to break (which would encourage his father to continue the beating with his bare hand). Between his actual behavioral problems, his pre-adolescent awkwardness, the fact that his step-mother did seem to truly want him dead, and his father’s absence and emotionally and physically violent treatment, Howard seemed doomed to a life of misery no matter what might have happened. What actually did happen is unbelievable.
Howard’s step-mother apparently conceived the idea that she could get rid of Howard if she got the weight of professional opinion on her side. She began visiting a series of psychiatrists to complain about her son’s behavior, but none of them would agree he had to be institutionalized or removed from the home. Several wrote consulting notes to the effect that they were convinced her harsh treatment was the problem and that she should moderate her behavior toward the boy. She moved from doctor to doctor trying to find one that would agree with her. Finally she stumbled onto Dr. Walter Freeman.
Freeman was the pioneer, in the US, of the new treatment of psycho-surgery. He actually coined the word “lobotomy”, and popularized the use of that treatment in this country. He was the first US physician to see the procedure, after it was developed in Europe just before WWII; Freeman brought it back to the States and traveled the country in specially-modified vans or station wagons that he called his “Lobotomobiles”, giving demonstrations of both electro-convulsive therapy (using a machine he built himself; when it broke down, he simply held the bare wires against the patient’s head for as long as he felt was appropriate, with no mechanism for monitoring voltage or current) and lobotomy. According to the Dully, relating reports of academic researchers who studied Freeman’s career, Freeman was a constant self-promoter and showman: he would perform several lobotomies in a day, every day, in front of medical audiences, liked to demonstrate how easy it was by sometimes using ordinary household implements rather than surgical tools, and developed a signature two-handed bilateral technique in which he would insert “leucotomes” (the lobtomy knife) into both lobes of a patient’s brain and then simultaneously jerk them both through the tissue with a flourish. At times, his death rate ranged upward of 20%. Nobody seemed to think this was cause for alarm. Patients were operated on without their own knowledge or consent, and authorization was freely obtained from courts or patient guardians after reassurances from Freeman that the procedure would solve all the patients’ problems. Often, no precise psychiatric diagnosis was attempted before the lobotomy was performed; lobotomies were used for conditions ranging from headaches to schizophrenia. More than a few were performed on minors, even pre-teens; there were questions about such cases, but little organized opposition. Freeman was profiled in popular magazines, and sometimes hailed as a god, delivering sufferers from their misery. There were many detractors in the medical community, but the great benefit of lobotomy was that it often made patients docile enough to live with their families without monitoring, meaning they could be discharged from the large state mental institutions that were commonplace then. This made the procedure wildly popular with the managers of those institutions, whose patients had no effective representation to oppose the treatment plans made for them by others.
After a few years, Freeman heard about, and again pioneered, a variation of the lobotomy procedure called “trans-orbital lobotomy”, often referred to as “ice-pick lobotomy”. In that procedure, a long, sharp, thin instrument was pushed along the eyeball parallel to the nose, and through the back of the eye socket (“orbit”) into the skull, and into the frontal lobe of the brain. The instrument could then be levered back and forth, and up and down, to tear through the frontal lobes and disrupt their neural circuitry. There was no method for visualizing the exact placement of the instrument in the brain, or the location, depth, or extent of the lesions created; the method was simply to stick the metal rod in through the eye socket and wiggle it back and forth to tear the brain tissue randomly. The effect was almost as dramatic as an open-skull lobotomy, but there was no external wound, and it could be performed under mild anaesthesia. The procedure could be done in an ordinary doctor’s office, and took about ten minutes. In many cases, the surgical instrument used was, in fact, an ice pick. (Freeman’s personal lobotomy instrument was labled “Uline Ice Company”.) Patients were sometimes sent home afterward in a taxi cab.
Freeman began popularizing the trans-orbital lobotomy, sometimes performing as many as two dozen procedures a day on patients in mental institutions and hospitals. In some cases, patients were operated on against their consent; after the procedure, they lacked the drive and wherewithal to sue. After some years traveling the country in his Lobotomobile, he finally settled in the South San Francisco Bay Area, near where Howard Dully’s family were living. Eventually, Dully’s step-mother asked to see him.
Freeman met with her a number of times over a period of two months, duly recording her wild stories of Howard’s unmanageable behavior (some of which later turned out to be pure fabrications – such as the story that he had beaten his brain-damaged baby brother almost to death). From the beginning the step-mother openly solicited some kind of dramatic professional intervention. Freeman hesitated at first, insisting he would have to meet the patient and interview the other family members before coming to any conclusion. (What seems incredible is that he began formulating treatment plans with the mother for weeks before ever once meeting Howard.) He interviewed Howard’s father one time; the father gave a much more balanced report of Howard’s behavior, but Freeman didn’t pick up on the clue. He began to meet with Howard himself, and found him reasonably normal though somewhat uncommunicative (who wouldn’t be?). But he kept meeting with Howard’s step-mother, who still filled him with tales of how afraid she was of Howard, how her other sons were afraid of him and were constantly beaten up by him (they deny this), and finally how Howard had beaten up his baby brother in infancy (his entire family denies this – and note that the step-mother was not part of the family at that time). Freeman seems to have accepted everything she said, and viewed Howard’s truancy and other bad behavior through this fictionalized and delusional lens. After four meetings with the step-mother, only one meeting (ever) with Howard’s father, and four visits with Howard himself, Freeman recommended that they should attempt to “change his personality” with a trans-orbital lobotomy. Howard’s step-mother immediately agreed, and took the papers home for his father to sign, which he did without ever speaking to the doctor again. Freeman cautioned the parents not to tell Howard what would happen – only that he would be admitted to the hospital for “tests”. Howard excitedly looked forward to his night in the hospital, because he had heard they gave you Jell-O there. And they did. It was two weeks after his 12th birthday.
Freeman lobotomized Howard the next day. Howard has no memory of any of the events of that day. He contracted a fever and an apparent infection (Freeman was infamous for not sterilizing his instruments before surgery; you can see, in the actual photograph of Howard’s procedure, [see photo at end, below the jump] that he is not wearing gloves), but recovered soon enough.
The rest of his life was a disaster.
I met Robert Rummel-Hudson last night at his New York book party, celebrating the release of Schuyler’s Monster, his memoir of his daughter’s struggle to meet the challenges of having been born with polymicrogyria – a neurodevelopmental disease that prevents her from developing spoken language – and his own struggle to meet the challenges of parenthood and the demands imposed by his daughter’s condition. The book grew out of Rob’s gripping, heart-rending blog, Fighting Monsters with Rubber Swords.
Robert has been documenting, step-by-step, the pathway he, his equally-admirable wife Julie, and Schuyler (pr. “SKY-ler”) herself have followed, first coming to terms with Schuyler’s developmental difficulties, then battling the public schools’ broken and indifferent system for educating special-needs children until finally moving to a city (Plano, TX, of all places) that offered what Schuyler needed. At the urging of his growing base of enthralled fans and well-wishers, he turned the blog into a book that hit the market just this week. It has already received considerable word of mouth and small-market press attention even before release; I am convinced it is just about to explode into a real sensation, and deservedly so.
Robert has an ability to communicate the pathos and humor of his family’s situation, and even more strongly Schuyler’s unbelievably spunky and winning personality, and her brilliantly unique triumph over the multiple dirty tricks life has played her. Schuyler is without question the star of his blog (which, he says, she still has not read, nor has she the book, either, though she is fully aware that she is a media queen). It is impossible to read their story without falling in love with Schuyler (and indeed she is regularly showered with largesse by fans, often anonymous, who have visited the family’s Amazon wish-lists). “Schuyler has a posse!”, I told Rob, and he agreed that one of the most satisfying side-effects of blogging about her condition is that she has garnered such a wide-spread support base. That is due to Rob’s ability to make her come alive through his words – though it’s obvious Schuyler is giving him a lot of great material to work with.
In person, Rob comes across just as you’d imagine from his blog: funny, personable, thoughtful, fiercely dedicated to Schuyler and her needs, worried about her future, and laceratingly honest about his own uncertainties and shortcomings (which I think he overestimates). It was great fun meeting him, and I was glad to see the St. Martin’s Press staff just as enthused about the book as were the many fans who turned out to meet the author.
I mention all this simply to add this plug for a book that deserves to be read, and will break your heart and change your viewpoint when you have done so. I can’t communicate the impact of Rob’s blog or the book it gave rise to, but I urge everyone to experience them for themselves.
(1) Go buy this book:
(2) Go read this blog.
You can thank me later.
UPDATE: Fixed an editing mistake.
Making with the sorely overdue link-love: two months ago, Amanda Marcotte (of Pandagon, and the best thing that ever happened to John Edwards) linked my prior post on right-wing propaganda about Margaret Sanger (as a way of attacking Planned Parenthood). She points out the fact that, in Sanger’s day, PP was actually anti-abortion (largely for reasons of the relative safety of the procedure, much lower then than now), and that the wingers seem to have no conception of the irony of their slanders.
The article generated a fascinating discussion thread, however (with minimal, but nonzero, trollage) - one that I only stumbled across today by following a visitor link (thanks!). I’m sorry to be so late on this but I encourage everyone to run over there; the discussion is interesting and, collectively, it includes a fascinating list of resources on the history of abortion, abortion and race, and sexual autonomy as seen from a variety of times and places, and presented in a variety of media (the rock-opera version of a 19th-century German play about the link between lack of sex ed and unplanned pregnancy sounds . . . wild – and I had no idea there was a whole list of early silent movies on the same topic!). Now I’ve got a lot more reading to do! So do you.
“Wendi Aarons” contributes an open letter to the McSweeney’s collection:
AN OPEN LETTER TO
MR. JAMES THATCHER,
BRAND MANAGER,
PROCTER & GAMBLE.February 6, 2007
Dear Mr. Thatcher,
I have been a loyal user of your Always maxi pads for over 20 years, and I appreciate many of their features. Why, without the LeakGuard Core™ or Dri-Weave™ absorbency, I’d probably never go horseback riding or salsa dancing, and I’d certainly steer clear of running up and down the beach in tight, white shorts. But my favorite feature has to be your revolutionary Flexi-Wings. Kudos on being the only company smart enough to realize how crucial it is that maxi pads be aerodynamic. I can’t tell you how safe and secure I feel each month knowing there’s a little F-16 in my pants. . .
Have you ever had a menstrual period, Mr. Thatcher? Ever suffered from “the curse”? I’m guessing you haven’t. . . .
Last month, while in the throes of cramping so painful I wanted to reach inside my body and yank out my uterus, I opened an Always maxi pad, and there, printed on the adhesive backing, were these words: “Have a Happy Period.”
Are you fucking kidding me? . . .
Today is International Women’s Day, and for that reason also Blog Against Sexism Day. I want to use the opportunity to take notice of the degree to which sexism is the root of many healthcare ethics issues affecting women, or, to put that another way, how much of women’s health issues arise from or are shaped by sexism and gender oppression.
[NB: I began this review just after the movie came out, almost 15 months ago, and never finished it. Finally, sitting around this weekend, sick and procrastinating, I decided to get it off the books. Here it is, for whoever's still interested.]
The 2005 techno-thriller The Island hides a ham-handed anti-biotech message amidst its helicopters, gun battles, and explosions of various kinds. It trots out some of the standard “clone army” cliches, but goes beyond this, in places literally taking its dialog directly from the religious-right’s anti-science talking points. It fills a certain niche in the long line of biotech-nightmare morality plays, but with a particularly preachy, and notably slanted, take.
I need to play weaker defense.
That’s a conclusion I just now came to after struggling to understand my own reactions to things I’d been reading, and in particular to why everyone I’d been reading seemed so angry all the time. Since it seemed to me they didn’t have reasons to be so angry, there was apparently something wrong, and I was sorely tempted to put it right. I knew, too, that they wouldn’t appreciate my assistance in encouraging them not to be angry about the things they were angry about, and then they would be angry at me, which really wouldn’t be fair.
So, before even attempting to help all those angry people realize they were wrong to be so angry, I’m already [more of] the asshole [than usual] – supposedly. And that makes me angry, so I began devising all these imaginary ripostes to the as-yet-only-potential criticisms I knew I would get for helping the angry people see things my way. And the more I thought about the issues at hand, the more I had to defend myself against attacks from people I was only trying to straighten out for their own benefit, to the point that this defensiveness defined my understanding of the issues – making myself right was the test of the correctness of the positions I took. The more tenacious my defensiveness became, the harder it was to understand what all the angry people were saying except in ways that automatically made them wrong, so I could be right.
Clearly, Tenacious D is a considerable mind-fucking auto-petard that one might best be rid of if one hopes to understand others in non-assholish ways.*
* Yes, it’s also the name of the worst rock-’n-roll band in the entire world, including all the French ones.
Eugene Volokh loses his shit over some Washington State regulations barring healthcare providers from imposing on patients for romantic or sexual relationships:
Say you live in Washington state, and you find yourself getting to know and becoming attracted to your dental hygienist–or for that matter your optician (that’s the person who fits your eyeglasses, based on the prescription provided by your optometrist). You’re interested in a romantic relationship, a sexual relationship, perhaps even marriage. You’re both consenting adults, you think, right? You have a right to marry, and even a right to have sex (given Lawrence v. Texas).
The Washington authorities don’t seem to think so. . . .
[T]he optician and waitress can’t date even after the two years have passed. . . .
So no dice with the patient’s sister. You can’t marry her. You can’t have sex with her. You can’t ask her on a date. You can’t even say she looks nice . . .
No matter how good your relationship with the person you’re seeing [. . .] someone else may file the complaint . . .
So much for the right to marry; so much for sexual autonomy; so much for consenting adults deciding whom to love, without the fear of losing their livelihood.
I think Volokh is partly misunderstanding the statute, and partly slanting his argument toward the most extreme of its provisions. He shows almost no concern for the problems the statute was intended to address, and launches himself on a barbarians-at-the-gates rant over fairly manageable concerns. But even if we do not blithely sweep away centuries of providers’ abuse of vulnerable patients in the face of Volokh’s anguish over the right of patients to date their dental hygienists, there are some real issues raised here.
Every day is freedom day, autonomy day, self-determination day, choice day, as far as I’m concerned. Reproductive choice is one part of the freedom and autonomy we all enjoy throughout our lives – the birthright of every moral person, the foundation of morality in both its constraining and its liberating guises. That pervasive freedom, and the moral responsibility it brings, must remain inviolate if we are to be moral persons at all, and to act from that stance of moral agency in any and every part of our lives. In that sense, every threat to the moral dignity of the individual is equally a threat to freedom in all its aspects and manifestations.
If you are pro-freedom, you must be pro-choice – and pro-free-speech, and pro-marry-whom-you-want, and pro-fuck-whom-you-want-and-how-and-when-and-why, and pro-feminist, and pro-speak-truth-to-power, and pro-read-what-you-like, and pro-write-what-you-like, and pro-vegetarian, and pro-wear-leather, and pro-wear-makeup, and pro-hate-makeup, and pro-piercing, and pro-no-piercings, and pro-disability-righs, and pro-lift-up-every-voice-and-sing, and pro-hip, and pro-square, and pro-people-in-all-their-crazy-ways – for freedom enables all of these, and freedom is lost when any of these is banned. That’s good enough reason – a reason that makes a necessity – for being pro-choice and all the rest, every single day you value freedom.
Saw a couple of offbeat movies recently, one pretty good, one very bad. Both had doctors in them, and they got me thinking about doctoring and what we want it to be.
What happens, f’rinstance, if your doctor’s a mobbed-up, drug-using, drug-pushing, fairly psychotic lowlife with sybaritic sexual tastes who doesn’t really mind seeing you die?
DB, of the eponymous “Medical Rants”, makes a good point about rare diseases:
The problem with Lemierre’s Disease is that it represents a “long tail” disease. Most sore throats are viral or due to streptococcal disease. At least we thought that until recently. Evidence from 2005 in two articles suggests that the organism thought responsible for most Lemierre’s Disease – Fusobacterium necrophorum – may cause as much as 10% of pharyngitis. . . .
For the past 30 years, the infectious disease community has worked to decrease the use of unnecessary antibiotics. They have assumed that group A beta hemolytic streptococcal infection is the only pharyngitis cause which needs “necessary antibiotics”. They have assumed that group C and group G streptococci do not need antibiotics. They have excluded the possibility of unknown bacterial infections. Now it appears that Fusobacterium necrophorum may indeed be an “unknown bacterial cause” of pharyngitis.
What can we do about the Long Tail?
Right-wingers have been beside themselves over a small cluster of deaths from toxic-shock-like syndrome, caused by infection by certain specific microorganisms, in patients who had obtained medical abortions using RU-486 or a similar preparation. Specifically, there have been 4 such deaths from 2003 – 2005, plus one previously; the most recent 4 all involved women in California who had been given an “off-label” vaginal suppository for Mifepristone Misoprostol (one of the two drugs used in the most-common medical abortion procedure), as opposed to taking it orally. These similarities prompted concern among health officials; the American College of Gynecology, which had endorsed the off-label usage, convened a study panel on the issue, and Planned Parenthood stopped using the vaginal-delivery method (which is otherwise more comfortable, easier, and more effective than oral delivery). The anti-choice contingent, however, of course began trumpeting the incidents as “proof” that all medical abortion was “unsafe”.
This “proof” suffers somewhat from certain facts: (a) no clear cause of the toxic syndrome in these cases has ever been determined; (b) the medication has been used safely, orally and vaginally, by over half a million women, as compared with only 5 deaths; (c) the death rate for medical abortion – as for every other form of early- to mid-term therapeutic abortion – is lower than that for childbirth, making abortion in general, and RU-486 in particular, the best choice for women from a safety perspective. Now, the results of ACOG’s review of the situation show that this safety differential favors RU-486 even more than was previously known.
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