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.

The winger blogs are all a-twitter over a story noting that the Omnibus Budget bill that was (finally) just passed contains a provision – known as the Dickey-Wicker Amendment, which the religious wingers have stuck in every budget since 1996 – prohibiting federal funding for research “in which human embryos are created, destroyed, discarded, or knowingly be subjected to risk of injury or death”. Setting some kind of a record for intellectual incompetence, the right-wing CNSNews mis-reported this as “Obama Signs Law Banning Federal Embryo Research Two Days After Signing Executive Order to OK It” – which, in one single sentence, misrepresents the event (he did not sign a law on embryo research, he signed the budget bill, which contained one small amemendment addressing embryonic research among its reported 3,500 pages of text and appendices), false as to fact (his executive order did not address embryo research), and completely wrong in its implication (the budget amendment does not undo the research policy Obama announced, as this headline implies). Despite this falsity and confusion, the event is viewed as some sort of humiliation for, or hypocrisy by, President Obama, since he had made a point of repealing the Bush ban on stem-cell research funding just two days before signing the budget with its unrelated embryo-research amendment. Much chortling and back-slapping is now underway, among people who know nothing about the issue and are apparently too dumb to read.

Yes, certainly the Dickey-Wicker ban is stupid, anti-science and anti-intellectual, and annoying. But it does not undo the policy that Obama overturned, and which Bush had previously implemented. (This much should have been obvious, even to the wingers, and even without reading: since the Dickey-Wicker Amendment predated Bush’s policy by almost 6 years, there would obviously have been no need for that policy, or the immensely divisive fight over it, if they merely did the same thing, right?) In fact, it’s effect is quite small, and easily evaded, and is aimed at an entirely different scientific procedure than the one addressed by Obama’s recent policy statement – not that anyone in the right-wing monkey cage seems to know that.

The Bush policy went far beyond the Dickey-Wicker amendment. It prohibited funding for any lab working on human embryonic stem cells in any way, other than research using a small number of specifically authorized cell lines. It meant that labs recieving any federal funding could not do any research on the prohibited cell lines (i.e., virtually all of them), even if the funding for that research was provided by another source. They could not even use the same labs and equipment – they had to build a completely separate facility to do the work, which obviously was prohibitively expensive. Since almost all research labs receive federal funding of some sort, the policy was intended to – and in large part did – completely shut down almost all stem-cell research regardless of funding source.

The Dickey-Wicker Amendment banned funding for reseach conducted on embryos themselves. This includes the process of creating stem cell lines for further research, since the stem cells are taken out of an unused, non-implanted IVF embryo, but it does not prohibit “stem-cell research”, that is, the use of stem cells themselves, not the embryos they were taken from. (A stem-cell “line” is a continuously-maintained collection of cells in laboratory flasks, transfered periodically to new flasks as they divide and grow. It’s one of the unique properties of stem cells that they can be grown permanently in this way, unlike most other body tissues. The line is created by taking stem cells out of an embryo, but that only has to be done once for each new line; after that, it’s just the individual cells themselves that are grown – they do not form embryos, and could not be implanted to create a pregnancy, while they are growing in the culture medium. “Stem-cell research” uses these separated cells, not developing embryos.) Dickey-Wicker has always been interpreted as permitting funding for stem-cell research, but not for the creation of new lines of cells. Scientists accommodated this by using private funding to generate cell lines, and federal funding for research on the cells. Bush not only banned that, but imposed restrictions on the usage of existing cell lines that choked off vast amounts of ongoing research.

Dickey-Wicker is a bad policy, because the federal government is the source of the majority of basic-science funding, but it doesn’t actually prohibit stem-cell research. The combined effect of the repeal of the Bush ban and the re-authorization of Dickey-Wicker is to restore the situation before Bush meddled with it, and to free up every qualified lab in the country to do embryonic stem-cell research using any cell lines available – instead of just those that can afford to build wasteful, redundant facilities. And, since the cell lines on which Bush did permit research were maintained in a growth medium that cannot safely be injected into a human body, they could not be used to develop clinical treatments as the research progressed. Obama’s policy change removes that barrier.

Note, finally, that it was Bush‘s policy that was criticized as hypocritical – both by left- and right-wingers – because it inisted on prohibiting large amounts of research for the supposed reason that doing so with the products of destroyed embryos was somehow immoral, but at the same time explicitly authorized doing exactly that thing on a small number of specifically-designated lines that were in no way different in origin from the many others that were excluded. It was clearly just an awkward and stupid political compromise that carried no moral conviction – but it bottlenecked a major scientific field for most of a decade.

It would be much better to repeal both the Bush and Dickey-Wicker anti-science policies, but even so, Obama’s reversal is a huge step forward. He is hardly at fault for being unable to also remove a stupid amendment has been stuck into the budget bill by winger cranks for over a decade now. As was Clinton before him, he is in no position to hold up the entire government budget over one minor issue. Like the anti-choice Hyde Amendment, and other idiosyncratic policies, Dickey-Wicker was forced into the budget bill – one of the few bills the president simply can’t veto – because a small number of extremists are willing to crash the government, and the larger number of practical public servants can’t let them do it. But it’s hardly a humiliation, except for the wingnuts who put it there. And its reauthorization, backward as it is, in no way undoes the great good Obama has done with his previous pro-science decision.

Crossposted to Lean Left, the political blog I contribute to, because I’m shameless taking advantage of the fact that Lean Left is aggregated at Memorandum and SufScrup is not.

I’m interested in the issues surrounding animal testing. I’m certainly not a member of the PETA crowd or anything, but at the same time, I’d certainly think we should keep such testing to a minimum, using it only where it’s necessary, useful, and relevant. But I honestly don’t know what all the issues are.

Thanks for the first-ever “Ask the Ethicist” blog post!

And now, what about animal testing? Just to get the ball rolling, here are some relevant issues:

1. What makes using animals in labs worthwhile?

Animals are generally used for lab tests for several reasons: first, much basic biological research concerns animal biology, for which the relevant animals are obviously the best model, and it is possible to study animal subjects in the lab without endangering the wild population of the same animal; in the case of research relevant to humans, animals may still be preferred because statistical analysis requires large sample sizes, which are easier and cheaper to achieve with, say, gerbils than with humans; testing may be invasive, painful, dangerous, or fatal, which again is more convenient with animal models than with humans, unless you’re running a Nazi concentration camp or a US prison; animals can be subjected to experimental regimens, including drugs, with unknown safety or side effects; animals can be used for inevitably fatal or harmful procedures such as the development of new surgical techniques or the deliberate creation of wounds or diseases for the testing of treatments; animal models can be biologically or genetically tailored to the specific research protocol to produce a uniform test sample; animals can be reproduced in the lab to increase the population with a rare condition, making it easier to test; animals are simply easier to control and don’t inject their personalities into the test procedure.

These benefits are predicated upon two assumptions: that animals are good models, biologically, psychologically, or sociologically, for humans, and that it is permissible to do things to animals that would not be permissible in humans. If both those assumptions are true, then animal testing obviously brings great benefits. Any treatment or procedure that is not tested on animals will have to be tested on humans alone, without preliminary indications that it is safe. If the assumption that animals are good biological models for humans is not true, that undermines the value of such testing and hence its moral justification. If the assumption that it is permissible to harm animals in certain ways is not true, that would prohibit types of research involving that harm, even if it were to be beneficial to humans.

2. What problems are there in using animals in labs?

An important problem is that the animals may not always be good models for humans after all; the literature is filled with examples of drugs that passed safety and efficacy testing in animals and were useless or dangerous in humans, and there are other examples of drugs that are safe in humans but dangerous in animals, and still other cases where drugs were safe in some animals but not in others, making the question of human modelling ambiguous. This is why animal testing is a preliminary step in development of human treatments, but human testing is still required. Some have suggested that this means animal testing can be done away with entirely, since it does not definitively prove a treatment will or won’t work, and does not prevent exposing humans to uncertainty anyway.

Aside from that practical issue, the moral assumption mentioned above is the focus of this discussion. Obviously, to the extent that it’s an open question whether animal tests are morally permissible, those tests are problematic – they may be a source of moral harm (to the animals), not a means of avoiding it (for humans).

3. What controversies arise in considering moral criticisms of such use?

Is it true that it is morally permissible to use animals for procedures that it would be immoral to perform on humans? That is, do animals have some lesser claim on moral protection than humans do? Do they have no moral claims at all?

How do we determine which moral claims take priority, and how does species identity enter into that issue? Why do we accord animals any moral claims at all (such as a right not to be mistreated), and why do we not accord them the same moral claims as humans? What standard do we use to determine such questions, and why that one?

4. What are some relevant moral issues underlying these arguments?

Leaving practical considerations aside, the question at the center of this topic rests on the issue of moral standing: what entities have moral interests, or a claim to moral consideration, and why? How do we mediate conflicts between entities that each have some certain level of moral standing?

There are simplistic moral arguments favoring animals, based on assertions of religious, emotional, or otherwise idiosyncratic personal values – that is, some people simply feel an affinity for animals, hold religious beliefs prohibiting harm to animals, or somehow feel that animals are “citizens of the earth” or “living creatures” and that that fact confers moral status sufficient to prohibit harmful treatment. Others assert a moral value to the natural world, such that it is immoral to destroy part of the natural environment because of its inherent moral worth (rather than because it is useful, or valuable, or necessary for life). The problem, of course, is that these are non-starters for anyone who happens to hold different beliefs or values – and therefore non-starters as policy because our policies cannot be parochial or arbitrary and carry compulsory moral force.

Thus, the assertion of animal interests generally follows some analysis of the moral status of animals that makes harming them a morally significant act.

That can be an argument to the effect that animals are moral persons with equal claim to moral interests, compared to humans. Jeremy Bentham argued that this was an inevitable consequence of utilitarian morality over 100 years ago, and Peter Springer has resurrected that line of reasoning in a way that has been influential in the current animal-rights movement. To make this argument, you have to define the threshhold for personhood fairly leniently. For Bentham, it was merely the capacity to experience pain. (“The question is not, Can they reason? nor, Can they talk? but, Can they suffer?”) From this perspective, any creature that can consciously experience pain is a full moral person, whether or not they have any other mental functions – so birds, fish, and of course all mammals are morally equal. This is why Singer promotes vegetarianism, and why some animal-rights advocates are against pet ownership as a form of slavery.

You can also argue that animals have lesser moral status than humans, but are still due some degree of moral consideration. On this ground, it might be permissible to use animals in some ways that did not cause suffering, but perhaps not to kill them, or to do so only when a comparable benefit to humans was expected. This argument would be grounded on a definition of personhood that required capacities beyond those of most animals – for instance, the possession of a unique sense of self-identity, or perhaps some kind of higher reasoning function. If animals have some, but lesser, moral status, then at the least we must alter our animal-handling practices to ensure that they are not excessively cruel, and perhaps we might have to cut out some practices as well – but a wide variety of common behaviors toward animals would still be tolerated, possibly including farming or killing them, or conducting research on them, under specific guidelines.

Finally, you can argue that animals are not moral persons and are thus due no moral consideration at all – they can be treated as if they were inanimate objects, such that the only considerations against using or killing them would be practical ones (maintaining species diversity, stabilizing the food chain, etc.). One might also work in some sort of protections against cruelty or gratuitous pain infliction, on grounds of a general duty not to be cruel, or for moral training purposes (avoiding developing bad habits), but not on the basis of the animal’s moral interests itself. Given this perspective, almost any animal-treatment practices that are not gratuitously cruel – including raising them for food or commercial exploitation, or even conducting relatively frivolous research on them – would be allowed, since there are no countervailing interests on the part of the animals to stand against them.

Note, though, that if we do not take the extreme abolitionist position, then whatever view of animals that we do take will impose at least some limits on our behavior. If we think animals have limited moral claims, there will still be some things we cannot do to them, but, since they stand at a lesser moral plane than humans, there will always be some things we can do to them. How far those limits go in either direction is open for debate, but most people in this position would agree, for instance, that it is wrong to torture animals for fun, but not wrong to use them in medicine to save human lives. Narrowing down those extremes is what the continuing debate is about (if not torture, what about forcing them to perform under stress in rodeos?; what about performing under less stress in circuses?; what about being owned as pets?; if medical uses of animals are allowed, what about medical research?; what about cosmetics research?). Even if we hold that animals have no moral claims per se, respect for suffering as suffering ought to impose at least some check on what we can do to animals capable of experiencing pain.

So, the debate over animals incorporates the debate over the proper definition of moral personhood. It also rests heavily on empirical questions about the degree to which they can feel pain, the degree to which they exhibit emotions or consciousness, and our interpretation of their various behaviors in that regard. This debate thus parallels, and both influences and is influenced by, identical debates taking place regarding humans in the context of abortion, stem-cell research, the treatment of newborns, and end-of-life treatment. It has unique elements, too, in that animal personhood must obviously be of a different type from human personhood, and convey different privileges even if that personhood is recognized (i.e., saying that animals have moral interests does not require saying that they should be able to vote, enter contracts, marry human beings, etc.; conversely, saying that they should not or cannot do those things does not by itself imply that they are not persons).

Species is an important issue in animal-rights debates, too. Animal-rights advocates often accuse opponents of “speciesism”, meaning making arbitrary moral distinctions between living things on the basis of their membership in one or another species. However, it is seemingly impossible to articulate an argument that establishes equal moral personhood for all living things, or even just all animals, without any discrimination between species whatsoever, especially given the huge number of invertebrate or microscopic species that very obviously possess no conception of the moral life; taking that position seriously would also lead to absurdities such as claiming that it is morally wrong for obligate carnivores to eat prey. So, we must make distinctions on grounds of moral personhood, and since species identity more or less determines moral capacity, as a baseline at least, those distinctions are going to include or exclude entire species, possibly with the exception of a few borderline cases where the evidence is more ambiguous. Thus, most animal-rights activists wind up drawing a line somewhere, allowing that it is permissible to make use of species with lesser mental capacity than those at the borderline, but that there are limits regarding species with greater capacities. Many attempt to draw this line to include some ape species; some go farther to include a larger range of mammals; Singer famously draws it provisionally somewhere among the Molluscs.

5. If we are not extreme abolitionists on animal-rights issues, how do we decide what kinds of treatment are justified and which are not?

It must be recognized that the different things we do to animals have different types and degrees of consequences, and also that the different benefits we derive from our treatment of animals are likewise of differing kinds and degrees of significance. The greater the human benefit derived, the greater justification there is for the process of obtaining that benefit; the more harmful the treatment required to obtain it, however, the less justified it is. The general approach to such situations is a “balancing” test of degree of harm vs. degree of benefit.

For this reason, much animal-rights activism has – reasonably enough – focused on particularly egregious harms to animals in pursuit of seemingly trivial benefits to humans: for instance, hunting rare species only for luxury products or gourmet foods; the cruel confinement of veal calves only to produce tender meat; or the use of irritating or deadly chemicals on animals to test cosmetics or soaps. But we do not have a system for establishing absolute degrees of harm or benefit (how bad is it to be immobilized in a pen or cage? how good is it to eat plump chickens or tasty veal?), so we cannot say with authority exactly when the balance of harms and benefits tips in different cases.

Notice, in this discussion, that there is no clear moral distinction between the use of animals in medical testing and their use in other ways – and so I have broadened your question to include all forms of use of animals. The “balancing” approach described above merely asks how much benefit – not of what kind, and likewise how much harm – not why it is inflicted. To most moral philosophers, there is nothing inherently “better” about research to save lives than research to invent cosmetics, except that the one outcome is obviously more significant in the lives of, and more highly valued by, the people benefiting; similar remarks apply to the different kinds of harms inflicted upon animals. Because medical care is so important, medical research on animals is most likely easier to justify than less-vital uses of them, but only for that reason. There may be medical treatments whose benefits do not justify the toll taken on animals to develop them (in light of the fact that most candidate drugs or procedures do not successfully emerge from development, and the few that do still require extensive human testing, it may be that almost no new medical discoveries truly justify the many thousands of animal deaths required to produce them – if we place a sufficiently high value on animal suffering). Then again, there may be less-important non-medical benefits that are justified, if the role of animals in producing them was minimal enough. So, in considering “testing”, we have to remind ourselves that animal use involves much more than the development of new and important medical procedures; it involves a vast amount of unsuccessful medical research and even more non-clinical basic-science research, developmental testing of consumer products (most of which are not exactly in the cure-for-cancer category), and the use of animals to test products and procedures for the farming or treatment of animals themselves. In addition, there are non-testing uses of animals such as for the production of industrial products and materials, hunting, entertainment, and pet-keeping, and the vast animal-based food industry, that must be taken into account.

These remarks may help outline the scope of the problem. You’ll notice no answers are given! But thanks for a great and timely question. The ball is now in the readers’ court!

Resources:

Animal Liberation, by Peter Singer
The theoretical Bible, and foundational text, of the animal-rights movement.

Animal Rights: Current Debates and New Directions, by Cass Sunstein and Martha Nussbaum
A new treatise by two well-respected academics.

Should Trees Have Standing? And Other Essays on Law, Morals, and the Environment, by Christopher Stone
The issue of moral and legal rights for non-person entities, from a legal perspective.

The Omnivore’s Dilemma: A Natural History of Four Meals, by Michael Pollan
A review of the entire US food-production industry, including problems with animal-based foods.

“Animal Rights“, “Animal Welfare” and “Animal Liberation Movement“, Wikipedia
Decent surveys of the distinct concepts and their histories, with lots of links and references.

“Animal Rights: An E-mail Debate between Peter Singer and Richard Posner“, at Slate
An epistolary debate between Singer and a well-known conservative US Federal judge.

But that can take many forms, one of which is mocking, in appropriately childish fashion, PETA’s own tactic for pressuring corporate chicken-torturers [sic]. They have a Web sign-generator site in which they encourage people to post comments about Kentucky Fried Chicken’s practice of, as they put it “tortur[ing] chickens for profit”. Whatever the hell that’s about, it interests me far less than the fact that PETA, as a group, is offensive and abusive to real people, whom I care about far more than the animal fetish-objects that are their sole obsession. So if we’re going to make little signs about cruelty and inappropriate moral priorities, well, let’s get our inappropriate priorities straight, first:

Make your own!

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.

First, as a look at the links given above will demonstrate the AIDS conspiracy Wright endorses did not originate with, and is not limited to, African-Americans. White conspiracy theorists have been throwing around wild rumors about HIV/AIDS and germ warfare for a long time, and have developed them into intricate and extensive – and often bizarre – criticisms of both the received history of the AIDS epidemic and the scientific grounding of HIV research. Peter Duesberg, the most infamous of this crowd, is white, and has solid scientific credentials (which is not to say he’s not crazy); it was Duesberg who advised Thabo Mbeki of South Africa, and lent credence to Mbeki’s crazed ravings, resulting in the destruction of that country’s public health system and uncountable deaths. Kary Mullis, also white and an infamous eccentric even before he won a Nobel Prize and went nuts, has likewise thrown his hat into that ring, lending still further credence to charges that are at best irrational and at worst irresponsibly dishonest or just crazy. Many of the other rumor-mongers are white as well.

So Jeremiah Wright is by no means acting alone in promoting such wild theories, nor are such theories evidence of “black nationalism” or “racial anger”. But they do have a particular resonance in the black-American community, and for reasons that make such beliefs, especially in that community, seem almost defensible.

The unconscionable history of abuse and mistreatment – by medical means among others – of black Americans makes it quite simply impossible to dismiss any further story of abuse as unlikely or unbelievable. The shocking reality of slavery alone – that an entire group of human beings would be degraded to subhuman status and treated as property, and not merely as such, but subject to unspeakable mistreatment and bodily abuse at the same time – would be unbelievable if it were not so mundanely true. After America did that to its own citizens, what else is not believable? What else is not possible? In the minds of very, very many black Americans, there is nothing they do not expect America could or will do to them – and on grounds of simple historical fact, they are far from wrong.

That suspicion and resentment find a distinct focus in the area of healthcare. The abuse of black Americans’ bodies by white America is a story that begins with slavery and extends to the modern day. In addition to the horrible abuses of slavery itself, the quasi-medical mistreatment of blacks it entailed stands as its own story. Black slaves were literally bred as stock, and their children sold out of their families, by slaveholders; they were systematically raped, openly, by their white oppressors for that purpose, as well as for simple pleasure. Their health was treated as an economic question – what care they got, and whether they got any, for their illnesses while in captivity was dependent upon its implications for their future profitable labor. In some parts of the South, it was simply cheaper to let slaves die of malaria (and replace them with slaves from more malaria-tolerant African sub-groups) than to treat them. But black slaves and ex-slaves played another role in American medical history.

Southern medical schools in the 19th century openly advertised for slaves or other black patients for students to practice on, and blacks were also often the source of cadavers for medical school dissections, and the subjects of medical experimentation, often against their will. Long before rumors of AIDS or other forms of medical mistreatment, there were long-standing fears in the black community of body-snatching and even vivisection in white medical schools. In some cases, ambitious doctors “borrowed” sickly slaves from white slaveholders, or or purchased them outright, for the purpose of performing experiments, usually (in keeping with the standards of the day) crude, unscientific, and painful or dangerous. James Marion Sims and his protege, Nathan Bozeman, perfected the surgical repair of vaginal fistula by performing a harrowing series of operations on black female slaves before the Civil War; some women underwent up to 30 operations before being cured. After developing a workable procedure on these slave women, Sims turned to operating on white women for profit for the rest of his career. (Ironically, today the procedure is used almost entirely on women of color, usually in the 3rd world, where the cause of these fistulas – tearing of the vagina in childbirth by teenage mothers – is concentrated.) Sims is today honored as “the father of gynecological surgery” with not one but two statues in New York City alone.

These practices continued into the 20th century. It is increasingly-widely known that many medical treatments, having been optimized on white male research populations, do not work as effectively on women and blacks. Again and again it has been shown that aggressive interventions – including basic procedures such as an immediate aspiring for suspected heart attack – are overlooked or under-prescribed for black patients (among other sub-groups). Blacks are vastly less likely to have health insurance in America, less likely to have insurance that covers their actual needs, and more likely to be denied coverage for recommended procedures. They are consistently more likely to remain undiagnosed for life-threatening illnesses, to remain untreated or undertreated for them, and to die of them, than white patients. And those are merely the everyday, systematic injustices that occur. The real scandals are even more shocking.

It has only recently been revealed that, after WWII, the US government conducted extensive experiments involving exposure of human subjects to dangerous levels of radiation, sometimes without their knowledge; almost all of the subjects were black. There have been many publicized scandals involving research on prison inmantes; what is often overlooked is that the subjects of those studies are not jsut prisoners but most often entirely or mainly black prisoners. Many white people today have heard of the infamous Tuskegee Syphilis Study; almost all adult blacks have heard (at least some form of) the story. To whites, the story seems disorienting, unbelievable – to blacks it is all too familiar. That story is illustrative here, in another way: among the black community, the already-horrible facts about the Syphilis Study are often exaggerated to make the story worse than was actually true. Instead of a program to monitor untreated syphilis among already-infected patients, it is widely believed by black Americans to have involved actually infecting healthy patients with the disease. Instead of a limited program that grew out of a well-intended public health effort (scaled back to passive monitoring when the Depression hit and funding dried up), it is often believed to have been a calculated and planned program of genocide. But the actual facts are staggering enough – and these exaggerations are logical extensions of what did in fact occur; in principle and in effect (if not in literal fact) they are not even exaggerations.

It is difficult for those who have not had experience in the area to understand the pervasiveness of distrust this history – particularly Tuskegee, but the rest of it as well – has engendered in the black community. Teaching healthcare ethics in inner-city colleges, I have never once had a class with more than a few black students in it in which it was not the case that at least some – usually almost all – of the black students had heard of the Tuskegee scandal; not one of my white students has ever known of it before entering the class. Working in a major university healthcare center in a majority-black city, I once discovered it was literally impossible to get any black patients to even answer a simple questionnaire or listen to explanatory information about advanced directives for healthcare (being approached on the subject by a white man in a white coat probably didn’t help). I heard more than one whisper to a companion, as I walked away, that this mechanism – the foremost tool for promoting patient autonomy and individual rights in healthcare – was a plot by whites to kill blacks by turning off their life support. To a person who does not share a familial or cultural history of abuse and mistreatment of the kind detailed above, these fears and obsessions seem almost crazy. Why is an entire cultural subgroup fixated upon one regrettable, but aberrational, scandal from decades ago? Why would they fear the system that, almost alone in modern society, still embodies a truly altruistic ethos and agonizes over its own failure to adequately serve its underserved client populations? How crazy do you have to be to think your doctor is trying to kill you?

Not crazy at all, if you’re black. It has been done. That is the bottom line – the inescapable truth that comes back again and again in any context which puts black Americans under the influence of the healthcare system. That system – particularly, and mostly, mainline medicine as practiced by white male physicians – has turned itself to the organized and systematic abuse of black patients and research subjects, not in one or a few isolated incidents, but again and again, in the most varied settings and through the most bizarre and abusive practices. It is not crazy – it does not even require any great stretch of the imagination – to think that medical doctors, or the government, would have created a disease to decimate the black population. They have allowed diseases to spread through that population while active working to prevent their cure. They have exposed blacks to diseases and toxic conditions, and invented birth control regimens marketed primarily to black populations, that had the effect of systematically diminishing, sterilizing, and to at least some degree eradicating black Americans as a group. They have connived at the importation of addictive drugs that have primarily affected the black community, in epidemic proportions. The Reagan administration did ignore AIDS for years, at a time when the most good could have been done to head off the eventual epidemic, out of its repugnance at the pimary victim populations of gays and non-whites.

If the government had actually anticipated that AIDS would particularly affect the black community, and stood aside to allow it to happen, that would be nothing more than an absolutely literal recreation of its behavior in regard to other diseases in the past. The step from there to the idea that the government might actually have created that disease is a small one, and hardly far-fetched in light of other things the government and medical researchers really have done. Now, it appears in fact that the US government did not invent AIDS, or deliberately encourage its spread through the black community – although they did stand by and watch for years as it happened in front of them. But with all this history behind, who would not suspect the government might have played an active, and not just a passive, role in creating the epidemic? If you were a member of a group condemned generation after generation to the kinds of treatment detailed above*, and then witnessed the history of AIDS – its prevalence closely tracked by government researchers who somehow could never quite find anything useful to offer as it destroyed the most vulnerable and downtrodden subgroups of American society – how could you not at least suspect that there was more to the story than met the eye? Given what actually has been done, time and again, generation by generation right up to the present, on what grounds can it be asserted that there is anything the government, or the medical community, might not do if they took it into their heads? What story possibly could be too far-fetched to believe in, given the range and number of seemingly unbelievable stories of medical abuse of blacks that are actually true, documented, and admitted?

Gerson, however – and I would guess at least 90% of white America – cannot grasp this. He really thinks it is unthinkable to imagine the things Jeremiah Wright imagines. In fact, he thinks such beliefs are so far gone that they – the beliefs themselves, and not the history that gives rise to them – are unAmerican:

[Believing that the US government created AIDS and unleashed it on black Americans] 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.

This reaction is in a way darkly humorous. Gerson finds it literally unbelievable that black Americans would believe that America is guilty of “monstrous crimes . . . perpetrated by a conspiracy of medical Mengeles”, and of “unspeakable evil”. The joke is that, not only do many blacks believe the things he thinks are unbelievable, but those things are, in fact, true. Leaving aside the question of AIDS, what was the 40-year Tuskegee Study but “a conspiracy of medical Mengeles”? Does not the unending history of research abuses, disdain for autonomy or consent, torturous experiments on helpless slaves and prisoners, and systematic mistreatment and undertreatment of black patients constitute “unspeakable evil”? And even if the AIDS story were true, it pales, in timespan, prevalence, death toll, and sheer moral degeneracy, beside the 400 250-year history of chattel slavery, and 400 years of systematic oppression, that America openly and deliberately imposed on its black citizens. Is that not “one of the most monstrous crimes in history”? Since America, and its doctors, did in fact do all this and more, how is it unthinkable that it should have committed just one further such abuse, in the case of AIDS? That belief appears in fact to be mistaken, but in light of history it’s hardly irrational. And if Wright, knowing what he knows, and believing (mistakenly) what he believes, does not actually urge the overthrow of the US government, is it not at least understandable he should cry out to God to damn the government?

But Wright’s accusation is batty, reflecting a sputtering, incoherent hatred for America.

This is nonsense. Wright’s accusation is perfectly rational, although false. I have no idea whether Wright holds a “sputtering, incoherent hatred for America” (though he appears to me to be in no way incoherent). But the belief in the AIDS conspiracy reflects nothing more than the established historical facts of the syphilis conspiracy, the Holmesburg prison dermatology conspiracy, the Norplant (semi-)conspiracy, the nuclear radiation conspiracy, the conspiracy to promote research on slaves, the conspiracy to steal black bodies for medical school dissection, and many more over many years. The widespread black suspicion regarding the medical profession is grounded on facts Gerson has obviously never heard of. It is far more rational, and in content far more true, than Gerson’s offhanded dismissal of such suspicions as “batty”, false, or inexplicable.

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.

Here I think Gerson is just suffering from the traditional Conservative Reading-Comprehension Disorder. Obama did not state any equivalence between the views of these parties – he said that he cannot eject either of them from his life for the same reason – that they are family. (And why would he? If he loves his grandmother in spite of her unconscious prejudices regarding blacks, why would he not love Wright in spite of his factual error regarding AIDS?) And again, as for Wright’s accusations about AIDS, he may be wrong but there is no ground for regarding those views as extremist, outrageous, or inexplicable. If Obama’s exposure to his grandmother’s unreconstructed ideas made him “cringe”, how could Wright’s knowledge of the very real history of medical abuse of US citizens not take the form of a much stronger reaction?

The fact that that reaction is forthcoming, and resonates so strongly, as I am sure it does, with so many black Americans, is a reflection not of their “hatred of America”, but of their acute awareness of America’s treatment of their families and others like them, and of their perception that that history has not fully run its course. In light of that history, the calls of oblivious whites for a “post-racist” or “colorblind” society are not just stupid, but morally offensive. Too many whites are like Gerson – simply uncomprehending that blacks can really believe that America would continue to treat them, today, the way America has always treated them in the past, right up to today. The first step in reconciling these two visions of America – a credulous vision of universal beneficence maintained by exhaustive ignorance of black history, and a corrosively suspicious vision grounded on pervasive historical reality – is to wake whites up to the historical grounds for, and justification for, black grievance and suspicion. That grounding of historical fact goes far beyond slavery and Jim Crow (as if those weren’t proof enough of the darkest suspicions imaginable); it is a factor of literally every generation, every family, in some way every life that makes up the black community in the United States down through the years, and it invades every aspect of such lives, including, shamefully and grievously, their encounters with the “healing professions”.

Obama – with perhaps too much sense of balance – brought forth the tiniest, least threatening glimpse of that history in his speech, and put it in the context of white grievances over “reverse discrimination”. (Talk about inappropriate parallels!) Even that was obviously too much for Gerson and whites like him. It spun his head, boggled him with aromas of “sputtering, incoherent hatred”. Until that reality sinks in with all its awful force – clearly too much for defensive whites to grapple with even at this date – Obama, and we all, may be doomed to continue living out that cancerous, Faulknerian past that is not past, within sight but not within grasp of what might have been.

UPDATE: As others have noted, slavery did not persist for 400 years in America; it is generally agreed that the first known slave was brought to the colonies in 1619, and slavery ended with the end of the Civil War in 1865, not quite 250 years later. It has been almost 400 years that black Americans have lived as the de facto, and for most of that time de jure, underclass. The description in the text above elided the distinction between the two; it has been corrected.

UPDATE: As Tgirsch notes in comments, Obama’s church is not affiliated with the Baptists. 
* And much, much more. A heartbreaking, infuriating, but very necessary review of the medical mistreatment of black Americans can be found in the indispensable volume Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, by Harriet Washington. As Washington herself notes, its 400+ pages only skim the surface of experimental abuse of blacks, and leave therapeutic mistreatment almost untouched. This legacy is truly evil, and poisonous in ways that can only be dimly sketched.

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? . . .

One one hand, this is a worthy contribution to the “stupid product marketing” museum – and Aarons is far from the first to comment on the absurdly chirpy ad campaigns for menstrual products, or their seemingly inexplicable design. But, without making too much of it, there’s something more here as well, something that reflects the “sexism as a health issue” theme writ small, as I previously tried to express it more broadly.

Simply put, women’s health is largely in the hands of clueless, careless, and uninterested (if not outrightly hostile) men, and this has consequences. Only a man would write “Have a Happy Period” on a maxipad. Only men would perform 80 – 100,000 unnecessary hysterectomies a year in the US, mostly on women in their reproductive years. Only men would create close to 100 different types and formulations of prescription birth control methods that act on women’s bodies, and not one for men. The effects are substantial, and pervade every aspect of care for women. But “Have a Happy Period” says it all. The rank ignorance of women’s lives, bodies, and health, and the thoroughgoing disgust with which women’s biology is perceived, even among professionals engaged in caring for them on a daily basis, renders the health options offered to women not merely absurd but destructive. The simple fact that women are a secondary concern for – and, still in this day and age, a complete mystery to – the men who shape their lives and healthcare, leads to asininity like happy menstruation, and to outrages like unnecessarily dangerous pregnancies and abortions.

Progress has been made on women’s issues, and women’s health, in many ways, but in many ways we’re still in the 1950s. Somewhere out there is an idiot (possibly named “Mr. James Thatcher”) who believed that cheery slogans on women’s hygiene products would be appreciated. Somewhere out there are legions of pharmacists – all, as far as is known, male – who think they can simply deny a woman prescription medications if they choose for her to live her sexual life differently from the way she has chosen for herself to do so. Somewhere out there, in a prominent place and in prominent positions, are these assholes:

They all look like they’re having a very happy period. But as long as men like these have any control over women’s healthcare, women will suffer severe dysgynorrhea. The only treatment is to eradicate the cause.

Hat Tip: Tgirsch at Lean Left.

This list, adapted from the UN’s 2006 Study on Violence Against Women, tells the story as well as anything:

International Women’s Day 2007

Take action to end impunity for violence against women and girls

• Violence against women is the most common but least punished crime in the world.
• It is estimated that between 113 million and 200 million women are demographically “missing.” They have been the victims of infanticide (boys are preferred to girls) or have not received the same amount of food and medical attention as their brothers and fathers.
• The number of women forced or sold into prostitution is estimated worldwide at anywhere between 700,000 and 4,000,000 per year. Profits from sex slavery are estimated at seven to twelve billion US dollars per year.
• Globally, women between the age of fifteen and forty-four are more likely to be maimed or die as a result of male violence than through cancer, malaria, traffic accidents or war combined.
• At least one out of every three women has been beaten, coerced into sex or otherwise abused in her lifetime. Usually, the abuser is a member of her own family or someone known to her. Domestic violence is the largest form of abuse of women worldwide, irrespective of  region, culture, ethnicity, education, class and religion.
• It is estimated that more than two million girls are genitally mutilated per year, a rate of one girl every fifteen seconds.
• Systematic rape is used as a weapon of terror in many of the world’s conflicts. It is estimated that between 250,000 and 500,000 women in Rwanda were raped during the 1994 genocide.
• Studies show the increasing links between violence against women and HIV and demonstrate that HIV-infected women are more likely to have experienced violence, and that victims of violence are at higher risk of HIV infection.

Aside from the ghastly statistics, and the obvious impact on women’s health of these crimes and oppressions, notice how much violence against women has medical overtones or involves women’s reproductive functions. A standard tactic, and one of the most vicious weapons, of misogyny is to use women’s bodies against them. This manifests in medical terms as much as it does as direct physical violence. For women around the world, including in the most “advanced” nations, encountering the medical setting, or merely trying to act on their own decisions about their own health or bodies, brings abuse, discrimination, frustration, danger, and not infrequently physical and psychological harm or death.

American women are relatively lucky in that only 25% of them are more than 50 miles from an abortion provider, and only 94% of rural counties lack one; they may be harassed at the clinic and at home and work for seeking abortion, but all deaths so far have been among clinic staff, not patients. They may endure forced pregnancies at the whim of religious extremists ranging from bombers who destroy their only access to abortion services to pharmacists who refuse to fill legal prescriptions for birth control to “sex educators” who provide false information about sex and make birth control unavailable – but at least they’re relatively unlikely to be burned to death for being sterile. Their healthcare may be based on research conducted mostly on men, but it’s generally better – for the 2/3 or so who have access to it – than that in the most repressive countries (for instance, Afghanistan, where women are not allowed to become doctors and male doctors are not allowed to examine female patients – this after it was “liberated”).

Around the world, women’s access to, and autonomy in utilizing, healthcare services is in an even more precarious state. In the poorest countries, families may simply not pay for treatment or medication for women. In other cases, women are not allowed to seek care on their own; they are spoken for by male relatives who decide whether they will use contraception, how many children they will have and when, what and how much food they will be given, and other such basic questions of health. As the UN figures note, genital mutilation and HIV infection are also direct results of women’s oppression and lack of autonomy; sexual abuse is rampant and also contributes to the HIV epidemic.

In addition to this basic, too-familiar direct abuse, the general lack of power, respect, and independence that results from sexism – from refusing to acknowledge and treat women as full and independent moral persons of value – degrades their health in other ways. The sheer psychological toll of putting up with sexist bullshit of every possible kind, almost everywhere you look, day after day, turns up in almost every aspect of women’s lives: from their opting-out of male-dominated fields in which they face discouragement or harassment; the absurd and often deadly struggles to meet external standards of bodily appearance that they are constantly encouraged into; the nagging, bullying, and abuse that discourages women from stepping outside the “feminine” stereotype, sexually, professionally, intellectually, or in any other way; the epidemic of depression found among women locked out of lives and careers of their own choosing; the wave of suicides seen in Afghanistan in response to unbearable religious oppression and abuse, and on and on. The constant encouragement of women to sacrifice themselves for their families, and to treat self-regard as selfishness, leads many to ignore their own health needs even when they become ill. The psychotic level of demonization of women’s sexuality – simultaneously with the social identification of women solely by their reproductive and sexual qualities – creates a climate in which women’s sexuality and sexual health become distorted to almost-unrecognizable degrees. Two female high school students were suspended from school this week for using the word “vagina” (though perhaps this is an example of non-sexist hysteria: a best-selling children’s book is also currently being censored by libraries across the country because it contains the word “scrotum”). There are perennial complaints and crackdowns on women breastfeeding infants in public places. Super-thin models literally die during fashion shows from anorexia. The words “chastity” and “purity” are not only being spoken again without irony, but are accompanied by the usual invective against sexually active women, and a truly creepy movement to make fathers out to be their daughters’ boyfriends and husband stand-ins. Religions of all kinds, despite progress in limited areas, retain a fundamental contempt for women in their teachings and practices, and in the aspects of daily life and social policy that they affect. The most extreme elements of major religions are again on the march, seeking – successfully – to impose the most repressive restrictions on women’s social, familial, sexual, and working lives, and to condemn them to literal purdah, torture, and slavery in some parts of the world; politicians actively cooperate.

In short, disrespect for women invades the body- and health-related aspects of their lives even more than all the rest. A large part of sexism, around the world, simply consists of discomfort with, and disgust at, women’s bodies and their functions. The repression of sexuality and other gendered aspects of normal human life is the universal result. In other ways, the general lack of power and independence most women suffer to some degree, and many women overwhelmingly, makes it impossible for many to maintain their self-esteem and mental health, or to look after their health needs.

In these ways and others, sexism is a bioethics issue. If there were any other aspect of human life that materially degraded the living conditions and mental and bodily health of more than 50% of the world’s population – that systematically resulted in the suffering and death of hundreds of millions of people from one distinct biological group – that barred access to effective care for some or all health concerns of that group – there would be outrage and aggressive action. It is time to recognize sexism and gender discrimination, as well as all forms of gendered oppression and lack of autonomy, as sources of illness and death – among all the other things that is wrong with them. Sexism, besides all else that it is, is a health issue. It causes injury, abuse, diseases, mental illness, and death, in proportions that approach an epidemic. Anyone who cares about the health and safety of human beings in general must care about sexism as a threat to those values for more than half the world.

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.

SPOILERS FOLLOW

Plot (such as it is)

If you’ve seen the trailers, or even just the poster, you know the plot of this movie. Story-arc-wise, it’s as obvious and clicheic as you could ask for, one of the worst of its type in that respect. But, just so we’re all on the same page:

The story is set in what at first appears to be a sterile, futuristic society that offers an unusually bland technical Utopia: everyone wears white jump suits, lives in hypermodern concrete cubicles, works absurdly boring and unchallenging jobs, exercises fanatically under supervision, and takes orders without question from computerized monitors that dictate what they must do, what they can eat, and whether they have too high ionic content in their urine. Friendships are discouraged, and when male and female citizens come too close together they are menaced by black-suited guards who gruffly order them to “watch your proximity”. Gradually it is revealed that they live in an isolated compound to avoid contamination from some unspecified holocaust that has ruined virtually the entire surface of the earth. The focus of their lives is “the lottery”, whereby lucky individuals are chosen from time to time to leave the compound and go to “The Island” – a tropical paradise which is the last uncontaminated spot on the planet. Pregnant women are favored – they “go to the island” as soon as they give birth.

One citizen – “Lincoln Six Echo” – hesitantly questions the inconsistencies he observes: how did things get like this?; what exactly is the purpose of their boring and repetitive jobs?; where does his friend, a scruffy tech-support character who moves around the unseen physical plant of the compound and does not wear a white jumpsuit, live, and why is he different?; how did a live moth get in the ventilator shaft, if every living thing on the planet was destroyed?; what is the meaning of his recurrent dream about a boat? He is the first to raise such questions, but he gradually infects the others with curiosity. He arouses the concern of the compound director, who calls him in for “therapy” and begins to monitor him.

Wandering around unauthorized, “Six Echo” stumbles into the medical wing. He witnesses a fully-grown clone being extracted from an amnion-like sac, resuscitated, and then branded and locked into the ID wristband all clones wear; a technician remarks “looks like we’ve got a good product”. He observes a pregnant woman – the most recent lottery victor – in labor. She delivers a healthy baby, but while she is asking to hold it the doctor injects her with a vile green substance. She goes into convulsions and dies as the delivery nurse holds her feet in the exam-table stirrups with a thoughtful expression. Running from this, he stumbles into an operating theater where the previous lottery winner is being systematically cut apart for his organs by surgical robots – he leaps screaming from the operating table and races down the hall, tubes and wires trailing. He is shot down by the black-suited security guards and dragged back down the hall, leaving a trail of blood. Clearly, things are not right.

Six Echo comes to the realization that the island is a sham and the lottery winners are being killed in these medical procedures. He attempts to escape the facility, dragging his doubtful but curvaceous female friend along. They escape to the outside of the facility wall, then through a digital camouflage screen, suddenly seeing the outside world as it is for the first time. They manage to make it up through a ventilation shaft to the surface, where they find themselves in an open desert. Soon enough they find other people, realizing that the surface is not deadly after all.

They contact Six Echo’s tech friend, who reluctantly explains the situation: “you’re not human”. They are clones of wealthy clients of a shady biotech company; grown to adulthood in their sacs and implanted with false childhood memories, they are kept docile in a programmed, safe environment until their bodily organs are needed to save or rejuvenate their “sponsors”. He is told “you’re not like us – real people”.

It’s obvious that the biotech company will go to any lengths to keep its setup secret – Six Echo and his not-quite-girlfriend (they are kept “at the level of a fifteen-year-old” and thus haven’t discovered sex yet; a real-world character is stunned to learn this and tells him “well, I won’t spoil the surprise – you’re in for a treat!”) must flee for their lives. The bulk of the film is taken up with a helicopters/jet motorcycles/machine guns chase sequence that is both unenlightening and unexciting; naturally the two unarmed, completely ignorant clones, on their first day in the real world, manage to destroy a mercenary army and all its hardware while surviving a 50-story plunge off a building.

Simultaneously, however, expository sequences with the biotech director make it clear what is happening: the clones were originally intended to be kept in a “permanent vegetative state” – which is what the firm’s clients are still told – but for some reason it was necessary to give them full consciousness in order to make the clone procedure work right. Now, the clones’ brains are establishing new neural circuits that correspond not to their own implanted memories but to the real-world memories of their DNA-donor “sponsors”, which is why Six Echo keeps dreaming about boats – his sponsor is a wealthy boat designer. Shocked that his firm’s “product” is developing its own will and independent agency, the director orders all “product lines” “recalled” – the growing clones in their amniotic sacs are killed, and the guards begin rounding up the existing clones on pretense of a mass exodus to the “island”, then stuffing them in gas chambers.

Luckily, Six Echo and his girlfriend Two Delta have nobly volunteered to return to the facility to try to rescue the other clones, and so manage to trick the guards, breach the security wall, and lead the clones on a dangerous climb up the ventilator shaft as the guards cut them down with laser rifles. The final scene shows the clones, in their gleaming jump suits, assembling in waves on the edge of the mesa that hides the facility, facing the sun for the first time and knowing that it is good.

Genre

OK, so so much hokum. The iconography of the film is interesting, however. I detect many quotations from other (mostly better) films, placing The Island in a distinct technical-dystopia tradition.

The obvious similarities to Brave New World and 1984 are unavoidable: vat-grown humans in a rigidly hierarchical system; technical amelioration of all inconvenient emotion; video monitoring of all residents at all times; etc. To some extent these parallels are inevitable in the tech-dystopia genre, and beyond the artificial-womb technology and the jumpsuits I don’t think the tone of The Island quite matches that of Brave New World – b0th are anti-bioengineering, but from different angles. In the end, these parallels are so obvious and so overused that I am inclined to discount them here. Others are more subtle and more interesting.

There is a very brief shot, looking upward from ground level, of near-future LA just as the clones arrive (by maglev train) during their escape bid. The sky is filled with tapering skyscrapers, and the canyons between them buzz with sky trams and flying shuttles moving in every direction. I am almost certain this is a deliberate recreation of an almost identical shot from the classic Metropolis – the prototype for all futuristic technical-dsytopia slave-army parables.

An escape sequence through a tunnel with shafts of bright overhead light, and more broadly the stark-white lighting scheme, alphanumeric character names, jumpsuits, and anti-sex regimentation seem distantly, but distinctly, reminiscent of Lucas’s first and in some ways best film, THX1138.

The general “athletic young male rebel gets hip to his murderous techno-fascist society, goes on the run with his sexy blond girlfriend in tow, gets shot at a lot, escape to a post-apocalypse wilderness” plotline is an unsubtle ripoff of Logan’s Run.

The ventilator-shaft escape with the laser rifles is an all-but-unmistakable quotation of the climactic scene from the first, genre-defining genetic-holocaust movie, The Andromeda Strain.

There is another brief shot, as the two escapees enter the (hypermodern, concrete) home of Six Echo’s sponsor, whom they hope will help them; it shows the building’s open-plan living room with a set of steps slanting up one wall. Again it lasts only seconds and is not emphasized, but it reminds me strongly of a very similar shot in GATTACA, also showing the (hypermodern, concrete and steel) home of the wealthy character who is using another character’s fluids and body parts for his own advantage, in another bioengineering-dystopia, “earn-your-way-offworld” social context.

The “clones in sac wombs” bit seems lifted from the very similarly plotted Scwarzenneger flick The Sixth Day – which would also explain the helicopters, automatic weapons, and explosions.

These references* put The Island at the end of a line of (mostly) biological warning films with similar cultural/scientific assumptions. The greatest crime of the cloners is to deny the humanity of their “product”. Whatever controls or limitations they may put in place (recall the “alcohol in the blood surrogate” that makes the Delta workers docile and complacent in Brave New World), humanity’s true nature will show through; the clones will develop intelligence and initiative, and claim their rightful place among God’s creatures, no matter what. (Recall also the “nature will find a way” theme from Jurassic Park – the dinosaurs mutate into breeding colonies even though there were made genetically sterile.) Naturally, inhuman corporate monsters claim the lives of their biological “products” for profit or personal benefit. (In Sixth Day, the officers of the cloning corporation and their wives were themselves clones; in The Island, the corporation’s clients incorporate the clones’ organs into their own bodies.)

Collectively, the message of the bio-warning films is that there is something essential to “normal” biological humanity that is overlooked or denied in technological intervention. It is inherently evil to assume control over the biological basis of humanity to such a degree that that essential nature can be overlooked. Those who seek such control are inevitably evil and can be relied on to treat the subjects of their technological work as non-human, in defiance of their essence.

What It’s All About

I dunno. This is one of the worst scientific-dystopia films ever made, and that in a genre filled with interesting but grossly dunderheaded schlock.

The criticisms are too easy and too obvious: the “cloning” procedure has nothing to do with real cloning; cloning does not transfer memories or experiences; “true human nature” does not just burst through cognitive blocks. (If it did, presumably every mentally disabled male would eventually “wake up” just like Ewan McGregor and turn into an unstoppable, commando-fighting, conspiracy-defying, good-lovin’ hunka man, and Scarlett Johansson would “wake up” and discover she’s his sexually curious girlfriend. And if that were true, I’d be shoving a knitting needle through my eye socket at this very minute.) But let’s let that nonsense go. This is not a film you bother to criticize on technical grounds.

Conceptually, the film has even deeper issues.

It’s hard, from the perspective of both content and context, not to see the “grow them in the lab then cut them apart for their constituent parts” theme as a metaphor for embryonic stem-cell research. And, in the scene where the sacs gestating the clone bodies are cut open in order to dispose of the inconvenient clones, the metaphor for abortion is as unmistakable as it is heavy-handed (arguably, it’s not even a metaphor). (The birth scene may also be a reversed metaphor for abortion: here the pregnant woman is killed and the fetus is kept alive, by a male doctor and female nurse who carefully mask their indifference to the murder they commit.) This makes that plot device intriguingly complex: it is both a literal (though scientifically false) representation of cloning, and a symbolic representation of stem-cell research and abortion – in all of which aspects it turns out to be grotesque and inhuman. (It’s a right-wing paranoiac trifecta!)

The viewer is meant to be horrified by each distinct aspect of this theme, but more than that, to carry that sense of horror over to their appreciation of the real-world procedure implicated in each of its aspects. The scene in which patients are killed on the operating table is gross butchery – so, presumably, is cutting apart a blastula to harvest its stem cells. The birth/abortion scene may be a (surprisingly subtle) call to see abortion staff as murderers, and the moral neutrality they claim for their acts to be as much a sham as is these workers’ indifference to the woman they murder. The gestation-sac murder scene surely has that intention. And throughout all this is the underlying premise of creating life in order to kill it and use its parts – a commodification, and mechanisation, of human life that, as we see it manifested over and over in each of these different bloody ways, we are asked to view as inherently illicit in and of itself.

We are also told the developing clones are kept in a “vegetative state” – though it turns out they are fully conscious. I take it the message is clear?

There’s more: the African mercenary assigned to track down the clones eventually comes over to their side. He identifies with them because, he tells them, he was once enslaved by an African warlord: “I know what it means to be less than human”. This encapsulates one of the most bizarre and cynical anti-choice slogans: that abortion is like slavery. (This was the reason for George Bush’s nonsensical response, in the 2000 presidential campaign debates, to a question about Roe v. Wade that referenced the Dred Scott case. It was one of his dog-whistle codeword shoutouts to the religious right.) They even manage to make it a black slave, notwithstanding that American slavery has been over for almost 150 years.

But of course the movie cheats. In criticizing stem cell research, we never see stem cells – we see Ewan McGregor and Scarlett Freakin’ Johansson. We appreciate the essential humanity of these biological “products” because they have human personalities and desires – we are emotionally embroiled in their lives, as in any movie character’s life, in ways that we are not, and cannot be, and do not apply to, fetuses or embryos. And the notion that “life will find a way” – that that human essence just will make itself known, is the greatest cheat of all: not because it’s technical nonsense, but because it asserts, as a plot device, the foundational moral belief of the right wing that is at the heart of most debate over these issues – namely, that all biological human “beings” are identical and have the same nature.

The stem-cell debate exists entirely and only because of the absurd religious assertion that embryos are morally indistinguishable from persons – that embryos are moral persons notwithstanding that they lack every possible or plausible desideratum of personhood. In The Island, embryos are persons because they’re Ewan McGregor and Scarlett Freakin’ Johansson! They’re six feet tall at birth, they walk and talk, they have fears and desires, they fight for their lives, they fall in love, and Ewan McGregor gets it on with Scarlett Johansson on the deck of a yacht. (And if that were what it meant to be a stem-cell embryo, I’d be stuffing myself into a test tube at this very minute.) The film makes the religious premise real in an insanely literal way: embryos are not just the moral equivalent of adults, they are adults! And there is no need, here, to argue that the lack of personality, thoughts, feelings, or language ability on the part of embryos does not make them morally distinct from adults who do have these characteristics – these “embryos” have all of those things.

When the former slave tells the clones that he is like them, he’s certainly right: he, like them, is a thinking, feeling, independent adult. The movie feeds us the “embryos” = “slaves” line by making the “embryos” fully adult persons, without asking us or them whether there would be anything strange in this intelligent, proud, full-grown black man saying the same thing to a blastula in a culture flask – exactly the actual equivalency the religious right unblushingly asserts every day.

When the two runaways confront their tech-service friend and force him to tell them the truth, the film makes him a caricature of the pro-choice position – using anti-choice language to do so. “You’re not human” is a pro-choice-style expression of personhood theory: embryos and fetuses are not persons because they have not developed the traits necessary for personhood. But in this case, the statement is obviously false: it makes no sense to say that to walking, talking adults, who clearly are members of the human species. Also, the language here refers to “human beings”, not “persons”; when he later makes a distinction between the two clones and “real people”, he introduces personhood but implicitly equates it with being “human”. This is standard right-wing rhetoric – to use the phrase “human being” in reference to moral persons, and then attempt to establish their moral bona fides by citing biological facts about species membership. The movie primes us to ignore the false equivalence between adults and embryos, and to accept the false equivalence between “human beings” and “people”. By rejecting, as the viewer does, the obviously false evaluation of the two adult humans in the film (they are human and they are persons; the techie denies both these facts), we are invited to assume the same statements about embryos or stem cells are similarly false. By accepting, unconsciously, his unremarked statement of identity between “human beings” and “people”, we are encouraged subconsciously to accept the anti-choicers’ similar misuse of those terms. The film stacks the deck by so clearly telegraphing the falsehood of the “non-human” and “non-person” claims in the case of adults, while downplaying or hiding entirely the false equivalence of terms, and the false equivalence of adults and embryos, that it evokes.

The film does more than cheat, however; more even than ratify uncritically the most extreme right-wing positions. It adopts and magnifies the misogyny of the anti-choice right to a monstrous degree. The birth scene, it was noted, is an abortion metaphor (a woman and her fetus undergo a “procedure”: one dies, one lives). By killing a sympathetic female character in a chilling, literally clinical way, during a metaphorical abortion procedure, we are subconsciously invited to view real abortions the same way. But the scene also incorporates, non-metaphorically, one of the particular ideological grotesqueries of the right wing: that abortion is somehow an assault on the woman having the procedure; that women are “victims” of their own abortions. In this instance, the metaphorical abortion becomes literally such an assault. The claim that abortion clinic staff are tricking women into harmful procedures for profit here is again made literal. The claim that abortion is more dangerous than childbirth – a reversal of the facts – is also made literally true. Seeing these parallels requires seeing the literal and metaphorical aspects of the birth scene at the same time – seemingly a contradiction – but the idea that one scene can have different levels of meaning is not a new one, and this scene, understood at both levels, is nothing more than an explicit and visual instantiation of almost every major talking point of the anti-abortion propaganda machine.

That is not the worst, however. Recall that the gestating clone-bodies are embryo metaphors: the destruction of the gestation sacs is the other major metaphor for abortion in the film. But in this case, the embryos gestate entirely alone – their development, and their “abortion”, takes place entirely in the absence of any representation of a pregnant woman. In the sac-destruction scene, abortion literally has nothing to do with a pregnant woman at all. There is no woman present. No woman is affected. The abortions are not justified by the needs of any woman – they are simple murder with no offsetting benefit of any kind. (In fact, they are murders undertaken to hide the sins of the one ordering the murders, the one who created the clone “embryos”. This is another metaphor – for the idea that slutty women have abortions to avoid the consequences of their reproductive irresponsibility)

This is the anti-choice position in its most vicious form, made absolutely literal. Anti-choicers are often accused of ignoring the women who have abortions, of seeing abortion as a procedure affecting only the fetus, of not caring about or noticing that a woman’s body, life, health, and interests are at stake. Well, it doesn’t get any clearer than this: abortion is really not about women’s health if women do not even exist as part of a pregnancy or abortion procedure. This as much as anything tells us where this movie is coming from.

Finis

I don’t have any long-reaching lesson to draw from this film, other than that confused and resentful right-wingers can make bad sci-fi too. It was startling, in a way, to become aware of the flood of reactionism buried in the modern-looking production values of this film, but I suppose it shouldn’t be. Right-wingers can hire CGI programmers just like everybody else. The film is certainly a product of its reactionary times – yet oddly old-fashioned-looking even when it was first made. (That it takes so many of its cues from 70s-era apocalyptics and panicky post-WWII literature is partly the reason, but then we must ask why, exactly, did its makers do so?) What prompted Warner Brothers to think an extended, preachy metaphor for stem-cell research and abortion, from a conservative perspective, in a sci-fi format, was just the ticket for late 2005 I don’t know, but they were clearly reading the political tea leaves.

Apparently, in the Bush years, everything new is old again.

*Wikipedia has a good article on the film in which they note further references to a number of obscure sci-fi movies I mostly hadn’t heard of. In particular, it notes that the plot closely parallels that of the super-low-budget 1979 horror film Parts: The Clonus Horror.

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?

The phrase “Long Tail” arises from ideas introduced by Clay Shirky and Chris Anderson,  referring to the statistical fact that the asymptotic “tail” of low-frequency events on the outer edge(s) of a standard statistical distribution can often sum to a greater percentage of all events than the seemingly huge bump of high-frequency events near the origin of the curve. That means that most of the impact of the phenomenon in question is accounted for by events that are rarely seen (e.g., Amazon sells more books all together in the form of obscure volumes that sell one or two copies a day than it does of the relative few massive bestsellers that move thousands of copies a day; in medical terms, a great deal of illness – DB reports an estimate of 25% – comes in the form of rare conditions that the treating physician may never have seen, but which occur somewhere every day, as compared with the few dozen common complaints that make up the bulk of any individual physician’s office practice).

The problem with long-tail events is that they are difficult or impossible to prepare for. Assuming these are the sorts of things that require prepration and training (for instance, studying up on medical diagnoses and stockpiling supplies to treat them – as opposed to merely stocking books in a bookstore which any clerk can then sell) you can’t make ready for all possible long-tail events because there are simply too many possible ones, of which only a few will actually occur to you personally. Doctors must concentrate on the diagnoses they are likely to see; it is humanly impossible for them to learn everything necessary about every possible one they could see. (There is a line in William Nolen’s celebrated The Making of a Surgeon in which he comes out with some obscure diagnosis for a difficult case, and the attending physician tells him “Learn all you can about appendicitis, Nolen, and leave the dum-dum fever to the experts.”)

This has two frightening consequences: the first, obviously, is that it almost guarantees sub-optimal treatment for a large percentage of cases, at least until those cases get to the point that specialist help is obviously needed; the second is one DB emphasizes – that some long-tail diseases may actually be increasing in frequency as “evidence-based” treatment becomes the standard. Strictly literal differential diagnosis, based on clinical probabilities, by definition will not initiate treatment for low-probability conditions in most cases, necessitating ineffective treatment until the clinician has worked far enough down the differential list to come upon the low-probability condition; in the meantime, an infectious condition has time to spread. Broader empirical treatment, such as presumptive antibiotics for all likely infectious conditions, may have treated many long-tail conditions effectively during the relatively brief historical window between the advent of truly effective medicine (early 20th Century) and the availability of clear research-based treatment guidelines for many conditions (late 20th Century). More-accurate diagnosis may thus, paradoxically, result in longer-delayed treatment and worse public-health outcomes than the offhand scattergun approach, in some cases at least. (Of course, the informal approach has great dangers in itself, including promoting bacterial resistance and exposing patients to unnecessary treatments.)

One problem with diagnostic uncertainty or delayed treatment is that they infuriate patients, who have as great a desire for instant gratification in their healthcare as they do in their sex lives, politics, or entertainment. Telling patients “I don’t know what you have; let me look it up and come back next week” will only drive them to another physician with greater confidence (though no greater knowledge) and more willingness to be accomodating; the same thing is anecdotally reported about doctors who refuse to prescribe antibiotics for obviously viral conditions. That also augurs for less diagnostic fussiness and more makin’ with the pills and the potions.

This suggests that one possible response to the long-tail phenomenon is simply to ignore it (sort of): to acknowledge that a large fraction of one’s encounters will be with rarely- or never-seen conditions, and that there is no way to prepare for these, and therefore to simply treat everything as presumptively in the fat part of the curve until proven otherwise. But it’s counter-intuitive to suggest that the right way to deal with challenging puzzles of medical knowledge is not to try to master that knowledge.

Suggestions?

Plus there’s the two dead chimps and a body chained to a laboratory door, but that’s the least of things.

As near as I can figure out, Dr. Sally Boysen, an experimental psychologist at Ohio State University, ran a chimpanzee experimental colony for over 20 years, publishing highly-regarded research on our closest primate relative. Last year, she ran out of funding, and the University – which seems to have had some sort of hostility to the program anyway, though I’m not sure why – arranged to ship 9 chimps to a Texas “sanctuary” that provides homes for ex-research animals but which does not use them for research or commercial purposes or public exhibits, and therefore technically falls outside the local regulations for such facilities.

The transfer was not without controversy: Dr. Boysen chained herself to her own laboratory door to protest the university’s shutting down her lab, and at the same time PETA – the Pee Wee Hermans of animal welfare – sued the Texas sanctuary, alleging among other things that it was in violation of animal housing regulations. When it was pointed out that that facility was not subject to such regulations, PETA filed an amended complaint alleging that the facility had inadequate housing conditions and was negligent in handling the animals. One chimp died after being sedated for transfer; another died from heart disease (common among caged chimps but not in the wild) shortly after being transferred. PETA also claimed that the University’s supervising veterinarian was negligent for not personally accompanying the animals in transfer, and demanded that he be fired.

In the aftermath, the GReat Ape Standing & Personhood (“GRASP”) project is criticizing PETA, both for turning its guns on an animal welfare facility (PETA itself “liberates” animals from research but has euthanized many of them, claiming they cannot be cared for; other animal sanctuaries refuse to euthanize any animals) and because its absurd legal strategy – naming the chimpanzees themselves as plaintiffs in the lawsuit – almost guarantees their failure while likely setting back GRASP’s own goal of eventually establishing actual legal personhood for apes (by carefully laying the legal groundwork first).

So: PETA is suing the facility that is caring for these ex-research chimps, potentially bankrupting it, while simultaneously operating “animal-rescue” facilities in which the animals are actually killed; GRASP is angry at PETA for being thoughtless and reckless, essentially for asking a court to recognize what GRASP contends should be recognized in court; everybody is angry at the University, which apparently is angry at its own researcher, who is angry at everybody else right back; the sanctuary facility just wants to be left alone to care for the animals; the process of caring for the animals has killed two of them already.

I’m still somewhat on the fence about ape personhood (thoughly leaning toward the “No” side), but as for the animal-rights movement in general, this scene is to me exemplary of how it manages all its activities, both practical and intellectual. I’d say these people deserve each other.