Finally, Some Sweet Health News

Proof, at last, that chocolate is a wonder food! Yes, I know I’ve thousands of words debunking bad science and bogus ideas about health and bodies. (Offline, it’s upwards of a thousand pages.) But I’m also on record as supporting the health benefits of red wine and coffee (oh, and more on coffee here and here, for nervous new moms). And now, with chocolate, we’ve got the trifecta! A yummy, healthy hattrick!

From Moonstruck Chocolate in Champaign, Illinois, posted by Flicker user eszter, used under a Creative Commons license.

The bottom line is that a meta-study just published in the British Medical Journal found that the people who ate the most chocolate were  37% less likely to have cardiovascular disease and 29% less likely to suffer a stroke. No consistent, measurable impact was seen on diabetes or heart failure. Popular reporting on the new findings has actually been mighty thin, beyond the gleeful headlines. The New York Times and the medical newswire Ivanhoe both offered up the bare bones: the good news, plus a few cautionary phrases about the need for further research and a disclaimer that you shouldn’t just go hog out on chocolate because OH NOES, THE FATZ!

So I took a peek at the study, which is freely available on line. As all important research should be! I don’t care if we historians have to go through a library; the people who want to read my work know where to find me, anyway. But health is a public good, such research is often publicly underwritten, and most medical journals are part of a rapacious oligopoly raking in 40% profits on other people’s work. Earlier this week, the Guardian compared these journals to Rupert Murdoch, except with extra, surplus, bonus evil. Kudos to the BMJ for bucking this trend and letting regular folks view the full text without ponying up $35 or more for the privilege.

On to the study itself, which is a review of seven earlier studies that were mostly observational in character. None were randomized and controlled, so probably the whole lot would be discarded as rubbish by the Cochrane Review. They largely relied on questionnaires administered to patients, which raises the specter of recall bias. (I often can’t remember what I had for lunch yesterday.) As in any meta-study, comparison is difficult because the individual studies relied on different measures and methods. But they weren’t crap science, either (that was the point of excluding other studies that weren’t adequately rigorous or informative).

Importantly, most of the studies under review did make serious attempts to control for confounding variables (even though this reader was prepared to forgive just about any methodological flaw):

Five of the seven studies included in this meta-analysis reported a significant reduction in the risk of developing cardiometabolic disorders associated with higher levels of chocolate intake (one on cocoa intake), even after adjustment for potential confounders, including age, physical activity, body mass index, smoking status, dietary factors, education, and drug use. Although we did not find any experimental studies (randomised controlled trials) evaluating the effect of chocolate on hard cardiometabolic outcomes, our findings corroborate those of previous meta-analyses of experimental and observational studies in different populations related to risk factors for cardiometabolic disorders.

In other words, the literature is pretty consistent: chocolate is good for the heart and your whole cardiovascular system. And contrary to how some commenters at the Times were trying to spin it, those benefits were not negated by fat, whether in the chocolate or in the human consumer. They accrued even in people who ate the cheap, sugary stuff (though this is one area where I’d like to see research, which would no doubt confirm my own prejudice in favor of very dark chocolate). I am not surprised by this, since chocolate milk has already gotten the Dr. SunGold stamp of healthy hedonism.

Another way in which this strikes me as pretty good science: The authors point to a couple of plausible biological mechanisms that could make chocolate protective, which include “increasing the bioavailability of nitric oxide, which subsequently might lead to improvements in endothelial function, reductions in platelet function, and additional beneficial effects on blood pressure, insulin resistance, and blood lipids.” Nitric oxide, as you may recall, is the linchpin behind the effectiveness of a certain little blue pill. Viagra was initially under development as a cardiovascular drug that just happened to have felicitous effects on blood vessels located further south.

So in conclusion, if your chocolate bar is still rigid after 4 hours, you may want to consult your physician. Or you could just take it in hand and nibble it ’til it softens. Melting it into a hot fudge sauce is another medically advisable option. And remember: all that erotic enjoyment is good for you!

As for me, I’m trying to get a syllabus together this evening, so no cocoa-inspired sexytimes for me! But I just poured a glass of red wine and broke out oa square of the dark stuff. For breakfast, it’ll be my classic homemade mocha with Snowville milk. Now some intrepid researcher just needs to reveal the wonder nutrients in cheese.

From Chocolatier Blue in Lincoln, Nebraska, taken by Flickr user J. Paxon Reyes, used under a Creative Commons license.

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The “Heartbeat Bill” Should Be DOA in the Courts

Oh, Ohio. The batshittery just never ends. As you may have heard, we’ve got pending legislation (House Bill 125, aka the Heartbeat Bill) that would make abortion illegal as soon as a heartbeat can be detected. That would be at six or seven weeks, when a woman might well not know she’s pregnant. (Keep in mind that spotting is fairly common during the first month of pregnancy when one’s period would usually be due, so even a woman tuned into her body could be fooled.)

This is the same bill for which Republican lawmakers called a fetus to testify. Actually, it was two fetuses, whose heartbeat was played for our esteemed legislators via ultrasound. (Quite sensibly, one of the fetuses refused to cooperate with the proceedings.)

Yesterday, the bill emerged from committee, but House Speaker William Batchelder won’t yet commit to a date for a vote. Batchelder is a Republican and a hardcore pro-lifer. Why would he waffle?

Turns out that this bill is splitting the anti-abortion camp. Ohio Right to Life – the biggest anti-abortion lobby in the state – is actually begging state legislators to back off of the Heartbeat Bill. They fear the bill couldn’t pass constitutional muster. Of course, this isn’t a principled objection. Ohio Right to Life remains committed to overturning Roe v. Wade. They just realize Anthony Kennedy is unlikely to vote to uphold a measure this extreme. (It doesn’t even include a rape/incest exception.)

I say, bring it on. Anything that divides the Republicans and anti-abortion lobbies is good by me. This direct challenge to Roe – which is what the Heartbeat Bill’s supporters actually crave – will go down in flames. If it passes the Senate and goes to the courts, the Supreme Court will surely refudiates it. This will strengthen Roe’s basic finding that the state cannot prohibit abortions prior to fetal viability. A successful court challenge might even take down Ohio’s 24-hour mandatory waiting period and “counseling” – or so fears Ohio Right to Life! My, this bill is sounding better all the time.

Here’s what really worries me. While we’re all distracted by chatter about vaginal sonograms in the Statehouse and the circus of fetuses “testifying,” another bill (H.B. 78/S.B. 72) has passed both chambers and is headed for the desk of Governor Kasich, who’s certain to sign it. That bill’s viability (so to speak) looks much stronger. It would ban abortion after 20 weeks (instead of Ohio’s current 22-week limit). In addition, H.B. 7 – which would place the burden of proof on abortion providers to show a fetus was not viable – is still lurking in the wings, along with other anti-choice legislation.

At least none of my representatives has threatened to criminalize miscarriages. Not yet.

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Technological Hubris, Grand and Small

I continue to be transfixed by the situation in Japan, where technology has shown its best and worst face in the past few days. “Best,” I say, because the terrible human losses would have been greater yet, had builders not prepared for violent earthquakes. There were certainly gaps in planning for the tsunami, in particular, but overall Japan’s construction technology saved untold lives – tens of thousands.

The nuclear plants partly had bad luck, but then again, the chain of power failures that’s now leading to overheated radioactive fuel rods was fairly predictable. I don’t know enough about the technology to give an explainer. Rachel Maddow continues to have good coverage. But essentially, you don’t have to be a nuclear engineer to know that highly radioactive spent fuel presents a problem for decades at a minimum, even under controlled circumstances. How many civilizations have survived for tens of thousands of years - long enough to keep ploutonium contained? And yes, some of the fuel rods (about 6%) at the Daiichi plant contain some plutonium.

Then again, with some technologies you really don’t need to be an expert in order to say: this is stupid. A case in point is the use of hormones to stunt girls’ growth lest they grow too tall to catch a husband. I knew that this was a fairly common practice in the 1950s. A recent study reports that the estrogen used to stop growth also mucked with these girls’ fertility, and as adults they have had trouble conceiving. Not all that surprising. What did shock me? The fact that this practice continues today.

This use for estrogen gained popularity about 50 years ago after researchers found it might limit the growth of girls who were much taller than their peers in adolescence. According to one estimate, up to 5,000 girls in the U.S. were treated with estrogen, and many more in Europe.

At that time, “women were basically supposed to get married and have children, and that would be harder if you were a very tall woman, everybody believed,” Christine Cosgrove, co-author of Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry’s Quest to Manipulate Height, told Reuters Health.

“There were so many parents, mostly mothers probably, who just feared that their daughters’ lives would be ruined if they ended up being six feet tall, because they’d never have a husband and a family,” she said.

Some tall girls are still treated with estrogen today — more in Europe than in the United States — and estrogen is currently given to these girls in about the same dose that is in a birth control pill, Cosgrove said. In the past, it might have been given at 100 times that dose before doctors realized the potential dangers, she said.

[Cosgrove is co-author of Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry's Quest to Manipulate Height, speaking here to Reuters.]

Two very different scenarios – one a matter of life-and-death, the other “merely” a matter of life foregone through infertility. Yet both reflect the foolhardiness of humans when it comes to technology. I’m no Luddite (my laptop is a cyborg extension of my brain), but could we just cut it out with the human experimentation? Because that’s what nuclear plants are, at bottom, too – an uncontrolled experiment with far too many uncontrollable variables. Also, perhaps friend-of-the-blog Hydraargyrum will chime in on this: humanity will never win against CORROSION, which is basically what I understand to be happening at lightning speed in those uncooled fuel rods.

Can’t we humans please learn for once, and put an end to the techno-hubris?

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Give Women Birth Control, Prevent Pregnancies!

Here’s an item from the annals of “no shit, Sherlock!” science: A UCSF study shows a stunning decrease in unintended pregnancy and abortion when women are dispensed a year’s supply of birth control pills at once. What’s stunning is not the basic trend line, but the magnitude of the study’s findings. Science Daily recaps it:

Researchers observed a 30 percent reduction in the odds of pregnancy and a 46 percent decrease in the odds of an abortion in women given a one-year supply of birth control pills at a clinic versus women who received the standard prescriptions for one — or three-month supplies.

Can I rephrase those numbers? Pregnancy declined by nearly a third, and abortion by nearly half!

This is such an an simple yet elegant idea, you’d think it would have occurred to someone decades ago. It’s also a politically charged idea in an era where Planned Parenthood is having to fight for its very existence.

Insurance usually issues a maximum of a three-month supply of any medication, including birth control pills. This is true even for medication that people clearly have to take for the rest of their lives, such as thyroid pills. (I haven’t been on the Pill in years, but I still sometimes come close to running out of my thyroid meds.) The situation is often tougher if you have to buy the Pill through a community clinic:

The findings of this study have implications for women using oral contraceptives across the country. Most oral contraceptive users in the United States get fewer than four packs at a time; nearly half need to return every month for resupply, according to a 2010 study published in Contraception.

Obviously, the requirement to physically show up at a clinic is most likely to hit poor women – and it will be most onerous precisely for these women, whose low-wage employers are unlikely to grant them time off for medical matters. As is so often the case in reproductive health, this is a social justice issue. I really hope this study will get the attention it deserves.

I adore this quotation from the project’s principal investigator:

“Women need to have contraceptives on hand so that their use is as automatic as using safety devices in cars, ” said Diana Greene Foster, PhD, lead author and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. “Providing one cycle of oral contraceptives at a time is similar to asking people to visit a clinic or pharmacy to renew their seatbelts each month.”

Of course, some Americans object to seatbelt laws – and even seatbelt use – as an infringement on their liberty. But I’m not talking about laws to require use of the Pill; I’m only saying that women should have access to it.

While we’re on the automotive analogy, isn’t the Pill more like a reliable set of brakes?

And wouldn’t the conservative attack on access be akin to sabotaging someone’s brakes?

 

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Defunding Title X: What Goes Around, Comes Around

This week I’m reading Michelle Goldberg’s masterful The Means of Reproduction: Sex, Power, and the Future of the World with one of my classes. In it, Goldberg traces the history of foreign aid for women’s health – especially reproductive health – from its Cold War, Rockefeller/Ford/Guttmacher beginnings to the present era.

In 2011, well into the second decade after the UN International Conference on Population and Development in Cairo, you’d think we’d be well along the path blazed there: foregrounding women’s need for education and autonomy. Nuh-unh!! Instead, the proponents of women’s reproductive autonomy in developing nations and the Global South face constant friction and opposition from groups funded by the Radical Christian Right in the U.S. This trajectory toward radical rightwing interference is lucidly, chillingly described in Goldberg’s book. It’s as though women’s bodies became a proxy war for the tensions over reproductive rights and justice back here in the U.S.

And now, with the House of Representatives today voting to defund Title X funding, that proxy war has come home. For details, see excellent recaps by Lindsay Beyerstein and Jill Filipovic. The legislation wouldn’t affect abortions – except to inflate their numbers by making birth control less accessible to poor women and young women. No, the target here is broader. It’s a war against all women, but especially those who are poor.

When I was young and underinsured, I too turned to Planned Parenthood, and I’m forever grateful for their services. Some women are transiently poor, like I was. Many struggle with poverty throughout their childbearing years. All of us deserve affordable access to basic services like a Pap test.

I believe this even though – or especially because! – I had a few dodgy Pap test results in my early twenties. Those diagnoses of “cervical dysplasia” scared me. Cone biopsies were threatened. The cellular abnormalities resolved on their own, as HPV usually does. Had I progressed toward cervical cancer, Planned Parenthood might well have saved my life.

All women deserve preventive care, and that includes the prevention of pregnancy. This is sooo not rocket science.

Odds are good that the Senate won’t stand for the House’s crap. Still, I’m appalled that a majority in the House signed onto it. While some members may try to hide behind a figleaf of fiscal responsibility, that’s balderdash, as Amanda Marcotte argues:

Of course, rhetoric that attacks federal funding for contraception as a state-subsidy for promiscuity obscures the fact that continuing Title X is one of the more fiscally sound things the government can do: Research from the Guttmacher Institute demonstrates that every dollar spent on family planning saves the government four dollars down the road.

(Read her whole piece – it’s excellent.)

No, this is strictly culture war ammo, just as the Mexico City rule and all the other right-wing meddling into brown and black women’s bodies has to do with ideology and misogyny – not fiscal soundness.

This is merely the continuation of funding politics imposed on the “Third World” – now aimed at women that Chandra Mohanty once called the “Third World” in the United States. This is the redirection of contempt for brown and black women’s bodies to those women living within U.S. borders. Women like me – white, securely middle-class, employed, insured, and slouching toward the end of my reproductive years – will be just fine. It’s poor women of color who will suffer. College students who can’t tell their conservative parents that they’re on the pill. Appalachian women lacking any form of health insurance.

Senate? The ball’s in your court. Please show us that you consider women human beings whose health is as important as men’s – who should have a chance to participate fully in society – and who should not be written off if they lack racial or class privilege.

In the clip below, Michelle Goldberg suggests that the U.S. culture wars have affected women outside the U.S. more profoundly than women here at home. Up until now, she’s been right. As to the future? Well, that might just be up to the Senate.

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Less Traumatic Surgery for Some Breast Cancers?

Here’s the backstory: Up to now about 20 percent of breast cancer patients – those found to have cancer in the lymph nodes under their armpits – had those nodes cut out as if they were little balloons that could carry metastases to anywhere in the body. And indeed, sometimes cancer spreads via the lymph nodes, which is why they had to go. Or so thought any responsible oncologist.

For the women who undergo extensive axillary dissection (that is, cutting under the arms and removing the nodes), the risk of complications goes up. They are more vulnerable to infection, but more importantly, many of them get lymphedema – painful, chronic swelling of the affected arm due to the inability of the lymphatic system to remove excess fluid from the limb. It’s miserable, disabling, and disfiguring. It can be progressive. It has no cure. You don’t want to have it. Women can also suffer nerve damage, shoulder pain, and limited mobility of the arm. (All of this goes for male breast cancer patients, too.)

But the medical thinking was: We need to cut out any microscopic cancers to minimize the risk of recurrence. What patient would risk her life to buck that logic?

Now, the sun has set on this thinking. A major new study has proven that for properly selected patients – those with tumors smaller than two inches whose cancer has spread to the nodes – axillary dissection and all of its attendant ills is not necessary. It confers no survival advantage. None! Chemo and radiation – which are de rigeur for anyone with nodal cancer – seem to work equally well if the nodes are left in peace. I have not looked at the study, but what I read in the New York Times was highly persuasive and well reported. (Were I the patient, I’d definitely want to scour the scientists’ original article.)

The new recommendation is irrelevant to most early-stage patients, whose disease has not yet spread to the nodes (which can be ascertained by examining a couple of likely suspects with “sentinel node biopsy”). Nor will it help those people diagnosed with more advanced disease. None of the patients in these two groups should be treated with axillary dissection anyway, under normal circumstances. But boy, it could make life after cancer a whole lot more comfortable for the folks who fall in that 20% – for whom lymphedema often became a painful lifelong reminder that they’d had cancer and it could recur at any time.

Will doctors actually take the study’s findings to heart? That’s where I’m skeptical. Axillary node dissection just met its Waterloo. But will breast surgeons – indoctrinated by education that says more treatment is better, and anything less is irresponsible – continue to fight the old battle? I’m afraid they will, and not just because I cynically think they fear lawsuits. (Any sentient doctor should fear lawsuits; they’re part of the landscape by now.) No, I worry that habit will prevail, along with the conviction that doing something is always better than doing nothing. The New York Times report that major cancer centers and a few individual doctors are changing their protocol:

But Dr. Carlson said that some of his colleagues, even after hearing the new study results, still thought the nodes should be removed.

“The dogma is strong,” he said. “It’s a little frustrating.”

Patients may need to push their doctors. We can ask them about our options. If they’re unwilling to question from old methods, we can find another doctor. I’m not in that position right now (thank my stars), but I’ve had multiple scary mammograms. If I do get cancer, I’d hope for an aftermath where my body wouldn’t bear more scars than necessary.

The rage expressed in the NYT comments section by women who live with those reminders – unnecessarily, they now know – is justified, even though their physicians did the best they could with the knowledge they had. But now that we know more? I wouldn’t want to live with that pain and rage if it could be avoided. Life after cancer poses enough other challenges.

 

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Giffords’ Husband in Space? When a Predicament Really Isn’t One

Would you leave your gravely injured mate on earth while you blast off for several weeks in outer space? Today came reports that Gabrielle Giffords’ husband, astronaut Mark Kelly, may be planning to do just that in April. Salon describes Kelly’s choice – to fly, or to stay home and support his wife through rehab – as “a troubling predicament.”

Really? I’d say that if this is a predicament, my brain is a porous pickle. (Which, incidentally, is possible.) Your partner gets shot, through the brain, and a large arc of skull is removed to prevent brain cells from dying due to swelling. Minimum spousal duty according to Sungold: you stick around at least until the missing piece of skull has been replaced. This takes months. In the case of CBS newsman Bob Woodruff, doctors waited four months before reopening the wounds and placing a prosthesis. Until the patient has a complete skull again (whether composed of their own bone or, like Woodruff, a synthetic material), she wears a bulky helmet to protect the brain.

For me, staying home would be, um, a no-brainer. But can Kelly really help his wife? Salon reports:

Research shows a strong social support network — family, friends, church or similar — is crucial for rehabilitating patients and improves the outcome.

But that doesn’t mean a spouse has to be there 24-7, 365 days, said Dr. David Lacey, medical director of acute inpatient rehab services at Wake Forest University Baptist Medical Center in North Carolina.

“You also have to look at what’s normal for the couple,” Lacey said. “If it were my parents who had almost never been apart for the entire 50-some years they were married, all of a sudden changing that structure would be a pretty dramatic impact.”

But what’s normal for Kelly and Giffords, through their three-year marriage, is spending a few weeks apart at a time — he in Houston, she in Washington or her home state of Arizona. However, Kelly, 46, kept vigil at her side in the days immediately after the Jan. 8 shooting in Tucson. The rampage outside a supermarket left six dead and 13 injured.

But nothing is normal when one partner is struck by a devastating illness or injury. Three weeks of normal life is not the same as three crucial weeks in rehab. Indeed, nothing is normal now about their previously independent relationship. Giffords will rely on her husband as caregiver-partner for a long time to come. Perhaps forever. It’s hard to feel indomitable, I suspect, when your brain is protected by thin skin and a helmet. It’s hard to feel enterprising when your mobility is highly restricted.

I don’t know Congresswoman Giffords or her husband (obviously!), but I’m irked by the presumption that Giffords ought to be game for her husband taking off, because that’s the kind of gal she’s always been. She’s not that gal now. Salon, again:

Mark Kelly has said he’d like the decision to be made jointly, with his wife’s opinion, if possible.

A former NASA colleague, Susan Still Kilrain, said if she can, Giffords will tell him to go.

Kilrain, in 1997, became the second American woman to pilot a space shuttle. Then, she was single. She recalls how Ashby’s wife, Diana, urged him to continue with his mission training despite her cancer.

“She really wanted him to stop sitting around and waiting for her to die,” Kilrain said. “All the wives would feel that way, and his wife (Giffords) seems to have a very big support system.”

That said, there’s no way Kilrain would resume training under the Kelly-Giffords circumstances. Women, she noted, tend to be the caregivers. She points to her own life story: She stood down from space flying after her first child was born, and quit NASA in 2002. She’s a stay-at-home mom to four children, ages 4 to 11.

“Me personally? I wouldn’t fly,” Kilrain said from her home in Virginia. “But I certainly would definitely respect his decision to fly. I wouldn’t second-guess that in a minute.”

For me, this type of decision isn’t just Monday-morning quarterbacking. I’ve been on both sides of this decision (minus the cool space stuff). And guess what? I didn’t fly. Nor did he.

When my husband fell terribly ill in Berlin, we stayed on for months while he completed treatment. I didn’t think once of taking the kids and flying back to the States. I dropped out of teaching (without any pay) for six months. Good thing, too, because the treatment was about as perilous as the disease. He needed help, as much as I could provide while also keeping the kids together, body and soul. I needed to be near him. We needed each other. Believe me, you don’t want to be on the other side of the world – or even out of this world – if your partner is gravely ill. That bit about “in sickness and in health”? It’s a vow that expresses the (temporarily) healthy partner’s need, too, to provide care and support and closeness. It’s not just about the sick guy.

Then, turnabout: Two years ago, when an MRI report suggested I likely had MS or vasculitis in my brain, my husband was scheduled to attend a conference in Germany. He was worried about leaving me, and so he asked my doc what he would do. “I’d stay home,” said my doc. And so my mate canceled his trip. Fortunately, my brain managed not to explode. (We still don’t know what was up, but we’re pretty sure it’s neither MS nor vasculitis.) My husband could have made his trip safely, after all. He would have worried the whole time, and I would have quivered in fear, again responsible for the kids but without knowing if they could count on me. I was also just plain sick – very sick. I say he made the right call. He says he doesn’t regret it.

I question whether we should applaud wives for playing the martyr, struggling against long odds and terrible pain while their partner achieves a dream. We do not expect quite the same of men, nor should we. Instead, how about if Gabrielle Giffords and Mark Kelly make a mutual decision that isn’t swayed by these cheering squads who seem to hope Giffords will gamely wave him goodbye? (That image conjures up the anniversary of the Challenger, which just passed, and how those brave families on the ground sometimes don’t get their astronauts back.) Maybe they’ll decide that he should fly after all. But if he stays with his wife, I can’t imagine how he could ever regret it.

Really. It’s not a predicament. It’s a no-brainer. (That cheap witticism is sure gaining mileage, yes?) If you do what’s least likely to cause regrets, the prognosis for future happiness and harmony will be better. You don’t need a neurosurgeon, astronaut, or even a small-potatoes blogger in Ohio to say this. Most of us know it as soon as we reflect on who and what we truly love.

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Colleges Can’t Magically Identify Potential Mass Murderers

I’ve been reading a lot more than writing the past few days. One of the themes that has popped up repeatedly in the discussion of the Arizona shootings is whether college officials should have been far more proactive in seeking help for Jared Lee Loughner. The New York Times today ran no less than three pieces on this topic:

• Shooting exposes limits on colleges facing troubled students
• Tucson shooting suspect worried college officials
• A brief window for help (an expert forum)

Couldn’t a caring teacher have intervened? It’s an appealing what-if, isn’t it?

Take for instance the piece that appeared yesterday in Salon, where Sarah Hepola interviews a psychiatrist, Dr. E. Fuller Torrey, on the probability that Loughner has untreated paranoid schizophrenia:

Hepola: … What do you do when you see someone like this?

That’s the $64 million question. Among his classmates, if you took all the information known about him and looked at it together, you’d say this guy is potentially dangerous. But one classmate saw one thing, another classmate saw another. The college apparently had enough information to know this guy should be off the campus if he didn’t get mental help. They knew people were purposefully sitting by the door so they could run fast in case this guy did something. This guy clearly struck people as dangerous.

In Arizona the laws are fairly liberal compared to other states. In lots of states the only way you could act on this is if he had demonstrated dangerousness to self or others. But in Arizona, it would have been legal to involuntarily take him to the clinic and have him evaluated. People don’t do this much, because we’re very concerned about people’s civil rights. How do you weigh the fears of a college atmosphere against the civil rights of the individual — an individual who will go in and say, “Look, I might be a little strange, but there’s nothing really wrong with me”?

That’s a key question. Did the college behave properly? Should the school have mandated some sort of mental health treatment for him, rather than kicking him out?

Legally, they could have. Whether they should have or not depends on who had what information and what it looked like at the time. The retrospect-o-scope is a hundred percent.

Exactly. The people around Loughner had only piecemeal information, the impact of which is “obvious” only now that we know how the story ends.

But that’s not the only problem colleges face. For one thing, the actual contact hours a professor has with students are pretty limited. I typically see a student four hours per week (unless they’re taking more than one class with me, the poor dears!). Loughner gave off enough scary vibes that the instructor reported him and the college ejected him until he got treatment. That didn’t happen at Virginia Tech, where as far as I know just one instructor was alarmed enough by Seung-Hui Cho to advise him to seek counseling.

In my eight years of teaching, I’ve had a handful of students who were disruptive of classroom dynamics. There was one guy I considered my “mini-MRA,” who belligerently challenged every idea I presented, but also seemed to think he could kiss up to me by calling me repeatedly at home. Another apparently aspired to become Jonah Goldberg’s clone. But I’ve only had one who gave me an intensely uncomfortable vibe. He talked about how people thought ill of him because he liked to wear a trenchcoat, just like the Columbine shooters. I spotted him again on campus about five years after I’d taught him, and I wondered if he’d had to stop out for mental health reasons. As a new instructor back in 2002, I just thought he was creepy and eccentric. Today, in the post-Virginia Tech era, I’d probably consult with a campus counselor.

But actually reporting someone isn’t a simple matter. Will the student retaliate once he’s put under a microscope? One of my graduate advisers was stalked for many months by a former student, and she had only given him the low grade he’s earned. Loughner, too, acted out when he didn’t get the grade he wanted:

Even in his gym classes, there were problems. In May, the police were called by Mr. Loughner’s Pilates instructor, Patricia Curry, who said she felt intimidated after a confrontation over the B grade she wanted to give him. She said he had become “very hostile” upon learning about her intention. “She spoke with him outside the classroom and felt it might become physical,” the police report said.

Ms. Curry told the police she would not feel comfortable teaching Mr. Loughner without an officer in the area, and the officers stayed to keep watch over the Pilates class until the class ended.

Ms. Curry must have been alarmed indeed to call the police. In her place, I’d be even more frightened about retaliation after class.

The danger of retaliation would be great if the student weren’t treated or didn’t adhere to his treatment. My university does offer psychological services, but they’re woefully understaffed. Severely depressed students are routinely told to wait a month until they can see a therapist qualified to prescribe medications. This has occurred even when the student was suicidal, and said so. Multiple students have told me that they sought help and endured a long wait to get in, only to find they had no rapport with their assigned counselor. One rape survivor told me her sessions were downright counterproductive. Much of the counseling is provided by graduate students. The experienced therapists are quite good, I think, but they’re far too few in number.

Pima College, where Loughner took classes, provides no mental health services. It has over 68,000 students. Much of Loughner’s behavior was bizarre rather than threatening – for example, insisting that the number 6 was actually 18. I can understand why they Pima expelled him but didn’t petition to have him involuntarily committed.

One of the New York Times articles makes the argument that colleges can keep a closer eye on troubled students if they remain enrolled. That’s true as long as students are in dorms. (Incidentally, the same holds true for substance abuse problems.) But when a student lives off campus, we cannot expect an instructor – who in community colleges may teach four or more classes – to keep tabs on a student she sees only four or five contact hours per week. Pima is not a residential school. Did I mention it has 68,000+ students?

It’s striking that no one is asking why Loughner’s former restaurant employers didn’t call in the state. Or why the dog shelter where he volunteered didn’t so the same. Or the Army! All of these entities recognized that Loughner had serious issues. The Army rejected him for having a drug arrest. Quiznos fired him for bizarrely refusing to respond to a customer, and his manage recognized a “personality change.” At the shelter, he exposed puppies to parvovirus after being clearly told to keep them out of a contaminated area. But the New York Times is not asking why these entities didn’t intervene.

I think the difference is that Americans still expect colleges to operate in loco parentis. Even residential colleges haven’t really borne that responsibility – or wielded that power – since the 1960s. We no longer have housemothers and curfews. Young people 18 and older aren’t legally children. Universities can’t act like their parents. Especially when the student is still living at home with his parents.

I don’t want to indulge in blaming Loughner’s parents. His father is reportedly an unpleasant fellow. They still deserve pity and compassion. They have lost their only son forever.

But we surely cannot expect an underfunded, overgrown community college to stand in for his parents, either.

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A More Zest(ra)-y Sex Life for Women?

Gratuitous flowers for a sex post: Cascading morning glories captured by me, Sungold, in October, back before the frost bit ‘em.

The Denver Post ran an article today asking why an arousal-booster for women called Zestra can’t find TV stations willing to run their ads, even as Viagra ads are literally driving in circles around us. Historiann took the article to task for its casual disavowal of feminism, and I’ve got nothin’ to add to her critique except a vigorous nod of approval. Figleaf chimed in to say that the stations’ ad policies spotlight the illegitimacy of autonomous female desire.

What most struck me about the article, though, was its conflation of libido and arousal, which is endemic in “science writing” that reports on “pink viagra.” Here’s how reporter Mary Winter framed it:

Now, you would not know it from the $300-million annual ad campaign for erection-enhancing ads for Viagra, Cialis and Levitra, but women suffer more sexual dysfunction than men do — 43 percent to 31 percent, according to the Journal of the American Medical Association.

In other words, the potential market for flagging female libidos is huge. But here’s the irony: When the makers of Zestra went to 100 television networks and stations to buy ads, the vast majority refused them. The few stations that did take their money would run the ads only after midnight or during the daytime.

The stations “told us they were not comfortable airing the ads,” Zestra co-founder Mary Jaensch told “Nightline.” The double-standard here — men, you deserve sexual pleasure, and women, what’s wrong with you hussies? — is breathtaking.

So how about this ad: a Camaro, a woman, and a vibrating driver’s seat?

(This is just the end of the article; read the whole thing here. Winter is very sharp and witty on the Viagra ads!)

In a way, it’s unfair to pick on Winter, because most writing about female sexual dysfunction fails to draw basic distinctions between arousal, orgasm, desire, and libido. It also tends to ignore the reality of the physical pain some women experience (which K has explored eloquently at Feminists with Female Sexual Dysfunction.) In practice, women can of course have issues with any or all of the above, and problems in one area can easily spill into another. A woman  suffering from vulvodynia, for instance, might be able to orgasm, but if sexual activity hurts, that’s likely to dampen her libido. Another woman might have a generally low libido (meaning she doesn’t crave sex very often) but develop desire responsively to her partner, at least in certain situations. There are probably as many variations as there are women.

Now, getting back to Zestra and the Denver Post: Winter’s article refers mainly to libido. She’s partly on the right track, insofar as that “42 percent” figure refers mainly to women who complain about low libido. (Some feminists have criticized that figure as too high, but let’s set that debate aside for today.) Winter does hint at the primary issue here – arousal – in that apparent throwaway line about a vibrating driver seat in the Camaro. Why yes, I think quite a few of us gals might enjoy such a ride! But if we got a good buzz per gallon, that wouldn’t mean our libido was revving – only that our engine was purring smoothly.

Libido is not the primary target for Zestra, though Zestra’s website refers to a whole host of potential benefits: stronger libido, greater satisfaction, more earth-shaking orgasms, and a more harmonious relationship with one’s partner. (That last point comes up only in testimonials; the overall tone of the website is “try this for yourself,” not “use this to please your long-suffering husband.”) It’s being marketed to women who suffer from sexual problems of any sort due to illness (including cancer), postpartum changes, menopause, antidepressants, stress, and even widowhood. But what does it really do?

Zestra’s primary mechanism, as far as I understand it, is to enhance arousal and response during sexual activity. As far as I can see without having tried it myself, it looks like it might increase engorgement and/or creaste prickling sensations in a nice way. In the best case, yummy sensations start a cascade of increasing desire during lovemaking. As a topical agent applied directly to one’s ladyparts, Zestra doesn’t act directly on libido, which is regulated by the brain and a complex dance of different hormones and neurotransmitters (including estrogen and testosterone, but also thyroid hormone, stress hormones, dopamine and lots of other nifty “messenger” chemicals). A topical gel won’t directly influence that chemical brew. It’s only logical, though, that if sex is more pleasurable, some women might want it more. Biological anthropologist Helen Fisher has written about how hot sex with a new partner gives us a dopamine high akin to cocaine (quick summary of her ideas here). Maybe hot sex with in a newly reinvigorated relationship can give us the same buzz?

Also, the testing for Zestra relied on women who committed to have sex eight times in a month, so it’s unlikely many of them had a super low libido. (For more details on the testing, check out the clinical study.) These women were already open to regular sex. As a group they sound to me more like women who basically like sex but were frustrated by difficulty getting aroused. They don’t sound like the subset of women who’ve given up on sex – a group that constitutes about 15% of American marriages, by the way. (This according to Tara Parker-Pope in the New York Times, where “sexless” was defined as no sex at all with one’s spouse during the previous six to twelve months.)

In other words, the mechanism behind Zestra appears to be entirely different than flibanserin, an orally-administered drug recently rejected by the FDA for ineffectiveness. Flibanserin was supposed to increase libido directly by changing one’s brain chemistry. It too was compared to Viagra, and quite wrongly so: Viagra targets a mans plumbing, so to speak. It produces an erection (though it almost always requires mental and/or physical stimulation to be effective). Flibanserin left physical arousal untouched while aiming to increase psychological arousal and desire.

Calling flib a “pink viagra” was just misleading. In the case of Zestra, the comparison appears more apples-to-apples, since both Viagra and Zestra appear to work by increasing engorgement.

I still think it’s too bad that flib flopped. Yes, the drug was intended to be a Big Pharma Bonanza. I don’t really give a shit. If it had really helped women live better, I’d be all for it. I trust women to make decisions about their bodies (though I also insist on our responsibility to understand our bodies. At any rate, flib failed to gain FDA approval because it didnt work.

As far as I know, there’s still nothing  on the market that specifically helps women who only desire sex once in a blue moon. For some women, hormone therapy (sometimes including testosterone as well as estrogen) delivers a libido boost. But hormones carry some risk. Women fear breast cancer if they take estrogen and they fear growing a beard and unibrow if they take T. But these are the choices, because there’s no drug that specifically targets libido.

Zestra interests me because it seems to be quite safe (worst side effect: transient burning sensations in some rather precious real estate). I’m skeptical to the extent that their studies are pretty small. Unavoidably, the very fact of running a study is an intervention in itself. This can have real effects on its findings. How many of the couples studied would have had sex at least eight times in a month? If most would’ve had less, that means Zestra wasn’t the only independent variable. Perhaps the twice-weekly commitment, combined with a new toy or just wall-to-wall pictures of George Clooney and Jon Hamm would fire their engines just as well. I’m pretty sure I’d be off and roaring on that program! (Where do I sign up?)

Seriously, I have been meaning to try Zestra just for the fun of it, since it sounds like its potential benefits might not be limited to people suffering from difficulty with arousal … and, y’know, anything for science! I’ve got a packet of it in a drawer but I’m not so sure what my lab partner would think.

As always, I’m very curious if any of you out there in bloglandia have given Zestra a whirl? And if so – are you willing to dish? Pretty please?

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John Boehner’s Tears: Hypocrisy or Brain Damage?

It’s possible that John Boehner cries easily for the reason I do: he’s easily touched and not so hot at self-control. But I’m not buying that. As Rachel Maddow pointed out in her excellent segment on Boehner’s waterworks, if the fate of America’s children reduces him to tears, he could actually take steps to improve their future!

Boehner’s not the first pol to cry easily and often in public; he’s just the most unexpected and the least discriminating when it comes to his triggers. Rachel traces the history of weeping politicians back to Edmund Muskie, whose alleged tears in New Hampshire allegedly derailed his 1972 Democratic primary. (Muskie’s damp cheeks – and the weird media reaction – are among my earliest political memories. He won that primary but lost the nomination.)

Rachel argues,

There’s nothing wrong with politicians showing emotion. There’s nothing wrong with politicians crying in public. It demonstrably does not hurt them with voters, but it shows us what they feel passionately about, and what’s wrong with that?

So true. And yet, while you can find military giants shedding tears in the ancient world, here in the U.S. we’ve liked our men tough and dry-eyed. For a political leader to cry publicly was pretty well verboten from the end of WWII until the closing years of the Cold War. The same probably holds true all the way back to George Washington and his unruffled wig, but this is a blog post, not a book. So let us think of our post-war presidents! Truman was gruff and bluff. Eisenhower never lost his military bearing. JFK drew much of his power from his aristocratic cool. (Did he ever once cry publicly over the loss of his infant son, Patrick?) LBJ couldn’t afford to look soft while playing hardball with Congress.

But then came Nixon. Tricky Dick did emotion, all right. He knew how to project self-pity all the way back in ’62, when, in his purported “last press conference,” he announced his withdrawal from politics, telling reporters, “You won’t have Nixon to kick around anymore.” By the early 1970s, he projected anger and paranoia pretty well, too. Indeed, Muskie’s destruction can be laid at the feet of Nixon’s henchmen and their ratfucking.

Even when forced to resign in disgrace, Nixon controlled his grief – in public. His resignation speech was calm and even resolute. (You can listen to his speech here.) My ten-year-old self felt sorry for him as I watched it, and I distinctly recalled tearing up despite knowing he was a crook and needed to go. Disgrace and shame push my empathy buttons even when that shame is richly deserved. But Nixon held it together, even launching into a policy disquisition toward the end. The WaPo described Nixon’s public composure but also the gap between the private and public man:

Mr. Nixon’s brief speech was delivered in firm tones and he appeared to be complete control of his emotions. The absence of rancor contrasted sharply with the “farewell” he delivered in 1962 after being defeated for the governorship of California.

An hour before the speech, however, the President broke down during a meeting with old congressional friends and had to leave the room.

He had invited 20 senators and 26 representatives for a farewell meeting in the Cabinet room. Later, Sen. Barry M. Goldwater (R-Ariz.), one of those present, said Mr. Nixon said to them very much what he said in his speech.

“He just told us that the country couldn’t operate with a half-time President,” Goldwater reported. “Then he broke down and cried and he had to leave the room. Then the rest of us broke down and cried.”

(Carroll Kilpatrick, Washington Post, 9 August 1974)

Goldwater is yet another guy who’s hard to imagine weeping.

In the wake of Watergate, the whole country felt emotionally ravaged. We found respite in blandness: Gerald Ford’s good-natured bumbling and Jimmy Carter’s be-sweatered earnestness. But we did not find collective catharsis. That would wait until 1980.

The defining moment in presidential emoting came with the election of Ronald Reagan, who – though not much of a weeper – brought his entire actor’s armamentarium to the office. At the time, critics gleefully described Reagan as merely a “B-movie actor.” No matter. His acting skillz, modest as they were, earned him his “Great Communicator” moniker and enabled him to transform American politics in both substance and style. (Peggy Noonan had a hand in all this, of course, but her lines would have flopped, had Reagan been unable to fill them with warmth and passion.)

And yet, Reagan wasn’t much of a weeper. Serious presidential tears came into their own with the first Gulf War. International relations scholar Steve Niva views the end of the Cold War as a watershed in public political expressions  of hegemonic masculinity. Suddenly, General Colin Powell was weeping at his high school reunion. General Norman Schwarzkopf raved about his love for opera. In an America that had shed much of its Vietnam Syndrome through Rambo and Reagan, it became possible, Niva argues, for American masculinity to be both tough and tender. (See Steve Niva, “”Tough and Tender: New World Order Masculinity and the Gulf War,” in The “Man” Question in International Relations, ed. Marysia Zalewski and Jane Parpart (Boulder, CO: Westview Press, 1998), 109–28.)

The floodwaters sprung all the dams in 1992, as Bill Clinton teared up at every tale of woe on the campaign trail. He wept his way through his presidency, and we’ve never been the same since.

Niva’s excellent article explains just part of this transition. Reagan laid the groundwork. The first Gulf War expiated the shame of Vietnam and allowed American men to claim their manliness again as long as it was cloaked in khaki. But the “tender” part of Niva’s equation requires further explanation. Men like Clinton were simply of a new generation. They had defied conventional masculinity by growing their hair long, questioning the corporate rat race, fantasizing of careers in rock and roll – or at least playing the tenor sax on the Arsenio Hall Show. They had tuned in, turned on, and dropped out – or at least, they “didn’t inhale.” Perhaps most significantly, many men of Clinton’s generation had married a new generation of women. Some were feminists. A larger number were too timid for “women’s lib” but still warm toward egalitarianism. Most of these women expected and honored male emotion, though still within constraints.

The Boomers and subsequent generations are thus willing to grant our male leaders some slack in expressing public emotions, as long as it’s for a serious cause. Rachel’s clip shows how both Bushes and Mitch McConnell – powerful Republicans all – cry in public without losing face.

But none of them are crying about TARP. And that brings us back to Boehner’s tears, which are quite extraordinary even for a tough-and-tender post-Cold War leader.

Go to about 8:30 in Rachel’s clip. You’ll see him beg tearfully for the big-bank failout bailout known as “TARP.” He has subsequently attacked those who voted for it, conveniently forgetting his own damp-eyed support.

Rachel nails him for hypocrisy:

As Americans we react to someone crying about children’s welfare because we think that it implies strength of his commitment to improve children’s welfare. It doesn’t always. When the new congress convenes and John Boehner is Speaker of the House, remember this: just because he’s crying about something doesn’t mean he’s going to fix that thing. Crying in public is neat. I’m all in favor. Crying in public, however, is not the same thing as fixing the thing that makes you cry.

(This and the previous transcript via Business Insider.)

I, too, think hypocrisy is the most likely explanation for the cavernous gap between Boehner’s tearful public pronouncements and his Grover-Norquistian actual policymaking.

But there’s an alternate explanation, and it’s a doozy. A few weeks back, Gregory House, M.D. (the TV doctor played by Hugh Laurie, my next-husband-in-spe) had a patient whose emotional expression was the exact opposite of what most people would feel. The “case” was medically incoherent, but it nudged the two brain cells in my head where I’d stored the concept of pseudobulbar affect. I’d read about this phenomenon – the expression of inappropriate emotions – when I was diagnosed with MS. (New readers: that diagnosis was later overturned, though it’s still my sword of Damocles.)

So could Boehner have pseudobulbar affect? If so, there’s a short list of conditions that can cause it. Multiple sclerosis. Amyloid lateral sclerosis (ALS, or Lou Gehrig’s disease). Stroke. Parkinson’s and Alzheimers’. Traumatic brain injury.

To put it bluntly: Pseudobulbar affect only occurs in a brain that has suffered considerable damage. If Boehner has any of the conditions I mentioned, he merits your sympathy and mine, no matter what his politics. But he also might not be capable of serving as the third in command. People can suffer from pseudobulbar affect without having impaired judgment. I’d want to be sure of that, however, and not just assume it.

I still lean toward hypocrisy and manipulative tactics as the most parsimonious explanation of Boehner’s tears. I just wouldn’t rule out brain damage.

Either way, I question his fitness for the office of Speaker of the House.

No word tonight on where Glenn Beck gets his waterworks. At least he’s not President – yet.

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Mother-Blaming Alert: You Are What Your Mother Eats

Earlier this week, I talked to my husband and kids, who are keeping the fires burning in Ohio while I’m visiting family in California. All of them were aggrieved. My husband was planning to fix broccoli and noodles for dinner. Both boys were insisting that they would not eat it and furthermore never had liked broccoli. Never mind that two reliable witnesses (both of their parents) have seen them eat it with gusto! The standoff ended when the broccoli was discovered to have both mold and bugs.

You might imagine that this was simply an instance of children being picky and ornery. You would be wrong. New research shows that I am to blame!

When I saw the headline on the medical news wire Ivanhoe – “Pregnancy Diet Predicts Food Choices of Children” – I figured it would insinuate that mommy is at fault. But the actual article was much worse. It managed to blame mothers directly in its very first sentence:

If you’re a mother to a finicky child, then you may be to blame for his or her picky taste.  A new study conducted at the University of Colorado School of Medicine uncovers the possibility that a mother’s diet during pregnancy can both familiarize the unborn baby with specific scents and tastes and directly influence what the child will later prefer to eat or drink.

“This highlights the importance of eating a healthy diet and refraining from drinking alcohol during pregnancy and nursing,” lead researcher Josephine Todrank was quoted as saying.  “If the mother drinks alcohol, her child may be more attracted to alcohol because the developing fetus ‘expects’ that whatever comes from the mother must be safe.  If she eats healthy food, the child will prefer healthy food.”

I’m dizzy with those leaps of logic. How did we jump straight from food to alcohol – the kryptonite of mother-blaming? And how many children are attracted to alcohol, anyway? Yes, fetal alcohol syndrome is a serious problem among the offspring of binge drinkers. I don’t see a lot of kids clamoring for a glass of Merlot. In fact, we’ve let our kids taste beer and wine, when they expressed curiosity, just so they could discover that it tasted “pooey” to them.

Read a little farther and you learn that Todrank et al. tested their hypothesis on newborn mice. For better or worse, mice don’t have much of a culinary culture. They aren’t tempted by the toys in Happy Meals. Nor are they exposed to my delicious vegetarian chili. Even in terms of the mouse lifecycle, one wonders whether the pups acquired a broader range of tastes as they grew. Also, mother mice are never told to drastically limit their diet while breastfeeding due to a colicky or restless pup.

My firstborn child tolerates much more spice than I do. He eats chard and Thai curry and Kalamata olives with gusto. My second son? He’d live on candy, breakfast cereal, hard-boiled eggs, Kraft mac-n-cheese, and more candy if we’d let him.

If this study has any applicability to humans, you’d expect to see the same pattern in every family: the firstborn should be a foodie, while subsequent children – conditioned by the relatively bland diet that families often adopt while feeding a toddler – should be pickier. You’d also expect the children of my spice-loving friends to be omnivores, yet many of them are pickier than my younger son.

It may well be that the biological effects on taste and smell that Todrank et al. found in mice have some applicability to humans. If so, it’s heavily filtered through culture. As parents generally know, young children usually have much more restricted tastes than their parents. I, for one, forced myself to eat broccoli during pregnancy even though it triggered nausea – and look where it got me!

Can we stop with the mother-blaming already? Most women consume a reasonably well-balanced diet during pregnancy. The few who don’t are usually either poor or plagued by hyperemesis gravidarum (that’s medicalese for uncontrollable barfing). Let’s not make mothers feel guilty because they failed to eat their brussel sprouts.

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Menopause and a “Broken Thermostat”

The other day, I googled “cold flashes.” That wasn’t a typo; I didn’t mean “hot flashes.” I meant COLD.

I’m not at menopause yet, and judging by family history I’m probably a good half-decade away. But over the past several years I’ve had even more trouble than usual staying warm. My internal thermostat went completely haywire when I got sick in January 2009 with the still-undiagnosed ailment that messed with my nerves and muscles and brain. Nothing could keep me warm. While that has improved somewhat, it hasn’t returned to my pre-illness state. Then, after a minor virus this fall, I started to notice that warm stimuli – the blessed touch of sun on skin, or the spray of hot water in the shower – could give me the chills. Goosebumps, even!

I wasn’t alone. A friend of mine, a few years younger than I, seemed equally miserable at those chilly soccer games at the end of this fall’s season. We were both hiding under blankets and nursing a thermos of tea as soon as temperatures dropped into the 50s.

I began to wonder: might freezing just be part of aging?

According to Google, yes. Women do report cold flashes, though they typically follow upon hot flashes. Somehow, the hot flashes, with their dramatic sweats and red skin, get all the press, while the chills get – well, the deep freeze in the media!

The root cause seems to be the same, though. The hypothalamus is responsible for keeping our internal temperatures running steady. In the decade or so prior to menopause (a woman’s last period), the hypothalamus stops running so steadily. Conventional wisdom holds that fluctuating estrogen levels send confusing signals the hypothalamus, but actually there’s an intricate interplay between the hypothalamus, pituitary, and ovarian hormones. Contrary to its image, estrogen does not function as the ringmaster – not on its own, anyway.

Whatever the exact mechanism, it sure feels like a broken thermostat to me. At the blog re:Cycling, Heather Dillaway objects strenuously to calling it broken, or attempting to “fix” it. She objects to any language that portrays menopause negatively or suggests that women “suffer” from it. She’s part of a noble tradition of feminist criticism that has pilloried the medicalization of women’s bodies. This critique, however, too often sets up a false opposition between how doctors tell women they should feel and women’s actual experience.

Sure, experience is partially shaped by our expectations, including biomedical ideas about women’s bodies. Menopause is indeed a natural transition, one that every cis-woman will undergo if she doesn’t die young. We should certainly oppose the idea that women’s worth is based on their youth, beauty, and fertility. We should celebrate the wisdom that can come with time.

But doggonit, my thermostat feels broken! I might fantasize about it improving if were to spend a week in St. Tropez, but realistically? It’s likely to get worse before it stabilizes or improves. And it’s not a trivial thing. When I’m unable to get warm, despite long underwear and a sweater, a heating pad, and an ambient temperature of 72, I don’t merely experience cold; I suffer it. Putting a positive spin on this merely denies my experience. To anyone intent on painting menopause in shades of rose and mauve, I ask: What color do they turn when they freeze?

For many women undergoing the menopausal transition, temperature regulation is only one challenge. Many women also report debilitating fatigue, which is also linked to a wonky hypothalamus. They wake up at night, drenched in sweat, heart racing. It’s not a panic attack; it’s “only” a night sweat.  Salon just ran an essay by Beth Aviv detailing her struggles to manage such symptoms after (admittedly foolishly) stopping hormone treatment cold turkey:

… I wake in the middle of the night, heat percolating to the surface like an underground spring — flooding between my fingers, into elbows, under my arms, onto my chest, my neck, my scalp until my straightened hair curls. If you could slide your fingers over my forehead, it would feel like you were finger-painting. Sleep does not return for hours.

The comments on Aviv’s essay are Salon’s usual mixed bag. There’s no shortage of people telling women to just “suck it up.” (This phrase appears repeatedly.) It’s mostly women piling on other women, as in this especially judgmental comment by a woman calling herself Semolina:

Most menopause symptoms are psychological. Some people enjoy making drama out of trivial events, and those are the folks who suffer mightily. I’m sixty years old and female and none of my friends has had this extreme problems — because I don’t hang out with drama queens.

Well, that Judgey McJudgey comment drew the smackdown it deserved from another commenter named Mona:

I see. Well, I am a 54-yr-old woman with a law degree from an elite university. A bit more than a decade ago, I suffered a severe emotional breakdown in the wake of the death of my oldest son via vehicular accident. Followed by that son’s father deciding to leave me for a man — that happened 6 weeks after we buried our 19 year old son.

As a consequence, I developed a crippling anxiety disorder. I’ve been in peri-menopause or menopause for about 8 years, and had been swimming right along assuming mine would be as easy as my mother’s.

It is now NOT. And it’s not in my head. It’s in the interference with my work toward recovering and living an emotionally stable life — a life with joy.

The extreme insomnia is not in my head. Nor the heart palpitations and the profuse sweating followed by cold clamminess ALL NIGHT LONG.

So, Seminola, I’m glad you don’t hang with “drama queens.” Neither do I. But some women have had, and continue to have, serious, dramatic problems that are, most decidedly, not in our heads. Or wait, they are, but not in the way you imperiously meant.

Now, obviously most menopausal women don’t undergo two personal tragedies in quick succession (though most of us do start to notice the losses piling up as we move through our forties). I’m offering Mona’s experience not to typify menopause, but to underscore its variability. She thinks she’s going to try bioidentical hormones, which I would likely try myself in her situation. (The debate on the relative safety of “bioidentical” versus synthetic and equine-derived hormones is not one I want to engage here – maybe in a future post?)

It’s great that some women sail through menopause, getting by with a sense of humor and a willingness to just suck it up. That’s their experience. I’m glad they were able to manage. I’m still early-days enough to fantasize it could be my experience, too, especially if I keep my house well heated.

But other women have other experiences. Some experience severe cognitive and mental health issues. Most face the more mudane – but still sometimes disabling – issues of body temperature regulation and insomnia. Oh, and sexual issues, but that would be a whole ‘nother post.

Point is, nobody gets to define your experiences for you. Not the perhaps well-meaning but ultimately wrong-headed doctors in the 1950s and ’60s who promised eternal femininity. Not those present-day doctors who fail to see patients as individuals, either demonizing Prempro (the most common synthetic HRT) or withholding it across the board. Not good-hearted feminists who want to put power back in women’s hands – but haven’t walked in your shoes, nor tried to sleep in your soggy sheets. Certainly not the Internet scolds who tell you to suck it up.

You. Only you get to decide what you’re experiencing, whether you’re suffering, whether something feels “broken,” and how – if at all – you might try to fix it.

Then again, maybe I’m a drama queen, and I just haven’t noticed it?

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TSA = Testy Sheep-like Ableism?

It’s become a cottage industry, this business of coming up with new phrases to fit the acronym TSA. Read the two following stories and see if you can come up with a better title.

Story 1: Multiple breast cancer survivors have reported TSA harassment due to wearing a breast prosthesis. A Charlotte-based flight attendant, Cathy Bossi, underwent an “enhanced” patdown because as a survivor, she worried about radiation exposure from the naked scanners. MSNBC reports:

The TSA screener “put her full hand on my breast and said, ‘What is this?’ ” Bossi told the station. “And I said, ‘It’s my prosthesis because I’ve had breast cancer.’ And she said, ‘Well, you’ll need to show me that.’ “

Bossi said she removed the prosthetic from her bra. She did not take the name of the agent, she said, “because it was just so horrific of an experience, I couldn’t believe someone had done that to me. I’m a flight attendant. I was just trying to get to work.”

This is just one reason why exempting the pilots from screening solves nothing (apart from relieving the government from worrying about the pilots walking out on their jobs). (Bossi gives additional detail on her experience here.)

But there’s more. MSNBC continues:

Marlene McCarthy of Rhode Island said she went through the body scanner and was told by a TSA agent to step aside. In “full view of everyone,” McCarthy said in an e-mail, the agent “immediately put the back of her hand on my right side chest and I explained I wore a prosthesis.

“Then, she put her full hands … one on top and one on the bottom of my ‘breast’ and moved the prosthesis left, right, up, down and said ‘OK.’ I was so humiliated.

And the stories just go on: a woman with a pacemaker, another breast cancer survivor, a man who uses crutches, a woman whose hip replacement hardware trips all the red flags, now more than ever … and that’s just in this one brief MSNBC report.

Story 2: At Detroit’s airport, Thomas Sawyer, a retired special-ed teacher, was selected for secondary screening after his urostomy bag showed up on the naked scanner. A bladder-cancer survivor, he needs to wear this bag to collect urine, since he had to surgically trade in his bladder for more years of life. Here’s how MSNBC reports the rest of his experience:

Due to his medical condition, Sawyer asked to be screened in private. “One officer looked at another, rolled his eyes and said that they really didn’t have any place to take me,” said Sawyer. “After I said again that I’d like privacy, they took me to an office.”

Sawyer wears pants two sizes too large in order to accommodate the medical equipment he wears. He’d taken off his belt to go through the scanner and once in the office with security personnel, his pants fell down around his ankles. “I had to ask twice if it was OK to pull up my shorts,” said Sawyer, “And every time I tried to tell them about my medical condition, they said they didn’t need to know about that.”

Before starting the enhanced pat-down procedure, a security officer did tell him what they were going to do and how they were going to it, but Sawyer said it wasn’t until they asked him to remove his sweatshirt and saw his urostomy bag that they asked any questions about his medical condition.

“One agent watched as the other used his flat hand to go slowly down my chest. I tried to warn him that he would hit the bag and break the seal on my bag, but he ignored me. Sure enough, the seal was broken and urine started dribbling down my shirt and my leg and into my pants.”

The security officer finished the pat-down, tested the gloves for any trace of explosives and then, Sawyer said, “He told me I could go. They never apologized. They never offered to help. They acted like they hadn’t seen what happened. But I know they saw it because I had a wet mark.”

Humiliated, upset and wet, Sawyer said he had to walk through the airport soaked in urine, board his plane and wait until after takeoff before he could clean up.

(Read the whole story here.)

There are so many layers of horror in these stories, I hardly know where to begin.

Anyone who has survived the pain, indignity, and fear of cancer and its treatment deserves nothing but kindness and compassion. I know that first-hand, having seen my spouse and my sister suffer. The same is true for every other disease and disability. People suffer enough from nature’s ravages; why add human callousness to the mix?

Passengers deserve to be heard, not ignored, when they try to explain their medical situation. As far as I can see, the TSA response is repeatedly, hey, we’re just doing our job, so get out of our way. (Subtext: STFU.)

No one – regardless of their physical ability – deserves humiliation. The TSA may appear to be applying policies “consistently” by not exempting passengers with disability or medical conditions, but the ultimate effect is profoundly discriminatory. If you wear a prosthesis or an ostomy bag, your choice is to face humiliation – or remain grounded, regardless of how far away you live from loved ones. The ableist impact of the TSA procedures is yet another instance of ostensibly “same” treatment resulting in gross inequalities.

And how ’bout that vaunted TSA professionalism? There’s no private space available when Mr. Sawyer asks for it. The officer responds with an eye roll. Neither of the two agents have the basic human decency (never mind professionalism!) to apologize.

As for a “private” screening being a right? Mr. Sawyer had to fight for it. Ms. Bossi was given it. Ms. McCarthy never even had a chance to demand it; her humiliation occurred in full public view.

Mr. Sawyer’s experience wasn’t as clearly sexualized as that of the breast cancer survivors, but all of these people are being harmed by the confluence of the rampaging security state with ableism and contempt for bodily autonomy.

One other factor is in play, too: the obviously woeful training of TSA officers. Badtux explains just how perfunctory his own training was when he once began a similar government job. Badtux views the inconsistency of TSA grope-searches results largely from half-assed training. Obviously the erraticness becomes even more egregious as soon as TSA officer lay hands on non-normative bodies: children, gender-variant folks, and people with disabilities.

Be that as it may, the TSA is still in violation of its own policies. Here’s what its website says about “assistive devices and mobility aids”:

• Security Officers will need to see and touch your prosthetic device, cast or support brace as part of the screening process.
• Security Officers will not ask nor require you to remove your prosthetic device, cast, or support brace.
• During the screening process, please do not remove or offer to remove your prosthetic device.
• You have the option of requesting a private screening at any time during the screening of your prosthetic device, cast or support brace.
• You have the right to refuse the offer of a private screening; however, you will need to allow the screening to be conducted publicly if you wish to proceed beyond the security checkpoint.

The TSA has clearly violated the second point. Also, re: point one, there’s a difference between touching the device (a breast prosthesis, say) and moving it around in a way that draws public attention to the fact that it is indeed a prosthesis. The TSA also violated the fourth point in these stories.

In the face of the TSA breaking its own rules and violating basic human rights, Obama says only this (again via MSNBC):

“I understand people’s frustrations, and what I’ve said to the TSA is that you have to constantly refine and measure whether what we’re doing is the only way to assure the American people’s safety. And you also have to think through are there other ways of doing it that are less intrusive,” Obama said.

“But at this point, TSA in consultation with counterterrorism experts have indicated to me that the procedures that they have been putting in place are the only ones right now that they consider to be effective against the kind of threat that we saw in the Christmas Day bombing.”

In other words: underpants bomber! underpants bomber!

Maybe it’s hard to imagine now, President Obama, but someday you too will likely live with a disability. This is not just an issue that affects a few unlucky elderly people. Many people living with disability are young or in their middle years. Disability is in all of our futures, unless we die young and violently. It will touch all of us, whether we’re now temporarily able-bodied, partially disabled, or living with disability 24/7.

There’s got to be a more compassionate course. How ’bout we start with some well-trained bomb-sniffing beagles, serious security for cargo, and real checks of employees working behind-the-scenes at airport? That might keep the TSA so busy, they’d have no time to mess with ostomy bags and prosthetic breasts.

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A Healthy Dose of Skepticism: Are TSA Strip-Search Scans Safe?

When the TSA first announced its rollout of body-scanners, my first thought was: What about privacy? My second: Are they safe?

While privacy is obviously and inarguably a massive issue, the facts aren’t quite as evident on the question of safety. Back in January, Lindsay Beyerstein made the point that one of the two types of scanner – the “backscatter” technology – uses x-rays, yet the machines are not subject to the sort of rigorous testing expected of medical equipment. Even CT scanning equipment, which is operated by trained medical personnel, has resulted in a distressing number of overdoses from wrongly calibrated machines, some of which were uncovered only after the FDA and the New York Times launched an investigation starting in late 2009.

TSA employees have no medical training – none! – and we have no reason to believe that they are prepared to recognized machine malfunctions. Indeed, they are so unprepared that one TSA employee told a pregnant traveler that the machines emit less radiation than do sonograms – a stunningly ignorant statement, given that ultrasound doesn’t rely on x-rays at all. (The pregnant woman was subsequently bullied into the body-scanners by repeatedly refusing her a pat-down.)

Lindsay also raised the question of cumulative radiation. How much is safe? I would argue that no matter how small the dose of x-rays, it is only justified if it will save lives, and if safer techniques would not produce the same results. The Israelis manage to make it work without routine body scans, primarily through painstaking intelligence on potential terrorists – no x-rays needed. (Link via the excellent overview of issues at Sister Sage.)

My husband has had cancer twice. It was treated with radiation the first time around. He’s had lots of CTs – too many – and caught some of the fall-out from Chernobyl back in 1986. He does not need any extra x-rays. My kids don’t need any extra x-rays. Nor do you or I, dear reader.

If I were a TSA employee on the front lines, I’d also want to know how much of an occupational risk I was running. On the one hand, the intensity of the radiation is purported orders of magnitude less than used in medical x-rays. On the other hand, what’s to keep the x-rays contained? The name “backscatter” is not reassuring on this score. TSA operators are spending entire workdays in close proximity to these devices.

The other type of strip-scanner does not use ionizing radiation. It relies on millimeter waves. Some questions have been raised as to the safety of terahertz waves, which may have the potential to essentially “unzip” DNA, but terahertz waves are not identical to millimeter waves, just adjacent to them in the spectrum. (Two abstracts on terahertz waves are here and here. My main takeaway is that their safety is not yet well researched.)

On its website, the TSA simply asserts that millimeter-wave technology is safe; it does not supply any data or link to any studies. I just ran a PubMed search on “millimeter waves” and “safety,” which turned up only six hits, only one of which seemed relevant. A review article in Health Physics from 2000 raised the question of whether occupational exposure (that is, of the sort some TSA employees experience) could result in hazards such as burns or cancer; I can’t access the full text, so I don’t know what they concluded.

It is striking, in any event, that PubMed yielded so little information on the safety of millimeter-wave scans. Business Week reports that their health effects are “largely unknown,” and that the president of the National Council on Radiation Protection and Measurements favors conducting a study that would assess their safety. Much of the information on the web conflates millimeter waves with the terahertz spectrum and thus appears less than trustworthy.

In short, the TSA may be correct that the low intensity of the energy from both types of scanners makes them unlikely to create a real health threat. If I were a frequent flyer or a flight crew member, I would still wonder why there’s so little hard information on their safety.

More importantly, I worry about a the lack of medical/technical oversight. Largely uneducuated low-level employees are operating these scanners. If a scanner were wrongly calibrated and delivered much higher doses, who would know?

At the end of the day, I still think the best health-related objection to the strip-scanners comes from Revere of the now-dormant but wonderful blog, Effect Measure. Revere applied his skills as an epidemiologist. He noted that any machine purporting to catch every would-be terrorist will have a substantial number of “false positives” – people who are flagged though they’re innocent. Precisely that is now occurring, as evidenced by the story of passenger Christine Holland (who subjected to a grope-search after the scanner suggested she was carrying contraband). Revere calculated how many false alarms would be raised by a machine with only a 1 in 100,000 false positive rate:

According to the Department of Transportation, during the last year there were about 710 million enplanements (US carriers, October 2008 – September 2009; excludes all-cargo services, includes domestic and international). That would produce 7100 false alarms, about 20 a day. How many passengers carrying explosives would the technology pick up? Well, we’ve had exactly 2 since 2001 (Richard Reid the shoe bomber and the current underpants bomber), or .25/710,000,000 enplanements (it’s actually less because enplanements have decreased substantially since 2001). So the probability of an alarm being correct is about 1 in 30,000 or .000033.

(Read the whole thing here.)

I swear Revere argued at some point that screeners will eventually become inured to false positives and thus won’t be alert if a real threat were to appear. I can’t find where he said that, but it’s a key point, so I’ll make it anyway. Add to this the tremendous waste of resources that goes into checking for liquids and gels, printer cartridges, baby formula, and other innocuous items. Now add the diversion of TSA energies toward thoroughly frisking and groping everyone from Jeffrey Goldberg to little kids.

In other words, the biggest health risk from the scanners is that we’re actually less safe from terrorists than we were before. Anyone else feeling queasy yet?

[Variation on my usual "I'm not a lawyer" disclaimer: I'm also not an M.D., a physicist, or an epidemiologist.]

Update 11/14/10, 9:40 p.m.: According to Agence France Press, serious scientists have raised concerns about the x-ray machines. Michael Love, a scientist who runs an x-ray lab at the Johns Hopkins medical school, stated that “statistically someone is going to get skin cancer from these X-rays.” In April, scientists at UCSF wrote the White House Office of Science and Technology, saying, ”While the dose would be safe if it were distributed throughout the volume of the entire body, the dose to the skin may be dangerously high.”

Update 11/15/10, 11:10 p.m.: Here’s the full text of the letter (.pdf) from the UCSF scientists. The potential health risks it outlines are compelling enough that I’m not about to let my kids go through a backscatter machine. I’m also floored by how little study has been done on their safety.

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Mirror, Mirror … in the Doctor’s Office

So let’s say you’re seeing your doctor, whether for a checkup or an acute problem. She looks you over carefully. Just on the basis of your appearance, she decides you’re at risk for significant health problems.

Sure, most readers of this blog are aware that appearance counts for a lot (too much!) when it comes to work and dating. But in the doctor’s office? Did you know that one common measure of health is whether you look your age? For all the time I’ve spent studying medicine, this practice was new to me.

Researchers at St. Michael’s Hospital in Toronto report, via Eurekalert:

“Few people are aware that when physicians describe their patients to other physicians, they often include an assessment of whether the patient looks older than his or her actual age,” says Dr. Stephen Hwang, a research scientist at St. Michael’s Hospital and an associate professor at the University of Toronto. “This long standing medical practice assumes that people who look older than their actual age are likely to be in poor health, but our study shows this isn’t always true.”

For patients, it means looking a few years older than their age does not always indicate poor health status. The study found that when a physician rated an individual as looking up to five years older than their actual age, it had little value in predicting whether or not the person was in poor health. However, when a physician thought that a person looked 10 or more years older than their actual age, 99 per cent of these individuals had very poor physical or mental health.

(Read the rest here.)

Where I live – in an Appalachian county in Southeast Ohio – I suspect you actually do see lots of people who look a decade older than their chronological age. I’m basing this on anecdata gathered partly while in the waiting room at the ob/gyn’s office, where grandmothers-to-be often accompany their young pregnant daughters. I live in a pocket of endemic poverty. Poverty does beat people down. It ensures that they’ll grab cheap, satiating calories over a bunch of colorful veggies – just because it’s not pleasant to go to sleep at night with a gnawing sensation in one’s belly. We know that diabetes, for instance, is rampant in this region. So is extreme obesity.

But the pitfalls of using appearance as a proxy for health ought to be obvious, too. Take, for example, your faithful blogger Sungold, whose miraculously youthful complexion is due to … being born near the 49th latitude with her head in a book. I think I probably do look a few years younger than my age (especially compared to the local population) just because I didn’t get much sun as a youngster. But does that mean I’m healthy? Long-time readers know that I’ve got something undiagnosed, which is sort of like fibromyalgia and a bit like thyroid issues and a mimic of multiple sclerosis – but is apparently none of the above.

People who have a medical problem but look healthy are not well served by this rough-grained appearance test. Doctors will tend to dismiss their complaints because hey, they don’t look sick.

People who look much older than their actual age may also be poorly served. For example, too many doctors address problems like obesity on a radically individualized level, often with a dollop of shaming for letting oneself get too fat. The people in my region look old because they face multiple oppressions. Whatever wise or foolish decisions they’ve made in the past, they need a doctor to propose constructive solutions, not prejudge them based on appearance.

I hope doctors will take this study to heart and move toward evidence-based medicine when it comes to appearance. By all means, if someone looks extraordinarily aged, use that as a reason to inquire further. But do inquire. Please do ask. Appearance can only project a 2-D image. Patients’ words and embodied experiences can supply the essential third dimension.

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Emotion, Menstrual Stereotypes, and Physics Envy

This USA Today headline is one of the most annoying I’ve seen in a while:

It’s true: Menstruation does affect women’s emotions

And no, I’m not irked because I’m PMSing. In fact, if it’s not TMI, I’m in the “follicular phase,” which the study cited in this article claims is the least emotional phase of women’s cycles!

Here’s what the study actually found.

Researchers used MRI to study the brains of women who viewed a series of pictures and rated them as pleasant, unpleasant or neutral. This test was repeated at different stages of the women’s menstrual cycles.

In the early follicular stage of the menstrual cycle, no areas of the women’s brains showed significantly increased activation while viewing the pictures. But during the midpoint of their menstrual cycle, when hormone levels were higher, the women had increased activity in the lateral prefrontal cortex and other areas of the brain involved in processing emotional information, the researchers found.

So no, it’s actually not menstruation that makes women more emotional, assuming the study’s findings turn out to be valid. It’s ovulation! And the hormones that accompany ovulation! Because that’s what happens at the “midpoint” of the cycle.

In fact, the article says nothing whatsoever about what happened in the brains of women who were actually menstruating or on the verge of it. The headline nonetheless preys shamelessly on the stereotype of the moody menstruating woman. Some of us do get moody, and that’s okay – but all women are not the same. (Also, this may be pedantic, but it’s sort of simplistic to say that “hormone levels were higher” at mid-cycle. It depends on which hormones you mean. First estrogen peaks, then progesterone hits its maximum several days later.)

Apart from the misleading headline, the study itself makes me wonder if function MRI technology is feeding into a kind of “physics envy” among psychologists, biologists, and biomedical researchers. Biologist and primatologist Robert Sapolsky offers my favorite explanation of physics envy:

This is a classic case of what is often called physics envy, a disease that causes behavioral biologists to fear their discipline lacks the rigor of physiology, physiologists to wish for the techniques of biochemists, biochemists to covet the clarity of answers revealed by molecular geneticists, all the way down until you get to the physicists who confer only with God. Recently, a zoologist friend had obtained blood samples from the carnivores he studies and wanted some hormones in the samples tested in my lab. Although inexperienced with the technique, he offered to help in any way possible. I felt hesitant asking him do anything tedious, but since he had offered, I tentatively said, “Well, if you don’t mind some unspeakable drudgery, you could number about a thousand assay vials.” And this scientist, whose superb work has graced the most prestigious science journals in the world, cheerfully answered, “That’s okay. How often do I get to do real science, working with test tubes?”

(From Sapolsky’s wonderful essay on testosterone.)

Obviously, MRI is way cooler than test tubes! It’s no wonderful that researchers would rather get big grants and fiddle with fMRI, because it not only seems like “real science.” Grants and equipment tend to impress tenure committees, as well. While we actually know very little about what – if anything – fMRI actually tells us, it makes for cool pictures of the brain and imposing CVs.

But surely I’m not the only person who read about this latest fMRI study and wondered: Golly, couldn’t the researchers just ask the women how they were feeling?

 

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“Birth Rape” Redux

The controversy about the term “birth rape” has ebbed in the blogosphere (which has a shorter attention span than my seven-year-old son). But that doesn’t mean I’ve stopped thinking about it. Nor, it appears, have other people. A reader named Ann took the time today to disagree with me vehemently:

To me there is not the slightest smidgeren of doubt that the women who state that they were raped, indeed were raped. Rape is NOT, absolutely definitely NOT only about sexuality. It is mainly about power and dominance. You will find very few among the BDSM community who are not aware of this.

Rape can – also – occur in the total absence of a feeling of guilt of the perpetrator. Whether a nurse, midwife or doctor think their deeds are justified because they have a right to go home early, or that woman birthing is too dumb or distraught to know what she wants, or whether a pedophile reasons that the 5 year old boy “wants it” because he happened to leave his knickers off, or whether the husband holds his wife down, thinking she’ll eventually come around, it all does not matter. It still is rape.

(Read the whole comment here.)

I fully agree that rape is not just about sex but about power. However, by its very definition, rape is about sexualized power. The abuse of medical power has to do with power too, but it has little or nothing to do with sexuality. (An exception would be a doctor who subjects patients to sexual touching – which most definitely belongs on the continuum of sexual assault, and which happens with distressing frequency.)

A doctor who violates consent is not acting from the same motivations as the pedophile. He or she is supported by our cultural values in ways that a pedophile is not. Yes, we live in a rape culture, but you would find very few defenders of a pedophile. By contrast, medicine enjoys partial immunity from criticism because of assumptions that lay people cannot understand it, that medical personnel always hold humanitarian values, and that they will always act in the best interests of the patient.

Of course, this isn’t true. Consider another truly vile category of gynecological violation: forced sterilizations. Doctors in Nazi Germany sterilized about 400,000 women and men, the vast majority of them against their will. About half of the victims were women. The Nazi program was inspired by smaller-scale compulsory sterilization programs in the United States, whose legality the Supreme Court affirmed in its 1927 decision in Buck v. Bell. Compulsory sterilization declined after 1942 in the U.S., but poor women of color have still been subjected to it in the post-war era, most notably in Puerto Rico and on Indian reservations.

There seems to be a common conception that if declining to recognize a phenomenon as rape is the same as trivializing it. And yet, we don’t call forced sterilization “rape,” nor should we. Doing so would obscure its specific nature. It would draw attention to the particular values that legitimated it: the pseudoscience of eugenics, contempt for disabled people, and society’s exaggerated deference to medical authority.

In short: something can still be an atrocity if it’s not called rape.

Insisting on accurate naming is not “language policing,” contrary to what Cara argued at The Curvature:

I also thought that a big part of anti-rape activism was about broadening our definition of rape, not narrowing it — throwing out the stranger jumping from the bushes with a knife as the only model of rape, and recreating a model that encompasses a wide variety violent experiences and promotes affirmative, enthusiastic, meaningful consent as minimum standard of decency rather than a nice bonus if you can get it. I thought that anti-rape activism was about acknowledging that rape is not just one thing, that there is more than one way to violate a person and to be violated, and that whether consent was given was more important than how much force was used. Especially in this context, the posts in question come off as nothing more than language policing, against particularly marginalized populations, no less.

(The rest of the post is here.)

First, I think we should be able to discuss the applicability of “rape” to specific phenomena without shaming other feminists as rape apologists, or saying that they are acting as oppressors, or blaming their words for harming victims. That happened in both Cara’s post and the comments to it. Critique is good; disagreement is healthy. But shaming only leads to groupthink, as the comment thread to that post shows. Only one commenter deviated even slightly from Cara’s position.

I actually don’t think that anti-rape activism is “about broadening our definition of rape” – not if this means extending the term into entirely different realms of violence that are not basically sexual. Of course I strongly support recognizing acquaintance rape, or marital rape, and other instances of sexual violence as just as real, traumatizing, and illegal as the “stranger in the bushes.” But “rape” is not an infinitely elastic term, nor should it be.

Specific names for specific violations are politically and analytically important because they push us to understand the roots of different forms of violence. In cases of medicalized violence, we need to consider the values that enable a scenario like this one, described at the blog Forever in Hell:

The problem isn’t that women in labor are uniquely in a position to be victimized by medical professionals. The victims of such medical professionals are not uniquely women in labor. In other words, you don’t have to be a woman in labor to be victimized by a medical professional. You simply have to be in a room with certain medical professionals.

Case in point: a friend of mine needed a lumbar puncture (spinal tap) in order to tell if he had Multiple Sclerosis or Lyme Disease. These two diseases can cause similar symptoms and similar MRI results, but have vastly different treatments, so distinguishing between the two is necessary. My friend is a large man, so he needed to have the lumbar puncture done at the hospital by a doctor.

Before the procedure began, the nurse told the doctor that the needle they had was too large, they needed to get another. “Too bad,” snapped the doctor. He had a schedule to keep, he had a golf game to get to. Waiting for someone to get the correct needle would take too long, so, before my friend could object, doctor forced the needle into my friend’s spine. When I say “forced”, I mean forced.

I could hear him scream from down the hall.

Then, to add insult to injury, the doctor refused to draw enough cerebral spinal fluid to allow for two tests. “We’ve got enough to test for MS, what more do we need?” he said.

That’s right. This doctor tortured a man so as not delay a golf game and didn’t even get the damn test done.

(The whole post is here.)

I don’t agree that doctors are the only offenders (as this post goes on to argue). The potential for abuse is greater among those who are more powerful, but other medical personnel aren’t outside the value system that enables medical battery.

But this example does show that the problem really is primarily with the values that underlie medicine. Yes, we’ve come a long way from the days when a white coat commanded automatic obedience. We have the patients’ rights movement to thank for that, which was driven in large part by feminist critics of medicine. However, as long as medical personnel remain unaccountable for violations of consent, some practitioners will abuse their power.

If we want to stop battery of women in childbirth, we’re not going to make much headway by combating rape culture. We need to call for more humane and democratic medicine. We need to demand medical education that would weed out arrogant abusers and reinforce respect for the patient. We need to insist that doctors hold each other and their subordinates responsible – and if they can’t, or won’t, the law needs to intervene, with civil or criminal remedies as appropriate.

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As We Age: A Short Argument Against Gun Possession

My father has always kept guns. Like most men in North Dakota, he was a hunter. Indeed, during my 1960s and 1970s childhood there, you could hardly be a man if you didn’t own a gun. He shot deer, mostly to my mother’s dismay, as she recalls trying to deal with preparing the meat through the miasma of morning sickness. He shot duck and pheasant. We ate some of those. I remember having to pick out the beebees. My brother learned to hunt at his side. One of his early Halloween costumes was “hunter.” He was all cute pudginess and colorful shotgun shells. Even with my early pacifist stirring, I loved those colors!

Once our family moved out to California in 1979, hunting was relegated to a yearly trip back to North Dakota, usually timed so that the guys could partake of the annual community supper in Dad’s hometown. The guns remained. As time passed and we acclimated to a world where no one left their back door unlocked, Dad’s guns tended to gather dust even as his worries escalated. In this new, not-always-golden state, you had to fear crime – or so the media told us, relentlessly.

By the mid-1990s, my father kept a handgun in his nightstand. It was loaded. There were also murmurings about a loaded pistol under the driver’s seat of Dad’s car. When my first baby was born in 1999, these guns sounded like worse than a bad idea; they sounded potentially lethal.

‘Round about that time, my dad blew a hole in the carpet of his home office. He had taken a gun out of the locked cabinet (to clean it? just to hold it?) and pressed the trigger, certain it was empty. It wasn’t. Luckily for him, the carpet didn’t bleed.

This month, my brother will travel back to North Dakota with my dad, quite possibly for the last time. Their original plan was to hunt duck and pheasant. Then my dad started to skid away from reality; he started talking about shooting antelope (which don’t exist in central North Dakota). My brother decided he’d swap blanks for live ammo. Now, even that seems dicey, and he’s planning to plead a sore foot and avoid hunting altogether. Honestly, they’ll have far more fun just visiting people and eating buffalo meat with people my dad has known for decades.

As for the guns in his house, my brother spirited them away earlier this week, as I wrote yesterday. What I didn’t know until I spoke with my sis today: My father immediately noticed they were missing, before my brother had a chance to trot out the cover story about him “cleaning” the guns.

My dad called the police. He called the fucking police! They came to his house and took a report about breaking and entering and burgling.

This snafu will be straightened out. The police will learn that my dad is cognitively impaired before they pick up the “perp” (my dear brother, who may well have saved a life by removing those guns). They’ll have it in their records that my dad is non compos mentis.

What can’t be fixed: the fear. All these years, my father has stewed in it. Guns were his talisman.

It’s not true that the only thing we need fear is fear itself. We need to fear the combo of guns and fear. After a lifetime of relying on guns to keep the bad guys at bay, my father has no shield in the very moment when he feels most vulnerable. And yet, if he continues to have access to guns, odds are astronomical that someone will die.

I know plenty of people who are responsible gun owners. My dad was once one, too. But I think anyone who owns a gun would be wise to ask: What will happen as I age? Can I be sure I wouldn’t accidentally use the gun against someone I love?

Because that’s exactly the danger with my dad. He’s often confused enough that he doesn’t recognize his own wife. He could shoot her, or his beloved dog, or even his newly beloved cat. I know damn well he’s not the only aging gun-owner with too much exposure to Faux News and too little ability to cognitively filter real threats from those imagined.

Might we be wiser to find other ways while we’re still young to master our fears, however well founded they may be?

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The Long, Strange Trip of Alzheimer’s

I’ve written before about my father’s declining memory. Until fairly recently, we took some hope in the fact that he was chronically very low on B12. He has problems absorbing it through his diet (due to longstanding but stable health issues) and we hoped that aggressive supplementation might help.

Then came the encounter where he didn’t recognize his next-door neighbor and kept re-introducing himself, saying he was looking for a “small animal, white with brown spots.” He couldn’t remember what sort of animal. (It was the cat he and his wife recently adopted. The fact that he loves it is also anomalous – he’s always distrusted cats – but very sweet.)

Then came the night when he misrecognized his wife. He thought she was my mom’s sister (that is, his former sister-in-law).

Then came the collision – his car with another – which was (predictably) his fault. Through some great fortune, no one was injured. Soon thereafter, my brother and his wife hid his keys.

Then came the episode where he came into the bathroom where his wife was showering, brandishing a shotgun. He’d heard a noise outside and fired off a couple of warning shots. We don’t know how true this is, because my brother had already confiscated all the ammo in the house (or so he thought). But soon thereafter, my brother spirited off all the guns. He’ll explain that he’s “cleaning” them, and this will be a very lengthy process indeed.

Then came yesterday’s doctor visit. My brother and his wife bundled my dad down to UC Davis, a good hour-long drive from his home in the California foothills. He was fit to be tied as soon as they were in the car. The doctor met first with my dad’s entourage. He didn’t need to see the MRI, he said; based on their description of my father’s behavior, it had to be Alzheimer’s.

Then my dad berated the doctor for a while, refused testing, insisted there was nothing wrong with him, and announced that any goddamned fool ought to know it’s normal for a guy to be a little forgetful when he’s nearly 80. I wasn’t in the room, but I’m sure there was a lot more cussing, there and on the ride home.

Well, at least there must have been a flash of my dad as he once was – feisty and cantankerous and just difficult. Who knew that I would someday mourn the man who used to harangue me about how wonderful Reagan was and how foolish those lilylivered liberals? Now, though, his rage is focused on his frustrations. It’s terribly hard for him, and it’s trying for his wife, who is bearing the brunt. He has detailed memories of people and events in North Dakota, 40 or 60 years ago. He just can’t remember how to work the TV remote. One outburst came after he called his wife at work, wondering why the house was so hot. She came home to find the AC on the coldest setting but every single window thrown wide open. “I can’t fucking do anything right,” he said.

Yes, in some sense he is raging against the dying of the light, as I once wished he would. But on a deeper level that’s not true, because in so many important ways, he is barely the man I’ve known for the past 47 years. His self is receding. And anyway, the rage is wholly impotent.

Somehow I’d managed to believe that my dad’s cognitive decline could be something other than Alzheimer’s. Now, this diagnosis sounds so final. It feels like both a life sentence and a death sentence for my dad. Well, I guess it is all that, and more. I feel like my father is already gone, and I missed the point when he left. It feels like I’m mourning him piecemeal. It feels as though there’s no space in my life for mourning or grief. Classes still need to be taught. Papers need to be graded (though I haven’t touched them since last night’s phone call from my sister, when I got the news). Kids still need meals, homework supervision, and nursing (the Tiger’s out of school with a fever). Only in the middle of the night is there time and space for weeping.

I hate that I’m so far from my family. I hate that the burden rests so relentlessly on his wife, and that my brother has had to do so much more than I. I hate that I can do so little to help. Yes, I can call him, and I don’t do it often enough. The truth is, I dread further evidence of decline.

The last time I spoke with my dad, I had almost found a way to navigate the mix of nonsense and fact. I just pretended he was tripping. I harked back to those times when I felt responsible for keeping a friend from having a bad trip. I didn’t let reality perturb me. Experience with altered states turns out to be a more useful life skill than I’d ever imagined.

He knew who I was throughout the phone call. For that, I am grateful.

But the day draws near when he won’t know me anymore. A couple of weeks ago, his wife – testing his tether to reality – asked him: “Do you have children?”

“Yes, three.” A pause. “I have a son.” He named him, then added: “I have two daughters. An older one and a younger one.”

“Do you know their names?”

A much longer pause. Then: “I have a Patty.”

“And your other daughter?”

“That’s the smart, funny little one.”

He drew a complete blank on my sister’s name. Perhaps she will forever be the smart young one, caught in the hardening amber of my father’s brain.

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Painting Pink Red

I’m not a big fan of the whole “awareness ribbon” thing, but if I had a pink ribbon, I’d be dyeing it red – a deep crimson – to express how pissed-off I am at the increasing trivialization of breast cancer. “Awareness” substitutes for the fury that ought to drive the search for effective and innovative cures and prevention. (Ditto for other cancers, too, though none of them have reached quite such dizzying heights of awareness.)

Just what is breast cancer awareness, anyway? We hear about it every year, and most of us probably think, “Early detection. Better funding for research. Support for women who are fighting the disease.” A few of us might think: “Investigating environmental causes. Asking why the incidence of breast cancer is actually rising.”

Well, we’d all be wrong. Here’s how Evelyn Lauder describes it at HuffPo (and yes, I know only I am to blame for reading HuffPo):

In 1992, I co-created the Pink Ribbon with Alexandra Penney, then editor-in-chief of SELF magazine, and in turn started The Estée Lauder Companies’ Breast Cancer Awareness Campaign. Today, the Pink Ribbon has become the ubiquitous symbol of breast health, and I’m thrilled to share that, to date, The Estée Lauder Companies has distributed more than 110 million Pink Ribbons worldwide. The 2010 Breast Cancer Awareness Campaign theme is: “Connect. Communicate. Conquer. Prevent Breast Cancer One Woman At A Time. The Pink Ribbon. Wear It. Share It.”

(More here.)

In other words: All you have to do is wear a pink ribbon! If we all just pinkified ourselves sufficiently, we’d wipe out breast cancer.

(To be fair, Estelle Lauder also donates some pretty big chunks of change to research, as is explained at the end of the HuffPo piece. But still.)

My second peeve with the Lauder campaign is that this year, they seem to be hopping on the save-the-boobies bandwagon. They’ve recruited several bloggers to pose nude, their arms shielding their nipples. All in the name of breast cancer awareness, of course. There’s a gesture at inclusiveness, with one man and one woman of color, as far as I can see, and one older woman in a three-generations shot. But that gesture is really just a slight nod. The rest of the women pictured are all conventionally sexy, white, and young enough to be winning the fight against gravity. (To be clear: I’m not dissing any of the bloggers involved, who likely went out of their comfort zone to promote a cause they care passionately about. I’m objecting to the overall impact of the campaign and the assumption that a sexy breast – and not the whole person – should become a focal point of activism.)

As I was viewing the site while sitting next to my husband on the couch, he glanced over and his eyes grew wide. “What are you looking at?” he wanted to know. To him, at least, these pictures didn’t convey any anti-cancer message.

I griped last year about the sexualization and ageism of the Save the Boobs video and the Blogger Boobie-Thon. But they were bit players compared to Estelle Lauder, which is one of the biggest forces in “think pink” marketing.

I’m no prude. I’m quite fond of boobs, myself (especially my own). But let’s be honest: Most of us who get breast cancer are no longer dewy and perky. The “passion” that the Estelle Lauder photo gallery was supposed to convey with a hand on the heart? That could be accomplished with clothes on, too. And then there’s the basic problem that it’s an outrage to make breast cancer – any cancer – sexy. Does anyone think that chemo patients feel sexier without their hair? That one’s libido won’t take a dive after a mastectomy or during the rigors of radiation and chemo? That anemia makes a gal or guy feel positively smoking hot?

People with cancer are usually still sexy to their lovers. But they often don’t feel that way themselves. No matter how good its intentions, a campaign that reduces their life-threatening disease to their lost “hotness” isn’t just sexist. It’s cruel. No amount of pink ribboning can paper over that.

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