Is It Anti-Feminist to Question Palin’s “Wild Ride” Story?

In my previous post, I promised I’d deal with feminist ethical objections to delving into the veracity of Palin’s claimed pregnancy with Trig. Is it illegitimate to ask questions about a candidate’s reproductive history? Are we invading Palin’s privacy, down to her very uterus?

The arguments for backing off from the tale of Palin, Trig, and her alleged Wild Ride fall into two main categories. (Let me know if you can think of others.)

1) Palin and especially her children deserve at least a modicum of privacy.

2) It’s always anti-feminist to second-guess women’s choices in childbearing and mothering.

On 1) privacy: As I mentioned in my last post, it’s standard operating procedure for presidential and veep candidates to disclose their medical records. While I would object strenuously to laws and policies that demanded the same of grocery clerks and accountants and locksmiths and (yes) college professors, the presidency isn’t just any job. There’s a reasonable case to be made for the citizenry knowing whether a candidate has a condition that might render her or him incapable of serving or exercising good judgment. We should have known, for instance, that Ronald Reagan was experiencing symptoms of Alzheimer’s.

We expect this disclosure of all candidates for the presidency and vice-presidency. Why should Palin get a pass? Why should her records remain private? Is it justifiable simply because she has a uterus? That would be sexist in its own twisted way, wouldn’t it – throwing us back to the days when ladyparts were still “unmentionables”?

Now it’s rather late to demand medical records be released, since Palin is no longer a candidate. But I think it’s still fair to say that Palin would have set the record straight on Trig’s birth, one way or another, had she only behaved like other candidates back in October 2008. Instead, she substituted secrecy for transparency (which didn’t surprise many Alaskans). She was nominated without any real vetting by McCain’s people, and they built an opaque wall between her and the press. She guarded her secrets while piling up lies. It’s not surprising that quite apart from Trig’s birth, the contents of her medical records would become subject to speculation.

Concern for the privacy of the Palins’ minor children (which included Bristol in 2008) is a legitimate and noble cause, one that I’ve consistently espoused. Let’s be clear: None of the brouhaha around Trig’s birth is actually about Trig. It’s about Sarah Palin.

The Palin children’s privacy has been breached, all right, but this has been almost entirely Sarah Palin’s own doing, apart from Bristol’s own self-promotion as a (*cough*) abstinence advocate. Who chose to use Trig as a political prop? Who decided to out Bristol’s pregnancy to the world instead of directly laying to rest the rumors about Trig’s birth? (Let us be clear: Bristol’s pregnancy in fall 2008 did not prove Sarah gave birth to Trig; it only made Bristol an unlikely mother to Trig unless he had actually been born earlier in the winter of 2008.) Who carried on a public feud with Levi Johnston’s family (which ultimately involved Palin’s grandson Tripp)? Who signed her family up for a reality TV show?

Mind you, I disapprove of the Gosselins and Duggars, too, for televising their children’s childhood. It’s just that none of them are running for president.

On point 2) – reproductive choice and trusting women – Melissa McEwan writes:

Birtherism, in which both conservatives and liberals are engaging, is a terrible and intrinsically misogynist game to play, entirely dependent on a belief that policing women’s bodies and reproduction is an acceptable recreation.

Actually, what’s going on here is not policing Sarah Palin’s body. What’s truly at stake is not what or who came out of her uterus. It’s what came out of her mouth. It’s her self-contradicting statements and outright lies.

McEwan tosses out a straw man when she says mockingly that the only acceptable evidence for “Trig birthers” would be video of Trig emerging from Palin’s vagina. Of course that’s silly. On the other hand, medical records showing that Palin truly was pregnant, underwent amnio, and gave birth when she claimed – well, that would be pretty darn conclusive. The unreasonable few would continue to hatch conspiracy theories. The rest of us – people like me and Litbrit – would say great; case closed; let’s carrying on dissecting why Palin, Bachmann, Trump, Santorum, and Co. are a danger to the United States. Andrew Sullivan would back off it too and devote himself more fully to his irrational quest for fiscal austerity. (Hmm, that’s one good argument for keeping the mystery of the Wild Ride alive.)

As I’ve written before, if Palin’s account of the wild ride is true, it displays epically poor judgment. By her own account, she board not one but two long flights after her water broke, without even stopping for a check-up before she left Dallas.

The party-line feminist response is: trust women. And I agree, we have to do that. Generally, women are trustworthy. That presumption underlies any pro-choice position on reproductive rights.

But what happens when a woman (or a man!) is reckless? What happens if a mother (or father!) makes egregious choices? Are we obligated to suspend judgment?

The consensus at both Shakesville and Feministe is that you turn in your official Feminist card as soon as you question the wisdom of anyone’s parenting or reproductive choices, no matter how irresponsible they may be.

Really?

To take a more extreme case, do I have to agree that it’s hunky-dory for a woman addicted to heroin and meth to have one baby after another, only to have them taken by Child Protective Services? As a matter of fact, I think it’s a pretty terrible situation. What makes me pro-choice is that I don’t want that hypothetical – but all-too-real – woman to be thrown into jail (as South Carolina has done, repeatedly, with pregnant women of color who are addicts). I don’t want her to be forced or coerced into Depo-Provera shots or Norplant. I do want the people who provide her prenatal and birth care (assuming she gets any) to compassionately counsel her about treatment programs. I want drug treatment programs to be abundant and free, so that no barriers prevent pregnant women from using them – unlike the many programs that have historically refused to admit expectant mothers! I want her caregivers to kindly and non-coercively explain her birth control options, including the potential benefits of long-term contraceptive methods (both the IUD and hormonal methods). I want her to have free access to birth control. If her children must be placed for adoption, open adoption should be the default unless there are very compelling grounds to separate the children from their birth mother.

That is a pro-choice position. I do see a need to exercise judgment. I do assert that childbearing while in the grips of an addition is a Bad Idea. Abandoning judgment, in such cases, would be abandoning responsibility. What makes this position pro-choice isn’t a refusal to judge; it’s rejecting punitive and coercive measures.

Now, Sarah Palin obviously is not comparable to a poor drug addict (unless you want to call power an addiction). Palin lives in a realm of privilege that insulates her kids, to some degree. CPS is not about to seize them even if she and Todd serve them Lucky Charms with crystal meth sprinkles for breakfast.

But the basic question still stands: Must feminists withhold judgment when a woman – or man! – makes reproductive or parenting decisions that are grossly unwise? Does it make us anti-choice to say that even though a woman has the legal right to implant eight embryos into her womb, it’s nonetheless an über-crappy decision? Does it make us anti-choice to say that medical evidence unequivocally shows that smoking is worse than crack for a developing fetus, and so every effort must be made to help expectant parents (not just mothers!) stop smoking?

And is it really anti-choice to say that Palin’s decision to fly home after her water broke not only potentially endangered her and Trig, but also exposed the whole plane to the risks of an emergency landing? I’m not saying “There oughtta be a law,” just that it was a piss-poor decision.

Again, this is not policing Palin’s uterus. This is questioning what went on in her brain. And if she runs again for POTUS, her brain is the organ that ought to concern us.

The good mother/bad mother dichotomy is still used as a cudgel. It’s one that feminists should always regard with deep suspicion.

But sometimes, bad mothering – and importantly, bad parenting – is egregious. When it occurs in politicians who position themselves as paragons of family values, it’s reasonable to ask about their general judgment and scrutinize them for hypocrisy. So while I regard it as out-of-bounds to criticize Todd and Sarah Palin for the fact that Bristol became pregnant, I do think it’s fair to criticize how they handled it in the national spotlight. When the Palins announced Bristol’s pregnancy instead of debunking the Trig rumors head-on, both parents threw their eldest daughter under the bus. (It was Sarah and her political who made that decision, but the First Dude was part of that inner circle and I’ll bet he could have vetoed it.) Similarly, it’s understandable that Sarah Palin would have kept her pregnancy quiet until late in the game. Most women who work for pay realize that they may be seen as less competent and committed once their pregnancy becomes public, and that goes doubly for female politician. What’s not reasonable is boarding a plane without any idea how imminent labor might be after leaking amniotic fluid.

If wanting politicians to exhibit sound judgment not just in public life but as private individuals – and yes, as parents – makes me an anti-feminist, so be it. Just let me know where I should turn in my F-card.

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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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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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What Naked Body Scanners Cannot See

A couple of weeks ago, while trying to understand why body scanners are ineffectual, I found this great clip. Trouble is, it’s in German. Now, I could fix this, because I’ve done a fair amount of professional translating, German to English. But more trouble ahead: We were heading into final exams, and I know how much time it would take to insert the subtitles, having done it once before. I figured I might tackle it after I finished grading, even though the main expert’s Bavarian accent is atrocious.

Now that my grades are in, I found the same clip via Clarissa’s Blog – this time with English subtitles. They contain more infelicities than if a pro had done the job, but the translation is perfectly serviceable. (When they say “plaster,” they mean “band-aid,” in American English.) I’m pretty confident the translation isn’t Clarissa’s, but we owe a debt of thanks to this person (I suspect a native German speaker) who took the time to do a conscientious job.

In any event, you will understand more than enough to be alarmed.

This, folks, is why we could double our national debt investing in these scanners and not be appreciably safer.

(Go here if you cannot see the clip.)

If any of my chemist readers is itching to pen a guest post on thermite, I will gladly publish it. (I know there’s at least one of you out there!)

The scanners are, of course, only part of the problem. Another loophole could allow a bad guy to sneak through 24 ounces of Evildoer’s Goo (thermite specifically? I dunno).  Jeff Goldberg recounts this three-way rendezvous between himself, security über-guru Bruce Schneier, and a TSO in Minnepoo:

We took our shoes off and placed our laptops in bins. Schneier took from his bag a 12-ounce container labeled “saline solution.”

“It’s allowed,” he said. Medical supplies, such as saline solution for contact-lens cleaning, don’t fall under the TSA’s three-ounce rule.

“What’s allowed?” I asked. “Saline solution, or bottles labeled saline solution?”

“Bottles labeled saline solution. They won’t check what’s in it, trust me.”

They did not check. As we gathered our belongings, Schneier held up the bottle and said to the nearest security officer, “This is okay, right?” “Yep,” the officer said. “Just have to put it in the tray.”

“Maybe if you lit it on fire, he’d pay attention,” I said, risking arrest for making a joke at airport security. (Later, Schneier would carry two bottles labeled saline solution—24 ounces in total—through security. An officer asked him why he needed two bottles. “Two eyes,” he said. He was allowed to keep the bottles.)

(Read the rest here; it’s hysterical, precious, and horrifying, all at once.)

See? If it says saline, it must be saline! And not thermite!

Wherever the new scanners are coming online, they actually intensify an existing threat: that of a bomb aimed at passengers being shepherded toward the security checkpoint. Even if only 20% of flyers are directed to the scanners, without any opt-outs or false alarms – well, that’s enough to slow the lines noticeably. In busy airports, the waiting times will balloon, as will the crowds, once the new scanners become more routinely used. They’re simply slower than the old magnetometer.

Schneier makes this point in the Goldberg piece just cited: we’re creating sitting ducks. In the Thanksgiving edition of the New York Times, Roger Cohen channels Osama bin Laden in a busy U.S. airport and observes:

bin Laden might also wonder at just how stupid it is to assemble huge crowds at the Transportation Security Administration’s airport checkpoints, as if hundreds of people on planes were the only hundreds of people who make plausible targets for terrorists.

Feeling safer yet?

So far Germany, at least, isn’t squandering its money on naked body scanners. But then, its watchdog media (ZDF is a publicly supported TV network) are actually doing their job right.

And really … if the intent of the grope-down was to save us from the underpants bomber, why weren’t “enhanced patdowns” implemented way back in early January 2010, when our memory of him (and our gullibility) had just hit another local maximum? After all, that’s when Chertoff traversed the airwaves to sing the praises of Rapiscan technology. “Enhanced patdowns” are a better bet than the scanner for actually catching the next underpants bombers (though I’m positive there won’t be a clone; next up will be the booty-bomb.)

Of course, I’m not defending the grope-downs. Not at all! I’m just pointing out that the timing of their introduction had nothing to do with “homeland security,” as it has been sold to us. It had everything to do with the first major rollout of the naked body scanners, however. They were a punitive means of guaranteeing compliance and organizational efficiency from the flying herds of American sheeple. Otherwise, we would have gotten the grope back in January, for sure.

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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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Of Tofu, Pop-Tarts, and Boobs

Addressing a proposal in Australia to make baby formula a prescription-only product, Spilt Milk strikes the perfect balance between breastfeeding advocacy and respect for women’s individual situations, experiences, and autonomy.

As a lactivist I obviously have a problem with the marketing of infant formula and any implication that it is as good as, or better than, breast milk. But as a human being I also know that people are hurt, seriously hurt, when they feel judged and shamed and when they are exhaustedly holding a hungry, crying, baby at 2:30 am and it feels like no one can help them.

Removing systemic barriers to breastfeeding certainly may require improved measures to reduce the popularity of formula – popularity which can be attributed to decades of marketing not only to the public but to health professionals. A big part of that marketing is about convenience: huge displays in chemist shops and regular sales at the supermarket of products in familiar-looking tins add to the impression of ease of use and the normalisation of artificial feeding. But whether we like it or not, formula and its ready availability is important to many families. Removing that now feels like a stick where a carrot should be.

Give parents the tools to make sound decisions that benefit them and their babies. Give parents not only choices, but supported, realistic choices. Don’t tell a woman who has to go out of the home to work, or who has other children to look after and little support, that the choice to dedicate perhaps days to increasing her milk supply through frequent feeding and skin-skin contact to avoid supplementing with formula is an easy one: it clearly is not. Education and information are hugely important but they are only part of the picture when practical barriers still so often interfere with breastfeeding relationships.

Adding practical barriers to formula use, as I think this proposal would, isn’t a particularly kind way to help parents. Being caught between a rock and a hard place doesn’t make the rock seem any easier to budge: it just makes it hurt more to be stuck there.

(There’s lots more where this came from.)

I want to zero in on the problem of shaming. It’s illuminating to shift the focus away from infants and toward the choices that we adults make about our own bodies.

For instance: I had a super healthy dinner tonight: baked tofu, locally-grown Carola potatoes, locally-grown watermelon, and sliced golden tomatoes that I grew from seed. (I had been trying to grow these ‘maters, Aunt Gertie’s Gold, since I read rave reviews about them on Garden Web, but managed to kill them on the first attempt by mixing in too much organic fertilizer when I planted them out. Another year, they failed to germinate. This year – success!) I added a dab of butter to the potatoes and marinated the tofu in teriyaki sauce. I was in late-summer heaven.

But last night? Late after the kids were in bed? I ate a strawberry Pop-Tart. And damn, was that good too.

What if someone had decided to shame me about that Pop-Tart? Would that have caused me to ascertain that those potatoes were also organically grown, instead of just sustainably? Might I have foregone the butter? (Admittedly, if I’d been feeling well instead of ushering out a nasty GI infection, that pat of butter would have blossomed.)

Hell No!

I would have had a Pop-Tart for dessert.

Now, luckily people have not often shamed me for my Pop-Tart weakness. We don’t eat them regularly. My kids love them precisely because a Pop-Tart is a pink unicorn in their world, and a yummy one, at that. Most crucially, though: I am NOT FAT. And therefore I can only shamed along the “bad mommy” axis for keeping Pop-Tarts in stock; I’m pretty impervious to fat-shaming. (Fat-shaming would surely be worth a whole ‘nother post, and this post would be a whole lot different if not for my thin privilege.)

Of course, “bad mommy” shaming is the main tactic used against women who don’t conform to the loftiest ideals of breastfeeding practice. They’re told in no uncertain terms that their child’s survival depends on what they feed him or her. And they’d better feed mother’s milk, but then the true shaming begins. The new mother is eating all wrong! At least, this must be true, or the baby would settle better, sleep longer, give up his eight-hour crying jags. And so they’d better watch out for garlic! Peanuts! Soy! Cow’s milk! Eggs! That dejected bottle of prune juice, purchased solely in the hope of warding off postpartum constipation? Might as well dump it, dear; no one else in your family will go near it.

Through all this, the mother is trying to suss out her child’s new and changing needs. If she’s poor and/or not white, the “well-meant” advice may well come wrapped in a thick wrapping of paternalism. How’s she supposed to develop her sense of mastery and competency in this hullaboo of “Yer doin’ it rong!”

Really, what new mothers need is respect for the fact that they still are humans, and that their body remains their own. The baby has a moral claim on breastmilk, sure; the mother has a moral claim on being an autonomous person. In most cases, she also is willing to make very significant sacrifices for her baby – her sleep, bodily fluids, her illusion of invulnerability,  the very minerals from her bones. Shame her, though, and you’ve shortcircuited her chance to figure out what combination of sacrifices (because there will be sacrifices) could help her child thrive without eviscerating her as a woman – as a person.

And darn it – sometimes every mother needs a Pop-Tart. Mine was strawberry. Toasted. And I haven’t breastfed since spring 2003, so how much more do new mothers need a Tart? I don’t believe food should have to be earned through moral machinations, but I do tend to think that I’ve got a lifetime entitlement to Pop-Tarts. I’m certain that there’s still one box of brown sugar/cinnamon in the basement. I will eat it with utter lack of shame. Next morning, with nothing but a Tart headache, I will help my kids get their reasonably healthy breakfasts and lunches. They are growing. I’m pretty sure we’re doing something right. Quite possibly something that deserves a Pop-Tart and champagne celebration.

I’d be interested in your metaphorical Pop-Tarts – and that goes for non-parents, too. What small self-indulgences keep you afloat? How do you gird yourself against scolds?

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On “Birth Rape”

(TMI alert, especially for the medically squeamish, and trigger alert for medical violence.)

The story of how I birthed my first child is a far cry from the dimly-lit, romantic scenarios pictured in hospital brochures and natural birth guides alike.

The Bear got stuck before his head was even properly engaged. I was in Germany, so you can’t blame what happened next on medicalized childbirth, American-style. I did have an epidural (at my own request, nay, demand!) and enough Pitocin to deliver a small elephant. My midwife tried acupuncture. We tried every possible position: all fours, squatting, draped over an elevated bed with my head hanging down. I even swallowed some homeopathic remedy. This was Germany, after all.

Still, he was stuck. After seven hours (!) of being fully dilated – which is four or five hours longer than a U.S. ob/gyn would tolerate without a c-section – my midwife had to turn me over to a doctor. Even then, he didn’t go straight for the knife. He proposed trying vacuum extraction, with a c-section as backup. Three tugs, three giant pushes, and three mighty shoves on the top of my uterus – out came the Bear.

I was grateful my son was healthy, and glad I’d avoided a cesarean. I thought I’d gotten off easy. The recovery proved me wrong. I’d lost a lot of blood and my healing was difficult and incomplete. In the long run, I probably would have been far better off with a c-section. The pushing on my uterus (“fundal pressure”) did a lot of damage to my pelvic floor, which persists a decade later. I was given a lengthy consent form that explained the risks of a potential c-section, but it said nothing about the risks of fundal pressure and vacuum extraction, particularly an extraction from so high in the pelvis.

In other words, I had no crack at informed consent for what was actually done to me. And I don’t want to hear that none of it matters since my baby was healthy. The violence of my delivery severely affected my ability to be an effective mother. Try hauling around a 13-pound infant six weeks postpartum, feeling as though your viscera are about to fall out. Then try it again with a 19-pounder at four months. The Bear was not a sleepy, contented baby. He was irked at the world. He needed to be walked around. I couldn’t do it. Not on the scale he demanded. For optimal healing, I shouldn’t have been lifting anything heavier than ten pounds. I felt utterly trapped.

Many women have traumatic childbirth stories. Many are uglier than mine and revolve around disrespect by medical personnel, which sometimes edges into outright violation. Over the past few years, some birth activists and feminists have started to label such stories “birth rape.” The term struck me as wrong when I first saw it (which I’m pretty sure was this post at the F Word). So I was glad to see a flurry of criticism ripple through the feminist blogosphere over the past few days, starting with Irin Carmon at Jezebel and then spreading to Amanda Marcotte at XX, Tracy Clark-Flory at Broadsheet, and Lindsay Beyerstein at Big Think. Even my friend figleaf has weighed in against using “rape” to characterize traumatic birth experiences.

In discussions of sexual violence, it’s not unusual for women who’ve actually experienced the trauma in question to use their experience as a trump card against anyone who disagrees with them. Ditto for childbirth experiences. In actuality, experiences vary, as do our interpretations of them. One woman may feel violated by a c-section, while another might feel relief.

So far, none of the feminist bloggers who’ve criticized “birth rape” have actually experienced childbirth in their own flesh. Their opponents may well say that this disqualifies them. I’m weighing in to support them, partly as a mother (and partly as a professional historian of childbirth and critic of medicalizaiton) who has in fact experienced a failure of informed consent and a traumatic birth (and who has studied some truly egregious instances of it in the past). Of course, my labor experiences don’t give me the right to trivialize other women’s feelings of violations, and I would never want to do that. At the same time, the trauma women experience doesn’t justify the inflationary and misleading use of “rape” to describe violations of medical consent.

It’s important that we can talk about birth trauma. We need a language of childbirth that will help us protect women’s autonomy. But it’s hyperbolic to call incidents of unwanted vaginal exams or artificial rupture of the membranes “rape.” It does an injustice to victims of actual rape by conflating two different phenomena, thus watering down the meaning of “rape.” It’s not as bad as the trivialization that goes along with saying, “Man, that test really raped me,” but both uses are on a continuum, because they’re both metaphorical, not literal.

I realize that proponents of the term say that a speculum is no different than a penis. Here’s how Amity Reed expressed it at the F Word:

A woman who is raped while giving birth does not experience the assault in a way that fits neatly within the typical definitions we hold true in civilised society. A penis is usually nowhere to be found in the story and the perpetrator may not even possess one. But fingers, hands, suction cups, forceps, needles and scissors… these are the tools of birth rape and they are wielded with as much force and as little consent as if a stranger grabbed a passer-by off the street and tied her up before having his way with her. Women are slapped, told to shut up, stop making noise and a nuisance of themselves, that they deserve this, that they shouldn’t have opened their legs nine months ago if they didn’t want to open them now. They are threatened, intimidated and bullied into submitting to procedures they do not need and interventions they do not want. Some are physically restrained from moving, their legs held open or their stomachs pushed on.

These things happened commonly in the past, and they still occur today. A commenter at Salon wrote:

Once, while still a nursing student, I heard a nursing supervisor inform a screaming patient in labor – “maybe you should have yelled like that 9 months ago and you wouldnt be here”. Later, during my own labors, I remembered her remark and it made me smile.

She smiled? Boy, I’m glad she didn’t attend one of my births. And it gets worse. A self-identified midwife commented at Salon:

The quickest example I can come up with is the time a doula friend of mine heard the OB say while a VBAC mom was pushing (pretty much under his breath, I don’t even think the mom heard this): “It’s the LEAST you can do for your VBAC” and he put one end of the scissors in her vagina and one in her anus and cut her a 4th degree episiotomy. No fetal distress, no reason beyond what I guess was his irritation at not just doing a repeat cesarean?

(Her whole comment was terrific, if you can stand to wade through the morass of misogyny that is Salon’s comment section.)

Stories like these are appalling. I feel sick and angry when I read them.

And yet, this is not rape. There’s nothing sexual about it, even though the assault is perpetrated on a woman’s genitals.

Let’s take a look at the legal definition of “rape.” It requires, as Amanda Marcotte points out, intent to violate someone sexually against her will. This is what the law calls “mens rea,” or awareness that one is committing a crime. If a prosecutor fails to demonstrate mens rea in a rape case, it’s still possible to convict on a lesser count of sexual assault (e.g., gross sexual imposition). “Rape,” however, is off the table.

The intent of this OB was to hurry the birth along. I don’t think it’s a stretch to say that he was also high on his own power, getting off on his dominance. But he wasn’t getting off sexually. Nor was he intending to commit a sexual act. What he perpetrated was neither rape nor a lesser form of sexual assault.

“Birth rape” is not just an exaggeration, though. It also does not say enough. It fails to specify what makes such violations of autonomy in labor reprehensible in their own awful way. First, doctors and nurses enjoy a high degree of trust. The minority of them who break our trust deserve contempt. Similarly, the discourse on medical ethics has been hammering on the importance of informed consent for the past few decades. We rightly expect medical professionals to have internalized this. Most of all, a woman in labor is extremely vulnerable. I don’t know of any situation where I’ve felt comparably exposed, defenseless, and liminal. To receive abuse from the very person charged with expecting you and your child has got to leave emotional scars.

What should we call these violations, then, if not “rape”? Well, “medical battery” works for me. (“Medical assault” would be more satisfying because of the parallel to “sexual assault,” but legally the correct category, as far as I understand, is battery, not assault.) I would also distinguish between situations where real bodily harm is perpetrated, as opposed to assholish behavior such as slut-shaming women in labor, and also as opposed to neglect of informed consent, such as I experienced. (I’m not speaking here of outright malpractice, though some cases of abuse may also constitute malpractice too.)

Medical battery in childbirth ought to be treated as a criminal offense. That’s not a stretch, legally. For instance, except in an emergency, a physician who performs surgery against the patient’s will is guilty of battery, and is subject to both criminal and civil law. Even failure to obtain informed consent is already subject to criminal penalties. In cases of assholish behavior or flawed consent (as in my own experience), medical professionals should be sanctioned by their peers. In those cases where professionals protect their own and refuse to discipline offenders, patients should go public with their stories.

The law already supports a woman’s right to autonomy in labor, just like it does for any other patient. Actually enforcing that right in court is tricky. Doctors may argue that they were forced to act due to an emergency. Proving otherwise may be difficult. But just the awareness that medical battery carries penalties could work as a deterrent to battery and lesser forms of abuse. In addition, it might serve as a counterweight to the pressure OBs often feel to take action – any action, even if it’s not supported by evidence – to avoid a later malpractice suit.

To avoid failures of informed consent, obstetrical doctors and nurses could do much more to enlighten expectant mothers on possible interventions, their justifications, and their risks. I would have been better off if I’d been provided any information on the risks of vacuum extraction. I knew a lot about forceps because they were used in the period of history I study. Vacuum extractors are newer, and so I was flying blind, even though I was an exceptionally well-educated parturient. I didn’t even know that vacuum extraction carries a significant risk of damage to the baby’s brachial nerves. Most women would’ve known less. This is just not necessary in childbirth, where there’s usually nine months to prepare and become truly informed. And yet, neither doctors nor nurses nor midwives nor childbirth educators are really preparing the women whose bodies and children are at stake.

I don’t imagine that these potential solutions would be a panacea. I do think, though, that they’re closer to the mark than the tactics that a notion of “birth rape” would suggest.

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The Contagion of Poverty (or, Why Wine Is Safer than Water Tonight)

Americans who oppose “big government” usually oppose “handouts” to the poor. But here’s the thing: You may be comfortable. You may think you have all you need. And yet, if there’s poverty anywhere in your vicinity, you will not be immune to its pernicious effects.

This came home to me again – twice -  in the past week. My adopted hometown, Athens, Ohio, is a lovely, liberal little college town tucked into the Appalachian foothills. The town itself looks reasonably prosperous, but it’s encircled the remains of a region that mined its coal and then hit an economic dead end. Some of the folks with no money and no future live right outside the edge of town in abject poverty, as I saw while canvassing for Obama in 2008. Within the city limits, the tax base isn’t so flush, either, since the 20,000 students and the university are essentially parasites on the permanent residents (whom they vastly outnumber). Just over half of Athens residents live below the poverty line, and not all of them are students.

Today’s instance of poverty splash-over: BOIL ORDER! Thanks to our weak tax base, the town’s infrastructure is crumbling. The water system is decrepit. Boil orders are issued as routinely as parking tickets. If you Google “boil order,” your second hit will be “City of Athens Boil Order Instructions.” Only the University of Missouri Extension Service outranks us. Sure, Boston had a boil order affecting 2 million people this spring, but Athens beats Boston on the Google! Boston! And its two million (2,000,000!!!!) water customers! If Boston can’t touch us, our title as the reigning champions of boil orders is virtually untouchable. (Yes, I realize most of the world should be under a boil order. Only my First-World privilege leads me to believe my family and I have a right to safe water from the tap. I’m not quite sure that Athens is located entirely in the First World.)

Today’s boil order alert went out via email at 3:30. (Email notification is still a novel service, implemented by our new-ish progressive city leadership.) I last checked my email at 3:25 before I picked up the kids. So I didn’t see it until 8:30, by which time we’d all swilled a glass or two of water and I’d washed our dinner veggies in it. Usually, boil orders affects other neighborhoods. Today, of all days, it hit my own.

So far no one is ill, and I think we’ll probably be fine. I suspect that the boil order is due to a hydrant that I saw spewing water this noon. (Hence the “splash-over” metaphor.) The likelihood of serious contamination is low. Still, I’m irked that we have to deal with the hassle until tomorrow evening. I’m uneasy as we wait and wonder if we’ll all come down with Athensitis indigestion.

Second case in point: the impact of poverty on local schools. I’ve written repeatedly about how often our kids miss school because there’s no money to clear the hilly county roads. (The city is rich in comparison to the county.) Now we’re seeing a decline in the elementary schools, which is having a ripple effect throughout the district.

At our back-to-school potluck, I learned that our little neighborhood school (let’s call it “International Elementary”) has 50% more kindergartners than in the past few years. At the last minute, they had to hire another teacher and carve out another classroom (which involved displacing disabled services to the poorest of our district’s five elementaries). There simply weren’t any open classrooms. Baby boom, you say? Unh-uh. They were all intradistrict transfers, most of them fleeing the second poorest elementary, whose test scores recently tanked. (You can see the data yourself at Greatschools.org under the listings for the “Athens, OH” district – and you can check out your own area schools as well.) I don’t know why their scores tumbled, though I’m loathe to blame the teachers. Much more likely, poor kids are suffering from hunger, which is rampant in our region, and can’t learn. Or their families are unable to be supportive because they received a crappy education, themselves. I’m guessing it’s the more affluent parents who are moving their kids, while the poorest children are staying put.

So the poverty in the county isn’t just hurting the two most vulnerable schools. It’s now spilling over into our excellent little school. I completely sympathize with the parents who are moving their sprouts; even it I didn’t, NCLB apparently gives them the legal right to switch out of a faltering school. In their place, I’d be attracted by International’s strong test scores and relatively diverse student body – which drew us to this neighborhood.

International Elementary will be fine for this year. But what about next year, when we’ll presumably need another first-grade room, too, and the years thereafter? What if we’ll permanently have three classrooms per grade instead of just two? The school is already in cramped quarters. The counselor and psychologist (who rotate through the district) share space with a skeleton in a closet. (Literally.) And you can’t extend the existing building. There’s just no space. I suppose you could just get rid of the playground … but even then, who’s going to fund the construction? The alternative – classes of 30 or more children – would just gut International’s strength, small classes with great teachers.

My point here isn’t just about “me me me,” though it sure feels good to vent. The larger point is that poverty can’t be contained. It spreads like a contagion – like a “miasma,” as nineteenth-century doctors would have said – and it ultimately affects us all.

So never mind altruism. It’s in everyone’s self-interest to ensure that the most vulnerable members of society have enough.

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Salmonella Culprit DeCoster: His Morality Is a Big Goose Egg

By now, you may have heard that the source of the recent salmonella outbreak is a single egg baron in Iowa, Austin “Jack” DeCoster. What you might not have heard: He’s just as reckless with his human employees as with his hens.

At Grist, Tom Philpott reports that in 2002, five undocumented female migrant workers brought criminal charges alleging that they had been raped by supervisors while at work. In a subsequent EEOC lawsuit, DeCoster settled for $1.5 million dollars. He has also been fined for housing immigrant workers in deplorable rat-infested conditions , for having employees handle dead animals and manure with their bare hands, and for repeated water-safety violations (some stemming from his hog farms). Philpott concludes:

The outrage here is not that Wright County Eggs has released nearly half a billion tainted eggs into the market, exposing untold numbers of people to sickness. DeCoster’s record of abuse — of people and the environment — has taught anyone who’s paying attention to expect such things from his operations.

The outrage is that regulatory authorities at both the state and national levels have allowed him to continue hiring workers and producing food as violations piled up.

(Read the rest here.)

Yes. But the problem isn’t just Jack DeCoster, even if the current outbreak is traceable entirely to his operations. It also goes beyond our lax regulations and their even laxer enforcement. The issue goes to the core of how we eat: our dependence on large-scale farming.

As I noted when swine flu first emerged, factory farming is a public health threat on a number of levels, including the breeding of novel viruses and bacteria. In addition, such farms routinely use antibiotics to control the diseases that inevitably erupt when you concentrate thousands or hundreds of thousands (!!) of animals. This is creating a perfect chance for bacteria to mutate into drug-resistant forms. It’s undermining our ability to effectively treat human diseases. And while some industrial farming operations may treat their workers well, DeCoster is not alone in exploiting them.

The overall problem is that industrial agriculture is geared to making profits, first and foremost – and the quest for profit-maximization has eclipsed human values. This has happened in many industries, of course, but it can be deadly in agriculture because of its direct impact on our food supply and public health.

DeCoster exemplifies sheer callousness to the human and animal wreckage he and his ilk have fostered.

• The hens crowded together, suffering from mutual aggression and sitting in their own feces.
• Their chicks, sickened with salmonella, who brought the infection to another industrial egg operation.
• The undocumented women whose bodily integrity was violated by supervisors who exploited a lawless atmosphere.
• All the other workers living and working in filth.
• And now the rest of us, who could be infected by a simple sunny-side up egg.

Thorough cooking kills salmonella, as Salon’s Francis Lam reminds us. From my own experience, I know that’s not quite enough. The cook who handled the raw eggs needs to wash her or his hands very thoroughly. The worst “tummy flu” I’ve had hit me after I’d boiled a bunch of eggs for dyeing at Easter and, distracted by a house full of company, hadn’t paid much heed to hand-washing. I was the only person who got sick, but I was down for a week, so immobilized that a girlfriend had to drop by to check on me and deliver ginger ale. I’m sure it was salmonella, caught from the shells. I can be glad I was young and healthy when it hit. And yes, those eggs came from factory farms (albeit in Germany, so they were subject to some regulation).

These days, I buy Kroger’s organic free-range eggs when I don’t have a local source. When my friends’ chickens are laying, I don’t have to buy eggs at all (and they just gave me three this evening – yippee!). There’s never a perfect guarantee of safe food, but our odds improve dramatically when we don’t rely on industrial mass production. And when we eat an egg from happy hens, we can be pretty confident that no humans have been treated cruelly, either.

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Catbloggers Caution against Catscans

Sooner or later, most parents end up in the ER with their offspring. And if you’re a frequent customer, chances are pretty good you’ve bumped up against the increasingly ubiquitous CT scan (aka “catscan”).

Our Tiger has racked up more than his share of visits, including one when he was three when he ran a fever over 104 F and complained of a terrible tummy ache. At our local hospital, the doctors ordered an abdominal x-ray, which indicated a dramatic case of … constipation. But since his fever was high and appendicitis couldn’t be ruled out, we were sent up to Children’s Hospital in Columbus. There, the resident on duty wanted to do a CT scan as soon as possible.

“Can you really diagnose appendicitis with a catscan?” my husband asked.

“Well, no.”

“Could we talk to your attending about this?”

The resident’s boss agreed that there wouldn’t be much point to a CT scan. They didn’t want to release us, though, because if we went home we’d be an hour and a half away. And so the attending took a truly radical step: she admitted us. We spent a short and restless night with the Tiger, his dad sharing the bed with him, me scrunched into a recliner. (The Bear stayed with friends who generously took him in at short notice.)

In the morning, the Tiger pooped. He felt better. His fever was dropping. We were sent home that afternoon. A few days later, bloodwork came back with signs of a bacterial infection in his blood (a strain of pneumococcus not covered by the vaccine). He got antibiotics and never had another unexplained high fever again. To this day, his appendix is just fine.

Most parents probably wouldn’t have resisted the resident’s suggestion. Heck, if I’d been alone, I wouldn’t have questioned it, even though I’m usually quick to ask. When you’re scared and alone with a sick child in the middle of the night, it’s hard to challenge authority. It was only my husband who had enough presence of mind to weigh the long-term danger of radiation. The resident’s only concern was not to miss something – anything – that modern medicine might ascertain. Long before young doctors learn all they need to be expert diagnosticians, they learn not to discharge a patient until everything possible has been done, no matter how pointless, expensive, and possibly hazardous. This is classic defensive medicine, driven more by fear of lawsuits than by the patient’s optimal treatment.

Don’t get me wrong. CTs are a great tool. They are just overused, whether out of technophilia or fear or liability, or both. And the New England Journal of Medicine notes in its July 1, 2010 edition that the use of CTs is underregulated. Rebecca Smith-Bindman’s article, “Is Computed Tomography Safe,” was initially available as a free full text, but it has disappeared (here’s a .pdf of the onscreen free version that I’m using as reference). Essentially, Smith-Bindman argues: 1) Hospitals somewhat rarely but regularly make devastating errors when CT equipment is improperly monitored, which sometimes results in severe accidents. 2) There are no clear guidelines stating when a conventional CT versus a more precise CT (with greater radiation exposure) would be appropriate. 3) There are no guidelines in place for minimizing radiation exposure, period. 4) The FDA approves technology and devices but it doesn’t oversee the actual usage of equipment. 5) Unnecessary radiation from the ostensibly “safe” CT can kill:

We [Smith-Bindman and colleagues] found that the risk of cancer from a single CT scan could be as high as 1 in 80 — unacceptably high, given the capacity to reduce these doses.

The NEJM article neglects any discussion of children, but the literature to date has raised even bigger red flags about pediatric uses of the CT scan. This is only logical. Kids’ bodies are smaller. They are still growing, so damaged DNA will have many more opportunities to go rogue. They have many years ahead of them – or so we hope – such that rogue cells have many decades to exact their revenge. A 2008 article in Time magazine puts the risk of a fatal cancer from a single pediatric CT scan at 1 in 500, and vividly illustrates why parents should be skeptical:

When doctors first ordered a CT scan for Jen Houck’s six-month-old daughter in 2003, the new mom was more worried about the risks of anesthesia (used to keep children from squirming in the machine) than of radiation exposure. In 2006 and 2007, her daughter, now 5, had two additional CT scans, 6 months apart, for what doctors initially thought was a growth abnormality. They’ve since determined the child was perfectly healthy. “All that, just to find out her head is bigger than normal,” says the 27-year-old mother of two in Boone, North Carolina. In hindsight, Houck wishes she had done things a bit differently. “I would have asked more questions about the necessity for a third scan so soon after the second.” She also says no one mentioned the option of a low-dose scan, and she has no idea how much radiation her daughter received. “I wish I’d known to ask the question.”

(It’s a good article – read the rest here.)

So today’s Caturday post is a bit of a PSA, or at least a cautionary tale (tail?): Don’t be afraid to question the risks versus benefits of a proposed CT scan. Even if it’s your kid’s health at stake. Especially if it’s your kid’s health.

(from ICHC?)

Editorial note from the patron cat of Kittywampus: Grey Kitty would have approved of the simpler, lower-energy greyscale catscan. Nice tail, too – very similar to GK’s own.

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Radical Compassion and the HCR Victory

I’m sitting in front of my TV, like so many of you, watching the post-HCR vote speechifying. I’m grinning like a fool, tearfully.

James Clyburn just said that Nancy Pelosi got it done through tenacity and compassion. I’ll have more to say about this later, but I think that this combination – which I’ll call radical compassion – is precisely what we need to move forward, and not just in the healthcare arena.

(And speaking of hope: My miniature iris is up, too.)

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A “Pro-Life” Rejoinder to Stupak’s Stupidity

As more wobbly Dem congresscritters commit to supporting the health care package, I’m guardedly hopeful that Bart Stupak is about to consign himself to the dustbin of history.

Nonetheless.

I’ve got two “pro-life” reasons why wafflers like my own congresscritter, Charlie Wilson, need to vote yes and put themselves on the right side of history.

First, a study came out this week in the New England Journal of Medicine that demolished fears that universal coverage – even if paired with liberal access to abortion through insurance – will drive up the abortion rate. Dr. Patrick Whelan found that in Massachusetts, abortion actually declined after coverage was expanded to virtually all residents:

The national health care reform legislation that was recently passed by the Senate has been modeled, in many respects, on the Massachusetts reform law; both lack the “public option” that was included in the House bill, which was the focus of the Stupak–Pitts Amendment prohibiting federal subsidies for health plans that would pay for abortion. Therefore, I hypothesized that the early experience in Massachusetts might serve as a good model in which to examine whether a substantial expansion in health care coverage might result in an increased number of abortions.

The relevant part of the Massachusetts program is Commonwealth Care, which provides subsidized insurance to the self-employed, small businesses, and unemployed individuals with incomes below 300% of the federal poverty level. This quasi-public agency began coordinating care through five private participating health plans effective January 1, 2007. I sought to determine whether this increased availability of care has led to an increase in the number of abortions performed in Massachusetts.

The number of abortions in Massachusetts in 2006, the year before the new law was implemented, was 24,245, including 4024 among teenagers. I obtained data from the Massachusetts Department of Public Health for each of the two subsequent years. Some 158,000 people were enrolled in Commonwealth Care plans during the first year. The Urban Institute estimated that between the fall of 2006 and the fall of 2008, the proportion of adults with incomes below 300% of the poverty line who were uninsured fell from 24% to 8%; 63% of all newly insured adults were in either Commonwealth Care or the state Medicaid program.

In 2007, the first year of Commonwealth Care, the number of abortions fell to 24,128, and in 2008, it fell to 23,883 — a decline of 1.5% from the 2006 level (see graph). The number of abortions among teenagers in 2008 fell to 3726, a 7.4% decline from 2006. These decreases occurred during a period of rising birth rates, from 55.6 per 1000 women 15 to 44 years of age to 56.9 per 1000 in 2006 and 57.2 per 1000 in 2007 (the latest year for which data are available from the Massachusetts Department of Public Health), and an increase in overall population (in 2008, the Massachusetts population surpassed 6.5 million for the first time, and it was nearly 6.6 million in 2009, according to the Census Bureau). The abortion rate thus declined from 3.8 per 1000 population in 2006 to 3.6 per 1000 in 2008. Overall, since 2000, the number of abortions in Massachusetts has dropped by 12% (from 27,180 to 23,883) and by nearly 36% since 1991.² The Massachusetts abortion rate has similarly dropped by a third, from 30 per 1000 women 15 to 44 years of age in 1991 to about 20 per 1000 in 2005, with most of the decrease occurring during the late 1990s.³

(I excerpted the main findings, but the whole article, including its graphics, is free and easily comprehensible to non-specialist readers.)

Or, to put it briefly, abortions declined both in absolute numbers and on a per-capita basis. The drop was steeper for teenagers.

Now, it’s possible that Massachusetts is simply mirroring national trends, where abortions have slowly declined in reason years (with, however, an upward blip nationally in 2006). But at the very least, it seems reasonable to conclude that in the biggest, best real-life laboratory we’ve got, access to abortion – which was a covered service for Medicaid recipients and the next-lowest income tier covered by Commonwealth care – did nothing to increase the number of abortions performed.

Whelan doesn’t speculate what other factors might be depressing the abortion rate, but I can think of two. First, there may be fewer unplanned pregnancies if Commonwealth Care is delivering family planning services and contraception to the neediest residents. Second, a woman confronting an unplanned pregnancy may be more likely to keep it if she knows she can count on good medical care for her child and herself. I don’t know enough about the details of the Massachusetts system to know if it really does provide decent reproductive health care, but this seems like a reasonable conjecture.

What would happen if we expanded the Massachusetts experiment nationwide? Well, the likelihood of an upward trend in abortions might be even slighter in more conservative states, where cultural attitudes discourage abortion. Those women might also be less likely to avail themselves of contraceptive services, so they’d benefit less from access to it. On balance, my gut feeling is that red states would continue to have more unplanned babies and shotgun weddings than blue states like Massachusetts, but their abortion rates will remain about the same. That’s just my instinct, and I could be wrong, but if Massachusetts women didn’t start aborting by the millions, do we seriously think the gals in Utah will?

The second “pro-life” argument I’d like our congresscritters to hear relates to our shameful maternal and infant mortality rates. Our ostensibly pro-life politicians are utterly silent on those two interlinked scandals. They shouldn’t be.

This week, Amnesty International released a lengthy, serious, well-documented study on maternal health in the U.S. (Go here for the link to the full, free report in pdf format.) At Mom’s Tinfoil Hat, Hilary writes:

It’s often asserted, including in this report, that infant and maternity mortality are key indicators in the health and social justice of a country.

I’d add that they ought to be key indicators for the seriousness of grandstanding “pro-life” politicians.

Take, for instance, the ranking of states according to maternal deaths. Maine comes out on top, with just 1.2 mothers dying per 100,000 live births. Vermont is second, at 2.6. You might object that these are small states with small populations, and that the number of women dying there is so small that figures may be deceptive. Could be. But then check out Massachusetts in third place with 2.7. Hmm, we’re starting to see a regional trend.

The District of Columbia rules the hall of shame with 34.9 maternal deaths per 100,000 live births, worse than Costa Rica. Georgia is second-worst with 20.5. (Figures are from pp. 104-5 of Amnesty’s report, Deadly Delivery: The Maternal Health Care Crisis in the USA.)

As Amnesty notes on its webpage:

During 2004 and 2005, more than 68,000 women nearly died in childbirth in the USA. Each year, 1.7 million women suffer a complication that has an adverse effect on their health.

This is not just a public health emergency – it is a human rights crisis. Women in the USA face a range of obstacles in obtaining the services they need. The health care system suffers from multiple failures: discrimination; financial, bureaucratic and language barriers to care; lack of information about maternal care and family planning options; lack of active participation in care decisions; inadequate staffing and quality protocols; and a lack of accountability and oversight.

So why should Stupak care? After all, these are just a bunch of women – disproportionately poor women of color – who should’ve kept their legs shut, right, according to Stupakian logic? In his view, aren’t these just throw-away mothers?

Well, when mothers die, babies sometimes die with them. Hemorrhage, eclampsia, embolism – all can endanger the infant as well as the mother.

While babies can’t yet talk, I don’t think it’s a big leap to say that most prefer not to be half-orphaned at birth.

Most significantly for Stupak and his allies, however, is that obstetric care benefits babies and mothers alike. Where mothers survive, infants are more likely to survive and thrive. That’s true here in the U.S. as well as globally. We do worse than Cuba when it comes to keeping newborns alive.

And guess what? Health care reform has the potential for helping mothers and (potential) babies get the care they need.

So I’ll be waiting to hear from Stupak and the bishops on how, exactly, killing health care reform will help preserve mothers and babies – and how, precisely, they can call the resulting deaths and complications “pro-life.”

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Medicare for All – Part III of an Infinite Series

Or maybe, just maybe, the idea will catch fire this time, bringing the series to a merciful end? (Oh-oh … gotta watch my death panel rhetoric!)

Amid all the hullabaloo over Dennis Kucinich pledging to vote “yes” on the health care bill, which blanketed NPR for the three hours I was on the road today, I didn’t hear a peep about a simple little bill that Alan Grayson is sponsoring. Nor had I heard about it in the full week that’s passed since he introduced it. And why should the media bother with this trifling little bill? Grayson’s H.R. 4789 is only four pages long. It’s probably a long shot.

But dang, what’s not to love about the “Medicare You Can Buy Into Act”?

Grayson isn’t grandstanding with the Senate health care bill now in front of the House, nor is he undermining its chance of passage. He’s just putting forward a public option as a stand-alone resolution in addition to the mondo bill, and he’s framing it in a way makes it hard to shoot down. Here’s what he said (via John Nichols at The Nation, who rocks for being on this):

Health care reform — here’s where we are. The House of Representatives is about to vote on a Senate bill without a public option. It looks like the reconciliation amendment will not have a public option. The House bill had a public option, but once the House passes the Senate bill, that’s history.

Which is why I introduced H.R. 4789, the Public Option Act. This simple four-page bill lets any American buy into Medicare at cost. You want it, you pay for it, you’re in. It adds nothing to the deficit; you pay what it costs.

Let’s face it. Health insurance companies charge as much money as possible, and they provide as little care as possible. The difference is called profit. You can’t blame them for it; that’s what a corporation does. Birds got to fly, fish got to swim, health insurers got to rip you off. And if you get really expensive, they’ve got to pull the plug on you. So for those of us who would like to stay alive, we need a public option.

In many areas of the country, one or two insurers have over 80% of the market. They can charge anything they want. And when you get sick, they can flip the bird at you. So we need a public option.

And they face no real competition because it costs billions of dollars just to set up a national health care network. In fact, the only one that’s nationwide is . . . Medicare. And we limit that to one-eight of the population. It’s like saying that only seniors can drive on federal highways. We really need a public option.

And to the right-wing loons who call it socialism, we say, “if you want to be a slave to the insurance companies, that’s fine. If you want 30% of your premiums to go to ‘administrative costs’ and billion-dollar bonuses for insurance CEOs who figure out new and creative ways to deny you the care you need to stay healthy and alive, that’s fine. But don’t you try to dictate to me that I can’t have a public option!”

And there is a way left to get it. By insisting on a vote on H.R. 4789. Three votes on health care, not two. The Senate bill, the reconciliation amendments, and the Public Option Act.

We got 50 co-sponsors for this bill in two days. Including five powerful committee chairman. But we need more.

Sign our Petition at WeWantMedicare.com.

Call. Write. Visit. Do whatever you can do to get you Congressman to co-sponsor this bill, and push it to a vote. Right now, before it’s too late.

I just adore the line about only letting seniors drive on federal highways. Because that, in fact, is exactly what we’re doing with the public option that exists right now, right here, in the United States.

If you’re a Grayson junkie and want to hear him personally digress on the federal highways and his $10,000 baby, here y’go:

As of today the bill has 74 co-sponsors. Unfortunately my congresscritter, Charlie Wilson, is not among them. He’s still too busy flirting with his fellow Blue Dogs, I’m afraid. Wilson is proudly pro-life, and scared as a little mouse that he might not be reelected if he votes yes on the big bill. After all, Wilson already voted for the Stupid Stupak amendment last fall.

I wouldn’t be too heartbroken if Rep. Wilson goes down in the next election. And if he does, then I’d like to invite Rep. Grayson to consider relocating to Ohio. I know, I know – he’s brash. He says things that offend. But that’s what can happen when you try to speak truths, not platitudes. Right now, his blunt, sensible words could save thousands of lives. We’ll see if they can be heard over the shouts of teabaggers and the grunts of obstructionist Republican congresscritters.

Oh, and Dennis Kucinich is on board with Grayson as a co-sponsor, too. Just goes to show that if you resemble a leprechaun, you’re bound to make the news on St. Patty’s Day.

[My earlier Medicare for all posts are here and here.]

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Downers from Big Pharma

What if the Senate Finance Committee – Max Baucus’ baby – weren’t obstructing “Obamacare”?

What if Obama had instead designated Baucus’ committee as ground zero for crafting the deal – the incubator for the winning legislation?

What if Obama’s campaign promise to reform health care was just a prelude to cozy deals with the pharmaceutical industry?

Cenk Uygur has the whole story, and it’s depressing as all hell. I’m betting there’s a drug to make us feel better. Too bad lots of recent studies have found anti-depressants to be no better than placebo.

(Via the wonderful Holly of Self-Portrait As.)

This is a much longer video than I’d normally post. It’s wonkish, ranty, and somewhat rambling. It also feels excruciating truthful. If you don’t need blood pressure meds by the end of it, you probably have undergone a conscience-ectomy.

Aargh.  I feel a Rahm Emanuel rant coming on. Time for my meds!

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Guest Post: Attack of the Snow Flu!

This comes from a local friend, with permission to print it – on the condition that I not refer to the superintendant as her boyfriend, too.

What is the most important part of a child’s education?

A.  Piano lessons
B.  Choir
C.  Going to School
D.  Play Practice

So which of these things should continue in case of bad weather?  One would think that school would persevere past play practice and piano lessons.  Alas, here in Athens, all of the extra curricular activities continue on through the occasional flakes with no disturbance.  The schools however, have been closed for three full days this week so far!

I understand that busses can’t run on every single road when a flurry is forecast.  Why is it not possible to have school for all who can make it there, unless it is likely that less than half the possible students can attend?  I’ve heard before that teachers teach at the level of the bottom 1/3 of the class.  Do we also cancel class for the small percentage of students who would be inconvenienced traveling to and from?  If choruses can harmonize without a few singers, and a play director still thinks it meaningful to practice even though a couple of cast members are missing, would the 4th grade math class be significantly hampered by the absence of a multiplier of two?

This past fall’s swine flu epidemic gave us policy that could be reinterpreted for weather.  Essentially, what we have in Athens is Snow Flu – some people get it, but not everyone is incapacitated.  When H1N1 was at the forefront of the news we were told to keep a kid with a runny nose or fever home for the day.  School wasn’t cancelled, they just went on without the missing parties and everyone understood this was for the benefit of the larger community.  I have no expectation that people who live at the end of 100 yard driveway at a 45 degree incline risk life and limb to arrive at school.  Just as those with flu symptoms were excused, the snow bound can be too, but the show can still go on.

Perhaps the superintendent should take his cue from the extracurricular leaders for a change.  Show up.  Work.  Proceed.

Addendum from Sungold: I was at said chorus rehearsal tonight, and I’d put attendance at about 95%. Just like any other week. I understand that the district worries about student safety, potential lawsuits, and social equity. But on the last point, it’s low-income parents who are most likely to lose a job over absenteeism. They depend on the schools not just for childcare but for nutritional support. The same grinding Appalachian poverty that hampers the county’s ability to clear the roads also puts these parents and kids at risk when the schools close unnecessarily.

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The Cruel and Stupid Politics of Hospital Discharge

Careful readers of my last post – the one on my little Tiger’s accident – might have picked up on one aspect of the night that really messed with my mind: the circumstances under which we were discharged.

Here are the bald facts.

The Tiger and I were in Columbus. Our home in Athens is an hour and 45 minutes away. My husband returned to said home, with our one and only car, on the understanding that surgery was a virtual certainty, and knowing that our older son, the Bear, would need reassurance.

There is no public transportation between Columbus and Athens, unless you count the highway-robbery airport van (available by pre-order) or, well, hitchhiking.

Since surgery didn’t happen, we were discharged at 4:30 a.m. The Tiger was about two and a half hours out from being fully sedated. His arm hurt. A lot. We would have taken a cab to a hotel, assuming we could 1) get a cab at that hours (probable) and 2) pay for it via credit card (somewhat dicier).

Fortunately, a very kind and determined social worker persuaded the Ronald McDonald House across the street to take us in for the night’s remaining few hours.

But this posed another problem: How was I supposed to cash in the Tiger’s prescription for pain relievers? The ER doc had written it for Lortab (Vicodin syrup – definitely superior to codeine), but even heroin wouldn’t have helped without a place to fill it. I asked if the ER could give us a sample to get us through to morning. Nope! Their internal pharmacy closed at 11 p.m.! Their advice? I should take a cab to one of the 24-hour pharmacies. They handed me a list.

Children’s Hospital is in the sort of neighborhood where all the windows are boarded up. I’d be very wary there as a woman alone anytime after dark, and probably in broad daylight, too. And I was supposed to go to a Walgreen’s in the midst of this blight, at 5 a.m., with a groggy, frightened, pain-ridden six-year-old. Um, yeah.

We went to the Ronald McDonald House and the Tiger slept for all of three hours before the pain roused him. A couple hours later, his dad scooped us up and we got him the medicine he needed. I was FURIOUS that he had to suffer needlessly. No one is going to convince me that pain builds character. Especially not in a six-year-old.

Our experience isn’t an anomaly. You’ve surely heard about women discharged within hours of giving birth (laws have been changed to prevent this) or with mastectomy wounds still oozing and bleeding. Men often get one measly night in the hospital after prostate surgery and are sent home on the assumption that their partner will know how to deal with catheters and potential blood clots.

I was venting my rage to a friend of mine, and she had an even more harrowing story to tell. Her husband suffered some severe burns a few years ago. The hospital discharged him at 10 p.m. – though he’d been an inpatient – and he was still running a fever. The nurses measured it once at 99.8, and that was it for him – even though his fever rose again. She had four little kids at home and had to make the trek up to Columbus to rescue him from prowling the streets with third-degree burns and a fever!

I’m not sure exactly what’s behind this systematic cruelty. Insurance policies often drive patients out the door before they’re ready. My friend’s husband was likely displaced to make room for an incoming patient. Conversely, my husband once spent a full weekend hospitalized after his chest pains had been determined to be completely benign – just because no physician was available to run one final test, and they evidently didn’t need the bed.

In the Tiger’s case, no long-term harm was done. I’m still irate that in the short term, his pain was not humanely controlled. Beyond that, though, we may have gotten lucky. One possible complication of his particular injury (a supracondylar fracture of the humerus) is compartment syndrome. Basically, swelling disrupts circulation and nerves to such an extent that muscles and nerves may suffer permanent damage. One medical source (Orthopaedia) recommends observation overnight to ensure that compartment syndrome isn’t developing, and adds:

Casting these injuries as means of definitive treatment carries risk of compartment syndrome, as swelling is not allowed in the cast…this is especially true with the greater amount of flexion used to maintain the reduction [reduction = replacement of bone into its proper position].

So, while I didn’t know it at 4:30 a.m. in the ER, early discharge posed a real risk. I knew to look for additional swelling of fingers, tingling, poor blood flow, etc. I didn’t know that the Tiger was at greater risk due to being discharged. I didn’t know that having a hard cast upped his risk. I only knew that he was in pain.

Cruelty merges seamlessly with shortsightedness.

And this is the world’s greatest health system? I’ve gotta figure out Rush Limbaugh’s trick.

Mind you, we have good insurance.

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Medicare for All, after All?

A few weeks ago I floated the proposal – which I swiped from Cenk Uyger – of using reconciliation to pass meaningful health care by vastly expanding Medicare. Now it seems that Ezra Klein is warming up to the idea:

My preference is that House Democrats pass the Senate bill and then run their fixes through the reconciliation process. But I think there is an argument that the current health-care bill has been terribly compromised by the months of controversy, the shady deal with Ben Nelson, the ambivalence of key legislators, the endless meetings with industry players, the wasted time, and the collective freak-out of congressional Democrats in the aftermath of Scott Brown’s election.

There is another option.

Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.

And that’s it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar. Medicare buy-in had more than 51 votes as recently as a month ago. The Medicaid change is simply a larger version of what’s already passed both chambers. This bill would be shorter than a Danielle Steel novel. It could take effect before the 2012 election.

(The rest of his column is here.)

I realize that reconciliation is tricky, and it can’t do things like eliminate discrimination based on preexisting conditions. It can only deal with budgetary items. Also, Medicaid is no panacea. It’s second-class health insurance in some pretty major ways. Many doctors won’t accept it.

Still, a massive expansion of Medicare would also be a massive step toward affordable health care for all. It would establish the principle of universal coverage without making millions of Americans essentially captive to private insurers. It could set the stage for further expansions of Medicare.

Regulatory reform could still be achieved, though probably in a more piecemeal way. How many congresscritters would come out in favor of preserving the insurance industry’s right to discriminate on preexisting conditions, if that were the centerpiece of a bill? (This would obviously assume the prior existence of an individual mandate, because otherwise people would try to game the system, only buying insurance after they needed it.)

Anyway, just ’cause Ezra Klein likes it doesn’t mean it will happen. But his suggestion does mean that the policy wonks who have a voice in the debate haven’t declared “game over.” It means that we could accomplish meaningful reform without the likes of Ben Nelson and Scott Brown and (shudder) Joe Lieberman. It could mean thousands of lives saved.

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Blog for Choice Day: “Choice” as a Feminist Idol

In a couple of my previous posts on Mary Daly, I mentioned that her secularized notion of “idolatry” – which she saw in first-wave feminists’ singleminded focus on suffrage – can be applied to modern-day feminism as well. Today, on the 37th anniversary of Roe v. Wade, I’d like to dwell on how “choice” has served as an idol – as a foundational concept that can’t bear the weight it’s been given.

“Choice” was an attractive term to the defenders of abortion rights in the 1970s because it provided a way to counter a growing “pro-life” movement without having to say that they were “pro-abortion.” Even today, defending “abortion” is a politically dodgy proposition. My Democratic ?? !! @*&$# congresscritter, Charlie Wilson, D-Bluedognia, proudly claims at every opportunity that he’s pro-life. He and his cronies are sure not going to come out in favor of abortion.

By now, though, we need a more flexible strategy, as lots of folks – especially radical women of color – have argued before me. What about access to abortion, birth control, sex education, prenatal care, and fertility treatments? How about reproductive rights and justice? What about bodily autonomy and self-determination?

Yes, it’s important that women have choices. It’s even more crucial that we have the material, social, and cultural wherewithal to exercise them.

Denying the means to exercise choice shows that we, as a society, just don’t trust women – especially those women who don’t already enjoy a panoply of privileges. Conversely, “trusting women” doesn’t matter a whit as long as their choices are highly constrained.

And while we’re at it, let’s remember than no one -  female or male, fertile or not – has real bodily autonomy without access to health care. Reproductive autonomy isn’t just a women’s rights issue. It’s a matter of human rights.

Addendum, 1/24/10, 3 p.m.: Based on the comments to this post, it looks as though I haven’t fully clarified why I think feminists would be wise to walk back from our overreliance on “choice.” From the get-go in the 1970s, “choice” referred to narrowly to the formal legality of abortion. It was a product of liberal feminism, which framed abortion in terms of negative liberty – or freedom from interference. However, that wasn’t nearly enough to secure reproductive rights for women, broadly conceived, including a right to birth control, sex ed, etc. This would have required the issued to be reframed in terms of positive liberty, which includes the resources and means to act and exercise one’s liberties. (I’ve written about these disparate concepts of liberty here.) “Choice” also failed to highlight even the violations of negative liberty perpetrated on women who were poor or non-white, such as coerced sterilizations and pressure to use abortion or long-term birth control.

In theory, of course, “choice” could embrace both notions of liberty and and could include issues beyond abortion. Despite some feminists’ efforts to expand the term, however, it continues to carry historical baggage. The popular understanding of “choice” is that it’s shorthand for legal abortion. Its meaning has constricted and frozen. I hear this from my students in women’s studies classes, as well as from critics within feminism. That’s why I’d prefer we stop privileging “choice” in favor of “reproductive rights” and “reproductive justice.” These concepts highlight the importance of positive liberties and challenge us to think about the whole spectrum of gendered health issues.

Thanks to figleaf and kb for pointing out that I didn’t connect all the dots – a hazard of writing when I probably ought to have been sleeping instead.

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