Friday, August 14, 2009

Weekend (by res ipsa loquitur)

If you're in LA, go see Marc Maron, the neurotic brainiac and nerve center of the late great Morning Sedition , at the Upright Citizens Brigade.

In New York, see Mother: The Soundtrack at the Upright Citizens Brigade. Bring your iPod.

In honor of Les Paul, take in a movie: It Might Get Loud. My favorite line in the NYT Les Paul obituary:
Mr. Paul, whose original name was Lester William Polsfuss, was born on June 9, 1915, in Waukesha, Wis. His childhood piano teacher wrote to his mother, “Your boy, Lester, will never learn music.”
Walk this boardwalk. Yes -- in Staten Island. The views are terrific.

Take comfort in the knowledge that advertiser after advertiser after advertiser is dumping Glenn Beck.

Catch up on serious reading you might have missed this week: Barbara Ehrenreich's Times opinion, Is It Now a Crime to Be Poor? John H. Richardson's Esquire article, When Did America Turn into a Bunch of Raving Lunatics? and this Human Rights Watch/ACLU report about the disproportionate assault corporal punishment inflicted on disabled children.

Cook. Here's something to do with the eggplant and basil from your garden.

1 medium eggplant
olive oil
feta or goat cheese
salt and pepper
slivered basil

Preheat your broiler Scrub the eggplant and trim off the top. Cut the eggplant into thick (1/2" - 3/4") slices. Brush each side with olive oil and then sprinkle with salt and pepper. Put the eggplant on a cookie sheet that's been covered with foil. Let brown under the broiler. Keep an eye on it: you want it browned, not burnt. Flip the slices. Let the second side brown. Remove the cookie sheet from the broiler. Put a dollop of either feta or goat cheese on the top (anywhere from 1 tsp. to 1 Tbl. depending on your preference). Back under the broiler until the cheese melts. Top with slivered basil.

Friday critter blogging (by Suzie)

Another still life: Cat with artwork that had not yet been assembled.

How men can have lots of sex with lots of women!!! (by Suzie)

1. Treat us like equals. It will make us like you better.

2. Stop rape. It's not enough for you not to rape women. You need to work to stop rape by other men, too. The existence of rape in the world makes some of us less interested in sex with you. Maybe we’re traumatized, or maybe we’re just disgusted.

If women didn’t have to fear rape, many more would be willing to have sex with men they didn’t know well. Some of you guys may be thinking, “But if they’re willing, why would they fear rape?” Because we want the right to change our minds or say no to anything at any time. Some of us wait to have sex because we're trying to figure out if you're dangerous.

Don't make jokes about rape and abuse that suggest it's no big deal or the woman wanted it. That irritates us.

3. Stop other violence against women in relationships. If you punch us, we won't want to have sex with you, unless we're hoping you'll fall asleep afterward and give us time to get the garden shears. The threat of violence makes many women leery of men. Once again, it's not enough for you not to beat women. You need to work to end all domestic violence.

4. Remove the stigma on girls and women who like sex and have a lot of it. This includes dividing women into Madonnas or whores, as well as using pejoratives like "slut" and "whore." If sex work continues, the workers would need to be treated with the respect accorded any profession, and male sex workers should be just as available to women. Why do I include prostitution? As long as there is one class or group of women who are stigmatized for sex, then all women risk being stigmatized.

5. Don’t insinuate that women are just trading sex for money or material possessions (unless one actually is). This sounds like you think women don't enjoy sex, which makes us wonder about your abilities.

6. Stop treating sex like a game in which women are conquered, or sex acts raise your status and lower hers. Why would women have sex with you if it’s going to lower their status? Don't brag to other guys about what you got a woman to do. If we find out, we may not want to have sex with you, or any man for a while.

7. Don’t lie to us or get us drunk or stoned or try to trick us in some other way to have sex. Depending on what method you use, we may be able to prosecute you for rape. Even if we can't, it makes us less likely to trust, or even like, men.

In the short run, deception may get you more sex with more women. But it's not sustainable. In the long run, it turns off many women to sex.

8. Don’t make your pleasure the focus of sex. Figure out what women like in bed, but don’t use porn or Howard Stern to teach you. Understand that each woman is different, and you have to communicate.

9. Unless we tell you that we love porn that depicts women being hurt and/or degraded, don’t suggest we watch. If we don’t like it, it may disgust us to know that you do. If the porn features attractive women who look like underage girls and paunchy guys from the Netherlands, it may turn us off, too.

10. Stop unreasonable beauty standards. Again, it's not enough for you to like a variety of bodies, ages, abilities, etc. This has to be changed everywhere. If we are ashamed of our bodies, we may have less interest in getting naked with you.

11. Leave or change any religion that puts restrictions on women that it doesn’t apply to men. Sexism gives us a headache.

12. If you live with a woman, do your share of child care, elder care and household chores. Otherwise, we may feel too tired or resentful for sex.

13. Stop thinking that your dick can cure lesbians. Many women understand the limitations of your dick, and we find this ridiculous and insulting.

Dear readers, do you have any other suggestions?
Note to offended men: Yes, I'm truly, sincerely grateful for feminist men, especially if your motive is social justice, not just to get lots of sex with lots of women.

It's Impossible to Live a Perfect Life in an Imperfect World (by res ipsa loquitur)

But is it possible to give up Whole Foods?

Is it necessary?

The opinion at issue.

Thursday, August 13, 2009

Without You/Me I’m/You’re Nothing (by res ipsa loquitur)

Did you have time to take a look at the New Yorker article -- Wilder Women -- that I mentioned the other day? If so, I came up with the following questions for discussion. Yes, I know they sound like one of those back-of-the-trade-paperback “extras” for book club use. Anyway, not in any particular order of importance …

  1. To what extent, if any, do the mother and daughter’s respective politics inform their relationship?
  2. Did Rose’s jump in social class have any effect on their relationship or on her view of her mother?
  3. At one point Rose said, “My life has been arid and sterile, because I have been a human being instead of a woman.” Rose had lived through first wave feminism, though, and certainly lived the life of a feminist. Why would she think the concepts mutually exclusive? As“just a woman”(by her daughter's definition), was Laura any less of a feminist?
  4. Although Laura had been writing a column for a while, her big literary success didn’t happen until she was sixty-five years old. Rose had been a successful writer for more than ten years by that time. What happens when mother professionally eclipses daughter?
  5. Rose claims to have received “no affection” from her mother, yet Rose shared her talent for editing with her mother, which by the author’s account, made them better books. Does Laura seem to have had anything to give to Rose aside from material to edit and to incorporate in her most successful work?

Did you read the “Little House” books? I read them all around second or third grade, as I recall. I know that when I asked my fourth grade teacher to give me a “grownup” novel, she directed me to My Antonia.

This is Laura.

This is Rose. (I like her hat.)

"You Gotta Give 'Em Hope" (by res ipsa loquitur)

Wednesday, August 12, 2009

"It Was About Her" (by res ipsa loquitur)

Updated below.

Journalist covers other journalists' reaction to Hillary Clinton's "flash of pique". This is "news". Blech.

I shut off cable over a year ago, so I don't know if the shouters have been covering this with their usual subtlety (I imagine Chris Matthews empaneling Maureen Dowd, Kathleen Parker, and Cokie Roberts (with Mike Barnicle thrown in for "balance") to discuss "The Clinton Psychodrama in the Age of Obama" or somesuch, but I figured it was only time before the NYT weighed in. They're terribly concerned that Clinton's trip to Africa, with its "quite serious intentions" "may be reduced to this:"
“Wait, you want me to tell you what my husband thinks? My husband is not the secretary of state, I am. So you ask my opinion, I will tell you my opinion. I am not going to be channeling my husband.”

No matter the issues she was talking about — encouraging good governing, ending Africa’s wars, lifting women up from their lowly position in a place like Congo. The interest in this trip, it seemed, was not about the problems facing Africa. It was about her.

The "interest" of reporters, he means.

Maybe one of the reasons it's always "about her" is because they always make it "about her".

At least they didn't say "fit".

Update: As usual, Judith Warner nails it:
As [Hillary Clinton] circles the globe in coming years, making the case for women’s empowerment, starting with their basic right to be taken seriously, Clinton really has her work cut out for her. And it isn’t just because the situation of women around the world is so dire, and the ocean of problems confronting them — maternal mortality, sex trafficking, domestic abuse, malnourishment, lack of education, lack of adequate medical care, just for starters — is so wide and so deep. And it isn’t just that her historic mandate — to equally empower the other half of the world’s population, to chip away at the forces “devaluing women,” in the words of Melanne Verveer, the State Department’s new ambassador at large for global women’s issues — is so huge and vague and seemingly overwhelming. It’s also because the tide of trivialization that washes over all things “Hillary” is just so powerful. That tide threatens to drown out anything of substance Clinton might attempt for a population whose problems have long been obscured in the androcentric world of diplomacy. And that’s a huge pity.
Warner is too polite to call out her colleague, Jeffrey Gettleman, for contributing to that "tide of trivilialization." In any case, the rest is very worthwhile.

Update II: Not just for boys. Tina Brown rides the tide. (I take issue with Jezebel's characterization of "[Hillary Clinton's] longstanding role in the Clinton media circus". Makes it sound like she auditioned for that role or something.

Tuesday, August 11, 2009

Mothers & Daughters (by res ipsa loquitur)

Thursday will be Mother-Daughter Day. Here is some homework- a New Yorker article about Laura Ingalls Wilder and her daughter, Rose Wilder Lane -- in advance of the discussion.

(The Gladwell article about Atticus Finch from the same issue, while not about mothers and daughters, is also interesting (and online).)

What is the State of the Debate? (by res ipsa loquitur)

...when the insurance companies begin blaming the doctors?

And yes, that headline, direct from the Department of the Utterly Obvious, really is "High Fees Common in Medical Care, Survey Finds".

Monday, August 10, 2009

mammo/sono/MRI (by res ipsa loquitur)

David Kurtz at TPM writes:
My personal experience has been that there remains a strongly conservative core segment of physicians who are wary of [health care] reform for temperamental and financial reasons (not to paint with too broad a brush, but a group that is anchored in the high-dollar medical specialties).
Last week I had my annual mammogram and breast sonogram. (I added the sonogram to my annual screening at the suggestion of my doctor about five years ago. It adds about $400 to the (pre-insurance reimbursement) cost of the annual screening, but the doctor thought it necessary, so I acquiesced without question.

This year, as she was performing the sonogram, the doctor suggested that I add breast MRI to my annual screening, to be done six months after the annual mammogram and sonogram. I have often found that the aggravation about the cost of such procedures is often a proxy for other feelings I have about them (e.g., fear, a desire not to have yet another agenda item to deal with, denial), and this was no exception. My first thought was, “Forget it! Not another test. This one will cost $1,500! Do you think I’m made of money? No way!” But I calmed myself while I dressed and when I went to her office to review the results of both tests (which were happily normal/negative), I asked her, “Why?”

Well, because my mother died in her early forties of metastasized breast cancer. Because two maternal aunts have had breast cancer. Because my breasts are dense. Taken together, these seemed like solid reasons, but I went ahead and asked a few more questions. “Who performs the MRI? Do I get it here?” (Her office has mammography and sonogram equipment on premises.) No. She does not (yet) have that equipment, but will soon. “In what instances does the Mayo Clinic recommend breast MRI?” I asked (because by many accounts, Mayo and Cleveland Clinic are way ahead of the pack in determining what procedures and tests are necessary). This question seemed to annoy her. She admitted that she didn’t know, but could check, and I told her I’d take care of that when I get home (turned out I met two of the criterion on Mayo's “Why It’s Done” list.) Finally, I told her I would like to discuss it with both my general practitioner and my gynecologist. This last statement seemed to really irritate her. She abruptly ended our meeting, by saying, “Fine, well I’m recommending you have one in six months,” and proceeded to write that on the form she asks all patients to sign upon receiving results.

I consider myself extremely lucky. I have good health insurance and, living in a large city, access to many doctors. I know where to find a lot of solid information about things like mammography and breast cancer. I’ve seen this doctor for years. So why bother asking, “Why?” Kurtz’s post reminded me that it was because of this New Yorker article by Dr. Atul Gawande, which is one I’ve recommended to many people since it appeared in early June, and which I wanted to share with you. I’m not pooh-poohing the necessity or effectiveness of mammograms (or sonograms or MRIs): quite the contrary. What I’m trying to say is that health care reform (some version of which I think will pass in the fall) is going to be just as difficult after we get past phalanxes of lunatic dead-enders hell-bent on disrupting congressional Town Halls as it now. I have always tried to be proactive with regard to my health care, yet I still found it very difficult to ask those questions, which were, after all, a series of challenges to an authority figure. And that authority figure, it seemed, found it difficult to answer them, perhaps due to the wariness Kurtz mentions above. I doubt that any of these phenomena -- my anxiety, her irritation, issues in the area of high-dollar medical specialties -- will evaporate with a bill-signing, and so it will remain important to manage all three.

Speaking of breasts: have you seen Hecate’s First of Month Bazooms Blogging?

What's lust got to do with it? (by Prometheus 6)

Female supervisors more susceptible to workplace sexual harassment
Study is first to examine trend over time and clearly demonstrate use of harassment as a workplace equalizer

SAN FRANCISCO — Women who hold supervisory positions are more likely to be sexually harassed at work, according to the first-ever, large-scale longitudinal study to examine workplace power, gender and sexual harassment.

The study, which will be presented at the 104th annual meeting of the American Sociological Association, reveals that nearly fifty percent of women supervisors, but only one-third of women who do not supervise others, reported sexual harassment in the workplace. In more conservative models with stringent statistical controls, women supervisors were 137 percent more likely to be sexually harassed than women who did not hold managerial roles. While supervisory status increased the likelihood of harassment among women, it did not significantly impact the likelihood for men.

"This study provides the strongest evidence to date supporting the theory that sexual harassment is less about sexual desire than about control and domination," said Heather McLaughlin, a sociologist at the University of Minnesota and the study's primary investigator. "Male co-workers, clients and supervisors seem to be using harassment as an equalizer against women in power."

McLaughlin and her co-authors examined data from the 2003 and 2004 waves of the Youth Development Study (YDS), a prospective study of adolescents that began in 1988 with a sample of 1,010 ninth graders in the St. Paul, Minnesota, public school district and has continued near annually since. Respondents were approximately 29 and 30 years old during the 2003 and 2004 waves. The analysis was supplemented with in-depth interviews with a subset of the YDS survey respondents.

The sociologists found that, in addition to workplace power, gender expression was a strong predictor of workplace harassment. Men who reported higher levels of femininity were more likely to have experienced harassment than less feminine men. More feminine men were at a greater risk of experiencing more severe or multiple forms of sexual harassment (as were female supervisors).

In a separate analysis examining perceived and self-reported sexual orientation, study respondents who reported being labeled as non-heterosexual by others or who self-identified as non-heterosexual (gay, lesbian, bisexual, unsure, other) were nearly twice as likely to experience harassment.

Researchers also found that those who reported harassment in the first year (2003) were 6.5 times more likely to experience harassment in the following year. The most common scenario reported by survey respondents involved male harassers and female targets, while males harassing other males was the second most frequent situation.


McLaughlin co-authored the study with sociologists Christopher Uggen, chair of the University of Minnesota's sociology department and a distinguished McKnight professor of sociology, and Amy Blackstone, associate professor of sociology at the University of Maine. The multi-method research was supported by grants from the National Institutes of Mental Health and the National Institute of Child Health and Human Development.

The paper, "A Longitudinal Analysis of Gender, Power and Sexual Harassment in Young Adulthood," will be presented on Saturday, Aug. 8, at 8:30 a.m. PDT in the Parc 55 Hotel at the American Sociological Association's 104th annual meeting.

To obtain a copy of McLaughlin's paper; for more information on other ASA presentations; or for assistance reaching the study authors, contact Jackie Cooper at or (202) 247-9871. During the annual meeting (Aug. 8-11), ASA's Public Information Office staff can be reached in the press room, located in the Hilton San Francisco's Union Square 1 & 2 room, at (415) 923-7558, (415) 923-7561 or (301) 509-0906 (cell).

Integration, Segregation, Aggregation (by Prometheus 6)

I want to start with an old essay I wrote at the start of my time as a Black partisan (no, I was not always one). At the time I called myself an "aggregationist."

Claude McKay said in his autobiography, "Negroes do not understand the difference between group segregation and group aggregation. And their leaders do not enlighten them, because they too do not choose to understand."

This is all too true. Fortunately, I'm not a leader. I have chosen to understand. And I have chosen to explain the difference, and the difference that difference makes.

Segregation and aggregation both refer to a gathering together of things according to some shared characteristic. Both imply considering that group a single entity. But just as all other things can be constructive or destructive, so can this viewing groups of people collectively. Aggregation is the positive side of this collective viewing, while segregation is the negative side.

What makes segregation negative is that it's something that's done to you, whereas aggregation is something that is done by you. Segregation is imposed on you, aggregation is chosen by you. When you aggregate, you draw together with people. When you segregate, you push people aside.

When I wrote the essay it was to explain why it is no sin for Black folks to actively support each other on principle…the nature of aggregation was under discussion. This time it is the nature of segregation being considered, and I'm doing it in connection with the widely reported "failure" of integration to "close the education gap."

Yes. Scare quotes. And you gotta do some history with me. Can't change it, but it is the only source of data we have to analyse.

We all know Jim Crow was the order of the day at the time Brown was decided. And as the neo-Confederates will never fail to reminder us, it wasn't only in the South that The Negro had problems. I think it safe to say that at the time a plurality of mainstream types actively disliked The Negro and a majority of the balance didn't much find him to be the sort of fellow one would associate with.

But have you ever wondered (okay, I'm assuming you knew) why there were so many intelligent, erudite Black folks so quickly after the War Between The States? One reason is their teachers volunteered to teach them. People who though it important enough that The Negro be educated that they moved into his midst. That all broke down of course, and wasn't intended to end segregation anyway...separate can be equal, but you have to give it an honest shot.

And it was almost tried.

It took me a while to wrap my mind around the fact that Brown v.Board of Education wasn't the seminal case decided that day. For some reason, perhaps because I wasn't as familiar with the details as I could have been, I thought the set of class actions was named for the case of greatest significance.


Ironically, it was not Brown but the case from South Carolina, Briggs v Elliott, that was the more important and interesting of the four. The Topeka case arose out of an 1867 law that permitted towns of more than 15,000 to segregate their elementary schools; the other states had constitutional and statutory provisions that mandated racial segregation at all levels.

The story in South Carolina was very different. South Carolina had been the nullification state in 1832, the first to secede in 1860, and since the 1890s had built a rigid set of laws and customs segregating the races. Harry Briggs, a tenant farmer and navy veteran, with five children, "figured anything to better the children's education was worthwhile...."[2] Clarendon County was part of the old cotton belt and most blacks were poor tenant or sharecropping farmers The county school enrollment was 6,531 blacks and 2,375 whites ; and the total value of the 61 black schools was officially listed as $194,575; the value of the white schools was put at $673,850. In 1949-50 Clarendon County spent $179 per white child in the public schools; but only $43 for each black child.[3] In District #1 of the county, where Briggs and the other plaintiffs lived, there were 2,800 African Americans and 295 whites.[4] Such a picture repeated itself over and over in the Deep South.

Even more significant that the statistics was the solution the State of South Carolina proposed:

At the beginning of the hearing the defendants admitted upon the record that 'the educational facilities, equipment, curricula and opportunities afforded in School District No. 22 for colored pupils * * * are not substantially equal to those afforded for white pupils'. The evidence offered in the case fully sustains this admission. The defendants contend, however, that the district is one of the rural school districts which has not kept pace with urban districts in providing educational facilities for the children of either race, and that the inequalities have resulted from limited resources and from the disposition of the school officials to spend the limited funds available 'for the most immediate demands rather than in the light of the overall picture'. They state that under the leadership of Governor Byrnes the Legislature of South carolina has made provision for a bond issue of $75,000,000 with a three per cent sales tax to support it for the purpose of equalizing educational opportunities and facilities throughout the state and of meeting the problem of providing equal educational opportunities for Negro children where this had not been done. They have offered evidence to show that this educational program is going forward and that under it the educational facilities in the district will be greatly improved for both races and that Negro children will be afforded educational facilities and opportunities in all respects equal to those afforded white children.

This wasn't what I would call a noble gesture, but the best one could do if one truly both believed in segregation and acknowledged federal law takes precedence: fulfill the law in the narrowest means possible, In this case it meant providing the "equal" part of separate but public facilities. This was the first sales tax ever enacted in South Carolina. It meant they had to pay to maintain their segregation...and the significance of that is they were willing to do so.

The offer South Carolina made has fascinated me for years. I've read a number of alternate universe science fiction and can't help by see that moment as a turning point

This would have been an acceptable outcome to folks on the ground because we minorities ain't stupid. I can assure you, based on talks with older folks than me, they were fully aware of how strongly the local white folks felt about segregation since they were the ones constantly being pushed aside. Do you know what the settlement the Black folks of Selma, AL originally asked for in their bus boycott? Only that they not be required to give up a seat, or be left on the sidewalk, after they'd paid for it. They had no problem being seated from back to front while white folks were seated from front to back, or even getting on at the back of the bus. They wanted what they paid for, and when the all the seats were filled the next passenger of whatever race would stand until a seat was available.

No, Black folks weren't stupid enough to directly repudiate such a deeply held fusion of religion and politics.

But even though South Carolina offered this up, the Brown legal team felt they had to consider the bigger picture. South Carolina was just one state; it would probably set a precedent for the other states of the old Confederacy given its status as historical role model, but how long would that take? There's this divine impatience you get when you're sure you doing God's will, when you surf the cresting wave of destiny. When I was studying the history of Europe (as one must) it occurred to me that Germany's biggest flaw pre-WW I was impatience. As Europe's dominant economy, home of the most prestigious learning and research centers, and with their growing influence, I really feel had they simply kept doing what they were doing all along Europe would have unified under Germany in the normal course of events. But when you're on that wave, you want to make sure you see the way it turns out.

From PBS's African American World site:

Several years before 1963, the African American community had adopted the motto "Free by '63". And by 1963, a hundred years after the Emancipation Proclamation, the civil rights movement had made much progress: lunch counters and other public accommodations had become integrated and the Kennedy administration announced new civil rights proposals.

I suspect divine impatience was an element in how the NAACP Legal Defense and Education Fund decided to handle these cases. I believe it affected the whole community. Black folks figured if they were in the same place at the same time as white folks were being taught they would learn too; this is a very different goal than integration

Thing is, they weren't expecting to change. Integration was to give us access to the stuff we need to have our own. And they didn't consider the fact that the mainstream's memory those legal cases that made us so giddy was different than ours, but just as fresh, vivid and inspiring. Given that we humans were happy to be on the winning side, how do you suppose being on the losing side made them humans feel?

Shouldn't have been so triumphal. Though I hate to say NewsMax got something right, Newsmax got something right:

In fact, the civil rights movement was not about politics. Nor was it about which politicians did what and which political party should take the most credit. When it came to civil rights, America's politicians merely saw the handwriting on the wall and wrote the legislation to make into federal law the historical changes that had already taken place. There was nothing else they could do.

Now, how would it feel to watch people you are convinced are not only your inferior but your subordinate stake out territory you expressly forbade him?

And if you're honest, how can you not see the reaction as a most eminently human one? You don't have to like it. But you do have to acknowledge it. It doesn't seem to me the Black community did so.

I'm not sure if our legislators took it into account or not, because the method chosen to integrate was SO blind to human nature it may have been intentional sabotage along the lines of Howard Smith's adding women to the Civil Rights Bill of 1964, with the intent of making it tough enough to frighten off the support Bull Connor so thoughtfully arranged. I mean, didn't we just lose over some buses? We have to let them sit wherever they want, but next to my sweet child? And it's bad enough you want to bus them over here, but what caring parent would allow their child to be shipped across the city before the sun even comes up sometimes to go to that school...the one even niggers don't want?




It's important to remember the collective response because the whole teaching vibe is voluntary. It's a matter of knowledge, skills and experience, yes, but it's also a matter of intent. You can't force intent, nor can you fake it. Right now there's a teacher somewhere grumbling and mad as hell because there ain't enough supplies for the whole week's lesson, but fuck that I'm coming out my pocket, bring that shit myself hmph how the hell they expect me to do my job I got kids to teach I'll put the can of corned beef hash in the fridge until it's firm slice it thin enough for sandwiches all week so I can get this stuff for my kids. Bastards.

It was years before our children were feeling that kind of love.

Then there was the change from integration-as-tactic to integration-as-goal. But I intend to post this today.

I guess what I'm saying in my overextended way is, when you look for a reason the "failure" of integration to "close the education gap" you can't be simplistic about it because now is always the result of a confluence of events, forces, human reactions and timing.

And if you're looking for someone to blame, don't. Because we're at the beginning of a new road and Black folks are as inexperienced at being free as white folks are having us among them as such. Almost as inexperienced. And it's still trial and error out here.

I'd like to think if we all keep that in mind it would help.

Sunday, August 09, 2009

Guest post by skylanda: The most assinine distractor in the health care debate

Sarah Palin calls it “evil.

Randall Terry of the tired old pro-life machine Operation Rescue calls it the “Kill Granny” clause.

The well-organized anti-reform conservative arms would have you believe that if the Obama health care package passes, government-sponsored panels will be convened to decide if seniors get life-saving treatments or get to die in the gutter.

That these panels appear nowhere in the actual bill seems to have no bearing on the panic flamed by the Randall Terrys and Sarah Palins of the debate.

That uninsured patients already live by the de facto, unacknowledged death-panel approach to care seems not to have entered into the debate.

That the origin of these myths lies in a clause that offers reimbursement to physicians who set aside visits for a sit-down talk about end-of-life care – something physicians already do, largely unpaid, every day – seems to stem the tide of rancor not at all.

As a primary care physician, let me lay out the case for full and just reimbursement for appointments dedicated to what (to steal from the right wing) amounts to “death care.”

In the last six months, I have taken care of a patient with advanced dementia whose daughter cares for her at home. The family is congenial but financially stricken, and tension remains over the matriarch’s care and the use of her remaining resources. The treatment for advanced dementia is minimal and mostly palliative, and we continue to pursue that at every visit, as well as a few minor other issues. But at every visit, I also ask the family (nay, plead with the family) to hammer out what their and the patient’s wishes are on the day that something unpleasant happens: pneumonia, a hip fracture, what have you. Do they want all measures taken? Do they want palliation over putting an elderly person through risky surgeries and pain that cannot be explained to a brain that has passed beyond the era of comprehension? And if the patient “codes” – heart stops beating in a manner that can deliver oxygen, lungs stop pulling air – do they want rib cracking chest compressions, shocks to the heart, a tube down the throat that will likely never come out of a her alive on the off chance she makes it coughing and sputtering through an ICU stay, or do they want to let her go?

I have broached the subject briefly at roughly every other visit with this family as they have dawdled along in their decisions as their elderly mother gets more ill and functional at every visit; this sounds something like, “Have you thought any more about what you might want for her care if something happen to her and she has to be hospitalized?” I do not get reimbursed for this; I bill under the diagnosis of dementia, we review and adjust some meds, and the talk comes as an afterthought. To my knowledge Medicare does not allow me to bill a visit to sit down and have a comprehensive talk about these issues currently; under Obama, it would…once every five years. These visits would be voluntary to the patient. They would be paid by Medicare. The outcome would be that the wishes of the patient would be documented and – in the best case scenario (barring the interference of family, the most frequent cause of unfulfilled end-of-life wishes I have seen) – honored. In medicine, we call this “patient-centered care;” it’s all the rage these days, or at least we like to talk about it like it is.

I want to be cared for in my death; I would put money on it that you want to be cared for at that final stage of life too. Most Americans die in hospitals with aggressive interventions still running at the bedside; when polled, most Americans express a firm desire to die at home, in the care of family with the support of the home health services like hospice (notably, finances and ethics are not at war here). Adequate, compassionate, dignified care requires some planning and some dedicated time to set aside the diabetes and the dementia and the aches and groans of the aged (and their families) to talk about the what-ifs and the what-thens of what will inevitably come for every one of us.

But these objections, these “kill granny” media campaigns, they are distractors. They are ways of mobilizing the AARP generation against a reform that is fundamentally beneficial to them: shoring up the enormous social and private financial burden that is healthcare in America is a fundamental part of rebuilding a flagging economy that at present threatens the stability of a retiring generation. By riling up seniors against the straw man of non-existent “death panels” and “kill granny” clauses, the right has shrewdly – and incredibly callously – used one of the most vulnerable cohorts to shoot their own selves in the foot.

Because, of course, the end is all economics. The neo-con right will always place private free-marketeering (in this case, the right of insurance companies to make a buck or two or a couple billion banking on your medical needs) over community health, and are entirely without conscience in doing so. The odious stink of money in the kill-granny media storm should turn any good Christian’s stomach; that Palin and Terry and their ilk wallow in it should be a good sign about the green face of the god that they worship most: capitalism.

That is not to say that there is no solid grounds on which to object to the Obama health care plan; there are many, on which I shall not even get started (ok, wait, I will: lack of a single payer plan, for one). But this red herring of death panels and kill granny tells far more about the media figures that promulgate the myth the health care plan itself. And it is not a pretty picture it paints.

Cross-posted from my infrequently-updated blog, Loose Chicks Sink Ships.

Sunday Art Blogging (by res ipsa loquitur)

Gian Lorenzo Bernini, 1621-22
Pluto and Proserpina (detail)
white marble

Simon Schama - "Power of Art: Bernini" - Part One

Update: After reading your comments, I decided to delete the image of the Bernini sculpture. I understand and am sympathetic to -- the feminist critique of this piece -- I also find it an incredibly beautiful sculpture. That said, one point the discussion has brought home to me ex post facto was that the image may offend feminists who view Echidne's blog as a sort of "safe space". Your comments lead me to believe that some of you do, and in light of that, I thought it better to delete the image. For those who would like to view it -- the detail is here -- and a full view is here at the Borghese Gallery site.

Breastfeeding baby dolls (by Liz)

It's okay for girls to play with baby dolls. The toy companies spend plenty of money on advertising and (pink) packaging and clearly people are buying them. Plus some measure of realistic play is good for our little ones. That's why pooping dolls were such a big hit last Christmas. This from a Washington Post article last December:

"For us, the peeing and pooping is pretty magical," said Kathleen Harrington, senior brand manager for Hasbro's Baby Alive dolls. "As adults, we might be a little grossed out. But it's so magical and so funny and so silly for these girls. This little doll is coming to life, so the little girl doesn't believe it's just a doll. It's her baby." Harrington calls it part of the doll's "Wow!" factor.

Not to be left out, Corolle has Paul the anatomically correct doll that wets. The company markets Paul, and his female counterpart, Emma, as "excellent potty training" products.

To be fair, some "experts" think the peeing-pooping dolls are too much. Susan Linn, professor of child psychology at Harvard and director of the Campaign for a Commercial-Free Childhood said in the same Washington Post story, "This toy is shocking enough that it's going to be noticed. But at best, this toy is unnecessary. At worst, it's really gross."

But not quite as gross, apparently, as the newest doll to hit the market: Bebe Gloton, from Spanish toy manufacturer Berjuan, otherwise known as "the breastfeeding doll." This doll comes with a vest the doll owner can wear that has little daisy appliqu├ęs over the nipples.The doll latches on and simulates breast feeding. You can see a demo video here.

Some in the media don't approve. On Fox & Friends an anchor introduced the doll story saying, "I don't even know if I can read this." And on the Fox News website, Dr. Manny Alvarez, managing health editor of, "wonders if Bebe Gloton might speed up maternal urges in the little girls who play it….Or, it could inadvertently lead little girls to become traumatized."

Dr. Alvarez may be the Chairman of Obstetrics, Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey, but I have done my fair share of both breast feeding and potty training and let me tell you, nursing is not traumatic. Dirty diapers, however, can be.

New Jersey Star Ledger parenting columnist, Eric Ruhalter, picks up on Alvarez's point that a breastfeeding baby doll might lead little girls to early pregnancy. In a recent column he wrote, "Weird. And I'm not sure that as elementary-school-aged children we need to be plugging anything too specific in terms of baby rearing. Especially right before they hit puberty and we start beating it into their heads that it'd better be a loooooong time before they get pregnant."

So playing with dolls is okay (for girls- I don’t think the mainstream is ready to hear that boys play with them too). Rock them in toy cribs, walk them in toy strollers, take their pretend temperatures, put them on pretend potties, give them fake bottles and diaper their plastic penises. But pretend to breastfeed them ? Nope -- that might lead to teen pregnancy.

On the Today Show, Kathy Lee Gifford didn't want to talk about the doll either. "It’s got a little creep factor," she said. Pooping dolls? Magical. Transformers? No problem. Bakugan Battle Brawlers? Carry on. SpongeBob? Perfectly normal. But Bebe Gloton? Creepy.

So the message to little girls: When it comes to dolls, bottle is best and breast is a bust.