Wow.

Everyone already reads the brilliant Amanda Marcotte of Mousewords, who is now permanently at Pandagon - right?

She took my breath away today:

I have also noticed that two values that BushCo likes to fling around are "life" and "freedom", but I have also noticed that the two are opposite values in their rhetoric. You can have freedom or life, but not both. They are pretty consistent in this viewpoint, and if they evoke freedom, you can be sure they are covering up for someone's death, and if they evoke "life", you can be sure they are trying to take away your freedoms.

Thank you, Amanda. It chills me to say that I think you're exactly right.

I Swear This Is My Last Schiavo Post

I've given my opinion about the Terri Schiavo case at length, and I don't necessarily want to keep contributing to the media frenzy. (As of this morning, Respectful of Otters is the number one hit on Google for "Terri Schiavo CAT scan." The next few links are to Alas, A Blog and Abstract Appeal. Fortunately.)

Through my referrer logs, I found a link to some additional information which does seem worthy of Yet Another Schiavo Post. The blogger who writes Pekin Prattles wrote to Ronald Cranford, one of the examining neurologists from the original Schiavo trial, inviting him to respond to the National Review article condemning the medical handling of Schiavo's case. Among other things, Dr. Cranford's reply addresses the questions about additional scan techniques:

An MRI was never recommended because, in this case and other patients in a permanent vegetative state, the CT scans were more than adequate to demonstrate the extremely severe atrophy of the cerebral hemispheres, and an MRI would add nothing of significance to what we see on the CT scans. Plus the MRI is contraindicated because of the intrathalamic stimulators implanted in Terri's brain. A PET scan was never done in this case because it was never needed. The classic clinical signs on examination, the CT scans, and the flat EEG's were more than adequate to diagnose PVS to the highest degree of medical certainty.

Pekin Prattles also reproduces a lengthy journal article by Dr. Cranford (it's mislabeled "Dr. Cranford's complete Terri Schiavo report," but it's obviously a summary article, not a medical report). It's well worth reading. He discusses the series of CAT scans taken between 1990 and 2002 (not just the 1996 one which has been widely reproduced on the net), the EEG evidence over the same time period, and Schiavo's clinical records from her attending physicians - correcting the widespread misapprehension that Schiavo's neurological condition has not been re-evaluated since the 1998 trial. The article also provides this searing dismissal of the parents' "experts" who testified that there were treatments which could restore Terri Schiavo's brain function:

The following is a sample of the completely fallacious opinions rendered about Terri’s medical condition by Drs. Maxfield and Hammesfahr. Twelve years after an hypoxic-ischemic insult, and serial CT scans showing extremely severe atrophy of the cerebral hemispheres, both doctors said there was a “chance for recovery,” with the potential for response to treatment. Dr. Maxfield testified that “abnormal brain dissolves, so what’s left [as seen in the CT scans] is “normal, functioning brain.” He further stated that the most recent CT scan shows “improvement.” They gave no published data to support their opinions on their proposed treatments of HBO and vasodilator therapy but instead presented an infomercial style approach of anecdotal cases of dramatic responses to their therapies. There are no credible articles in the peer-reviewed medical literature on HBO or vasodilator therapies as effective treatment for patients with chronic brain damage. The articles on the internet on vasodilator therapy, including those by Dr. Hammesfahr, are extremely poorly written, and only a cursory examination of these articles would tell any medical professional that they could not have possibly been peer-reviewed.

"Abnormal brain dissolves, so what's left is normal, functioning brain." Well, no problem, then. She didn't need her cerebral cortex, it was abnormal. If this is the best the Schindlers' experts could do, it's no wonder the trial and appeals courts have found so consistently for Michael Schiavo.

Terri Schiavo's Freedom Of Religion

I am relieved to see that the U.S. District Court was unimpressed with Congressional grandstanding in the Schiavo case. But I found something unexpectedly chilling in the arguments presented by the Schindlers' lawyer. Among the expected due process claims was the argument that Schiavo's rights to the free exercise of religion were being trampled:

Gibbs said that "fairly dramatic developments," including a statement by Pope John Paul II that removing a feeding tube would be a sin except in rare instances, are proof that Schiavo's constitutional rights to freely practice her religion are being infringed upon. Refusing to resume her tube-feeding would "jeopardize her eternal soul," Gibbs said.

Law professor Ann Althouse paraphrases the argument succinctly:

The federal religion claims assume that she must now want what the doctrine of the Catholic church requires, because, when she was able to think about such things, she was a Catholic.

The Schindler family is arguing that, regardless of what has been determined in court about Terri Schiavo's actual wishes, the courts should be required to place a higher weight on what the Catholic Church wants her to have wished. If the Appellate Court agrees with them, it sets up an enormously disturbing precedent in which religious doctrine is presumed to trump individual conscience.

Hundreds of thousands of U.S. Catholics have Living Wills - would they be rendered legally invalid if they include provisions to refuse artificial nutrition? What about cases in which a Catholic minor seeks judicial bypass to obtain an abortion without parental consent? Would the judge be required to take the Catholic Church's position into account, if it is indeed a violation of religious freedom to allow someone to make a choice which "jeopardize[s] her eternal soul?" It's hard to imagine anything so theocratic happening in the United States, and yet the argument is being made, in federal court, that the Vatican's opinions should be allowed to intrude upon personal family decisions.

Needless to say, the proposition that "she must now want what the doctrine of the Catholic church requires" is entirely specious. American Catholics widely disagree with the church on a broad number of social positions, including the use of artificial contraception (90% believe that it is acceptable, and as of 1988 59% of all Catholic women of childbearing age were using methods of birth control other than periodic abstinence), abortion (31% of U.S. women seeking abortions are Catholic), the death penalty (48% support it), and - as a matter of fact - the removal of Terri Schiavo's feeding tube (pdf). The last link is to a recent ABC news poll which found that 63% of American Catholics supported removing the feeding tube. So much for the Schindler's argument that, because Schiavo is Catholic, the court is required to determine that her wishes are identical to the Pope's.

Terri Schiavo, Part II: The Ethical Post

(Read Part I: The Medical Post.)

People who have been reading Respectful of Otters since the start know that I am strongly opposed to euthanasia and physician-assisted suicide. Because the concepts of "euthanasia" and "killing" (as in, "so now it's okay to kill someone just because they have a mental disability?") are being thrown around a lot in the Schiavo case, I wanted to write about where I see the differences.

What is at issue in the Terri Schiavo case is not whether it is legitimate to kill her or actively promote her death (for example, by an overdose of morphine), but whether it is legitimate to refuse medical treatment intended to prolong her life. (Make no mistake about it: nutrition and hydration are medical treatment, when they're supplied through a stomach tube.) While the distinction between active promotion of death and witholding lifesaving medical treatment may seem like hair-splitting, in fact they are critically different.

No one has the responsibility to submit to everything that medical science could potentially do to prolong life. As individuals who own and have sovereignty over our bodies, we have a fundamental right to bodily integrity. No one has the right to invade our bodies without our consent, even if their purpose is apparently benign. If we are competent adults, we have the right to refuse medical treatment at any stage of an illness. That might mean opting out of a second round of chemotherapy after a first round of cancer treatments has failed, preferring to focus on preserving quality of life for the time we have left. It might mean deciding to die of a terminal illness at home, even if hospitalization could add a few extra hours or days. It might mean requesting aggressive pain management, knowing that it might depress respiration and shorten our lives. We have the right to say "enough," and let the natural dying process take its course. We have the right to have the integrity of our bodies unviolated by unwanted medical treatment - just as we have the right to insist on aggressive efforts for life extension. We have the right to choice. And when we are no longer able to exercise that right ourselves, we have the right to designate our closest others to do so on our behalf.

To define the exercise of that right as "killing" is to pervert the end of life unimaginably. My grandfather died at home at the age of ninety, after a slow decline from Alzheimer's disease. He died in his own familiar bed, surrounded by people who loved him. He was not in pain. His breathing slowed and slowed, and finally stopped. If it is "killing" to refuse life-preserving medical treatment, then my grandmother murdered my grandfather when she failed to call the paramedics. The others present at his death were accessories to murder. But who would have benefited had my grandfather been forced to squeeze out a few extra days in an intensive care unit, on a respirator, confused and disoriented? In what way would that have furthered a culture of life?

The natural course of life ends with death. To allow that natural process to take its course is profoundly different than hastening it along. Asking others to refrain from interfering with nature is profoundly different from asking them to make, or be complicit in, the decision that nature is not progressing quickly enough - as in euthanasia or physician-assisted suicide. Euthanasia asks the physician to play God, to decide whether another person's life is sufficiently without value that it should be actively terminated. The cessation of life support asks the physician to stop playing God, to refrain from intervening further in a disease process which has its natural terminus in death.

Terri Schiavo is under no moral or legal obligation to stay alive at whatever the cost to her bodily integrity, in order to assuage our fears of death or nuture her parents' unrealistic hopes of a miraculous recovery. A court has determined, based on the testimony of several witnesses, that Schiavo's wish would have been to remain unviolated by a feeding tube if she had no hope of recovering. That ruling has been affirmed and re-affirmed. It is our best estimate, our only estimate, of what Terri Schiavo would have wanted. If we want our own rights to bodily integrity preserved, we have no choice but to uphold hers.

Update: Whoa. Never mind me; go read Hilzoy.

Science And Lies

One of my favorite women called my attention to the obscene fraud perpetrated by Dr. Eric Poehlman, who falsified data in order to pump up his federal grant applications. Grant reviewers typically rely heavily on the "Preliminary Studies" section of the application, in which researchers describe prior data supporting their current hypotheses. It's common to include the results of studies conducted so recently that the data hasn't yet been published (and thus subjected to peer review), so it's easy to see the potential for fraud. Not that peer review alone would have been likely to uncover a fraud so egregious:

Dr. Poehlman represented in the 1995 Annals Article that he had tested 35 healthy women for basic metabolic characteristics and retested the same women six years later for the same characteristics. In fact, Dr. Poehlman falsified and fabricated test results for all but three of the 35 women in the study. [...]

In 1996, Dr. Poehlman initiated a new project where he planned to recruit subjects who had previously been tested at UVM from 1987 to 1993 and retest them for the same and additional physical and metabolic characteristics over time. [...] Dr. Poehlman exaggerated the number of subjects tested and changed the values for the physical characteristics of the subjects and the test results for these subjects (often reversing the values from the initial test and the retest) in order to create trends during the aging process that were not reflected in the actual research data. [...]

Dr. Poehlman used data purportedly from the Prospective HRT Study in two grant applications to NIH seeking federal funding for additional HRT studies. In fact, Dr. Poehlman did not have access to the data and just fabricated the preliminary test results in the grant applications.

As far as I can tell from a quick Medline search, the main thrust of Poehlman's "research" appears to be that women get fat when they hit menopause, that this poses enormous health risks, that hormone replacement therapy should be used more widely, and that menopausal women should be encouraged to diet. Just to add a feminist outrage component to my scientific outrage.

I admire Walter F. DeNino, the research assistant who blew the whistle. DeNino must have known that he might be ending his own research career forever. A research assistant typically doesn't survive going up against a tenured professor. Fortunately, now that Poehlman's been so conclusively brought down, DeNino shouldn't suffer any worse consequences than the loss of his Poehlman-related publications from his vita.

As someone who makes her living off grant-funded research, I admit that I take considerable satisfaction in seeing the Hammer of God descend on Poehlman, via the federal Office of Research Integrity:

Dr. Poehlman has agreed to pay $180,000 to settle a civil complaint related to numerous false grant applications he filed while at UVM. In addition, Dr. Poehlman will pay $16,000 in attorney's fees to counsel for Walter F. DeNino, a research assistant whose complaint of scientific misconduct spurred an investigation by UVM. Also, Dr. Poehlman has agreed to be barred for life from seeking or receiving funding from any federal agency in the future, including all components of the Public Health Service, and to submit numerous letters of retraction and correction to scientific journals related to his scientific misconduct. Dr. Poehlman also agreed to be permanently excluded from participation in all Federal health care programs.

That last line means that not only is his research career over, but so is his clinical career. You can't be a practicing physician in the U.S. if you're barred from accepting Medicaid or Medicare reimbursement - unless you become a private practitioner to the wealthy, and how likely is that if you're burdened by a fraud conviction?

But there's more. "He's also facing criminal charges," I announced to my Significant Otter. "He could go to prison for five years."

"But that settlement sounds like a plea bargain," he said, sounding surprised.

"It is. In exchange for Poehlman doing all those things, the U.S. Government has agreed not to give their opinion on whether or not Poehlman should get a more lenient sentence."

That's all his deal got him - not an agreement to seek a lesser charge, but simply a "no comment." That's what I mean by the Hammer of God.

Terri Schiavo, Part I: The Medical Post

I had hoped not to blog about the Terri Schiavo case, but was driven to it by today's report that she was subpoenaed by House Republicans today in a last-ditch effort to prevent the removal of her feeding tube. Apparently, interfering with a person subpoenaed by Congress is a federal offense, and the Party of Big and Intrusive Government had no hesitation about using its naked power to interfere in a family dispute which has already been heard at every level of the courts.

If you haven't been following closely, the best summary I have found is here, with links to relevant court documents. I'm not going to review the whole case - I want to concentrate on the 17 medical affidavits recently introduced by Schiavo's parents, "based on the fact that new evaluation and therapeutic technologies can significantly impact brain damaged and disabled persons." The affidavits can be found on Schiavo's parents' website. I learned about them from Ampersand, who also linked to Majikthise's perceptive commentary.

Ampersand prefaces his analysis (with which I fully agree) with the disclaimer, "I’m not a doctor, of course." Neither is Majikthise (with whom I also fully agree), but I am. I have a doctorate in clinical psychology. I have completed a year-long practicum in clinical neuropsychology. I'm not qualified to evaluate Terri Schiavo myself - that would take a board-certified neurologist or neuropsychologist - but I am certainly qualified to evaluate the adequacy or inadequacy of someone else's evaluation. And so I have read every one of the 17 affidavits, plus the report of the examining physician on whose findings Schiavo's parents are basing their case, plus the rulings from the trial court and the court of appeals.

None of the 17 affidavits are by providers who examined Schiavo. Only one of the 17 providers claims to have reviewed her medical records. The remaining 16 providers apparently based their statements primarily on six snippets of videotape, totalling 4 minutes and 20 seconds, which have been posted on Schiavo's parents' website and broadcast repeatedly on the news. Several of them explicitly say that they viewed these clips on the net, and the others all refer to the same short samples of behavior (e.g., Schiavo's eyes tracking a balloon). Many of them say they read news stories about Schiavo. One admits to only seeing news stories and photographs. They all reference their experience with "similar patients," but without qualifying what they mean by "similar." For example, one doctor draws comparisons to catatonic patients - but catatonia simply refers to an absence of voluntary motion or interaction, and can be caused by any number of things. Another references stroke patients, and two more talk about patients with Alzheimer's. As Ampersand points out, not one of them mentions the specific degree and type of brain damage that Schiavo has, as documented by her CAT scans:

Theresa's brain has deteriorated because of the lack of oxygen it suffered at the time of the heart attack. By mid 1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. [...]

Although the physicians are not in complete agreement concerning the extent of Mrs. Schiavo's brain damage, they all agree that the brain scans show extensive permanent damage to her brain. The only debate between the doctors is whether she has a small amount of isolated living tissue in her cerebral cortex or whether she has no living tissue in her cerebral cortex.

Most of the affidavits mention sophisticated new neuroimaging techniques which have been developed since the 1996 exams, and recommend that Schiavo receive a functional MRI (which tracks blood flow in the brain in response to specific stimuli) or a neuroSPECT exam (another functional imaging test). They note, correctly, that functional tests are capable of providing much more information about the nature and extent of brain damage than structural tests like a CAT scan. Yet Terri Schiavo's cerebral cortex is not damaged, it is absent. The affidavits repeatedly fail to engage with this finding. Thus, we have Dr. Ankerman: "The long duration lack of speech seen after injury trauma is not always due to destruction of brain structure. Sometimes it is due to a state of brain dysfunction that is reversible." Dr. Uszler: "Standard MRI or CAT scans are anatomy scans; they tell you if the tissue is there and its current structure, but these tests do not tell you whether the brain is working." And, most incredibly, Dr. Terman: "If the results of her response to certain neurological tests, for example the fMRI, were similar to that of normal individuals with undamaged brains, such data might indicate that there is some potential for her rehabilitation."

I suppose that these statements are technically true. Speechlessness is not always due to destruction of brain structure, but if massive destruction of brain structure is present, that's certainly the way to bet. CAT scans tell you if tissue is present and structured normally, but not if it's working; however, if tissue is absent, you'd think its lack of functionality could be assumed. And yes, if Terri had the same fMRI results as a healthy person, that would bode well for rehabilitation - but as we sometimes say here at Respectful of Otters, it's equally true that if my aunt had testicles, she'd be my uncle. Terri Schiavo doesn't have a cerebral cortex. She's not going to have a normal fMRI pattern. She simply couldn't. So it's pointless to speculate about what it would mean if she did.

What about the "new treatments" which might help Schiavo? Many of the providers assert that she could be trained to swallow, and they're probably correct. Swallowing is a brainstem reflex, and Schiavo still has her brainstem. The muscles of her throat could be stimulated - Mr. Lakas suggests using electric shock - to produce an automatic swallowing response to liquid nutrition. It's hard to see how that would amount to an increase in quality of life, however, given the mechanical nature of the reflex and the likely increased risk of choking or aspiration pneumonia. What else? One of the doctors (Ankerman, again) recommends the off-label use of an Alzheimer's drug, based on unpublished anecdotal evidence that it helps catatonic patients (not patients in a persistent vegetative state). Another recommends hyperbaric therapy, about which the trial court judge had previously pointed out, "It is interesting to note the absence of any [published] case studies since this therapy is not new and this condition has long been in the medical arena."

Two others make unsubstantiated claims that Schiavo could somehow be taught to communicate: "By helping Ms. Schiavo to communicate she will be able to tell us things, such as whether or not she wants to die, and if she wants a divorce" (Ms. Hyink), "sometimes even if a patient can only answer "Yes" or "No" it is still possible to determine what that patient wants in terms of end-of-life medical care" (Dr. Terman). Indeed, if Schiavo were capable of speech or meaningful communication it would be much easier to determine her wishes. That hypothetical, however, is completely irrelevant to the case.

The 17 affidavits all put considerable weight on the fact that, in the video snippets on Schiavo's parents' website, she appears to be responding to stimulation. Her eyes track a balloon. She smiles in response to her mother's voice. The affidavits therefore conclude that Schiavo is appropriately responsive to external stimuli, and that she is at least minimally conscious - not in a persistent vegetative state (PVS) at all. Yet none of the exhibited behaviors are, in themselves, unusual for patients with PVS. According to the National Institute of Neurological Disorders and Stroke:

Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace, cry, or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands.

So the presence of smiles, grimaces, vocalizations, and eye movements alone is not relevant to the question of whether Schiavo has retained any degree of consciousness or may benefit from therapy. They may be in part reflexive - as when she "smiles" when her cheek is stroked - and they may be completely random. The key to the 4 minutes and 20 seconds of video is that Schiavo seems to be responding in a meaningful way to specific stimuli. All 17 experts who reference the videos take for granted that they demonstrate meaningful emotional or communicative responses. Could they really all be wrong?

Oh, yes. All you need to know to illuminate the question is that the six snippets of video were selected from 4 1/2 hours of tape. As do most people with PVS, Schiavo emits random behaviors and noises. If a person gives enough commands or makes enough interaction attempts over the course of several hours, by sheer coincidence some of Schiavo's random behaviors will appear to coincide with their commands. Both the trial court and the appeals court viewed the entire 4 1/2 hour tape, and both concluded that her responses were indeed random. As the original court decision pointed out:

Dr. Hammesfahr testified that he felt that he was able to get Terry Schiavo to reproduce repeatedly to his commands. However, by the court's count, he gave 105 commands to Terry Schiavo and, at his direction, Mrs. Schindler gave an additional 6 commands. Again, by the court's count, he asked her 61 questions and Mrs. Schindler, at his direction, asked her an additional 11 questions. The court saw few actions that could be considered responsive to either those commands or those questions. The videographer focused on her hands when Dr. Hammesfahr was asking her to squeeze. While Dr. Hammesfahr testified that she squeezed his finger on command, the video would not appear to support that and his reaction on the video likewise would not appear to support that testimony.

Hammesfahr's own report makes clear that he relied on a ludicrously low standard to conclude that Schiavo's responses were purposeful:

Interestingly, some of the commands, such as close your eyes, open your eyes, etc. she tended to do several minutes after I gave her the command to do so. She had a delay in her processing of the action. However, when praised for the action, she would then continue to do the action repetitively for up to approximately 5 minutes. As we had moved on to other areas of the exam, at times she was continuing to do the previous command, then at inappropriate times since the focus of the exam had changed.

He commanded her to emit some of her known behaviors, such as closing or opening her eyes. If she did, that was a "hit" - a sign that she had obeyed the command. If she did so several minutes later, that was still a "hit," apparently no matter what else he'd asked her to do in the interim. If she continued , long after he'd moved on, that was not a sign that she was unresponsive to his subsequent commands but, instead, a sign that she was responsive to praise. Almost any response, correct or incorrect, could apparently be interpreted to signal consciousness. Hammesfahr, like Schiavo's parents, wanted to be convinced.

Terri Schiavo's case is tragic, but not medically complicated. Nothing about it suggests any room for diversity of medical or neuropsychological opinion. The "experts" who submitted affidavits appear to know little about her case beyond what they were able to glean from cherry-picked videotape segments only a few minutes in length. They recommend sophisticated neuroimaging techniques which are not relevant to the question of the feasibility of rehabilitation when the cerebral cortex is gone. Frankly, I can't imagine what led any of them to believe they had sufficient information to submit an affidavit. But some of their statements offer disturbing clues.

Dr. Eytan would seemingly reject any pre-injury statement about the conditions in which a person would prefer to refuse medical treatment, "because we are all in the process of changing." In the greatest unintentional irony of the entire stack of affidavits, she remarks that "Ms. Schiavo is not the same person as she was when she made her alleged remarks about not wanting to live in a certain condition." By this logic, she would apparently argue to invalidate any Living Will or advance directive. Dr. Senno states that just because Schiavo hasn't had any higher neurological functions for the past fifteen years, that doesn't mean she won't suddenly develop them today or tomorrow. By that standard, again, no one could ever be removed from life support. These doctors reject the fundamental right to refuse unwanted medical intervention. Imagine being kept alive forever in a mindless, volitionless, decerebrate, unresponsive condition, regardless of anything you might previously have said about your wishes to avoid such a state - just in case some new treatment were developed in the future which might cure you. That appears to be the new standard these medical providers are advocating.

(Tomorrow I'm planning to post about the ethical aspects of the case.)

Update: Ampersand posts an image from Terri Schiavo's CAT scan, next to an image of a healthy brain. The amount of brain tissue missing is truly shocking.

It's That Time Again...

Earlier this week, the perennial question made it into the mainstream media: "where are all the women bloggers?"

I find that I don't have anything more to say than I did the first time this came up in my blogging career, or the second time, a couple of months later, or the time I discovered that everyone thought I was a man. (That's stopped now that I'm openly using the p-word, right? I don't have to post pictures of my nine-months-pregnant belly?)

So instead of diving into the controversy again, I'll leave you with this masterpiece from tild~:

At The Bottom Of The Slippery Slope

One of the blogosphere's favorite topics is the faux "journalistic objectivity" achieved by presenting every story as if it had two equal sides - as wickedly illustrated by The Daily Show :

STEWART: Th-that's not a spin thing, that's a fact. That's established.

CORDDRY: Exactly, Jon, and that established, incontravertible fact is one side of the story.

STEWART: But that should be -- isn't that the end of the story? I mean, you've seen the records, haven't you? What's your opinion?

CORDDRY: I'm sorry, my *opinion*? No, I don't have 'o-pin-i-ons'. I'm a reporter, Jon, and my job is to spend half the time repeating what one side says, and half the time repeating the other. Little thing called 'objectivity' -- might wanna look it up some day.

STEWART: Doesn't objectivity mean objectively weighing the evidence, and calling out what's credible and what isn't?

CORDDRY: Whoa-ho! Well, well, well -- sounds like someone wants the media to act as a filter! [high-pitched, effeminate] 'Ooh, this allegation is spurious! Upon investigation this claim lacks any basis in reality! Mmm, mmm, mmm.' Listen buddy: not my job to stand between the people talking to me and the people listening to me.

Taking that particular journalistic tactic to its logical conclusion, C-SPAN's Book TV has refused to air a talk by Deborah Lipstadt, the noted historian who successfully defended herself against a Holocaust denier's libel suit - unless her talk is "balanced" by the Holocaust denier himself. As Richard Cohen explains,

The word balance is not in quotes for emphasis. It was invoked repeatedly by C-SPAN producers who seemed convinced that they had chosen the most noble of all journalistic causes: fairness. "We want to balance it [Lipstadt's lecture] by covering him," said Amy Roach, a producer for C-SPAN's Book TV. Her boss, Connie Doebele, put it another way. "You know how important fairness and balance is at C-SPAN," she told me. "We work very, very hard at this. We ask ourselves, 'Is there an opposing view of this?' "

Sadly, this is not a new experience for Lipstadt. In her 1993 book Denying the Holocaust, she details the ways in which Holocaust deniers have successfully exploited American values of free speech and open-mindedness to cast themselves as a legitimate "other side to the issue," which must be represented in public fora in the interests of fairness. In the preface to the second edition she reports that, time and again, news producers asked her to participate in debates with Holocaust deniers or to appear on an equal footing with them in "he said/she said"-style broadcasts. She quotes Montel Williams urging viewers to stay tuned to learn whether the Holocaust "is a myth or is it truth."

Holocaust deniers intentionally blur the distinction between the First Amendment right to speak freely, without government restraint, and the right to publicity, an audience, and scholarly consideration. Unfortunately, both in the media and in academia, far too many people have been taken in by these tactics. However repellent the ideas of Holocaust deniers, they argue, it would stifle intellectual freedom and journalistic objectivity to... well, apparently, to insist that the truth be presented as the truth.

The Lipstadt case is such a monstrous caricature of journalistic fairness that it's provoked outrage from The Washington Post's Richard Cohen, who has himself been far too prone to engage in the faux-balanced, "on the other hand"-style commentary that passes for moderation these days. I'd like to believe that his column will spark careful media reflection on journalists' responsibility to differentiate truth from obvious lies - but if Lipstadt's experiences in the early 90s are any indication, well, I shouldn't be holding my breath.

A Tale Of Two Hazards

In preparation for my new job, I'm reading - and adoring - Susan Douglas and Meredith Michaels' book The Mommy Myth , which outlines what they call the "new momism": "the insistence that no woman is truly complete or fulfilled unless she has kids...and that to be a remotely decent mother, a woman has to devote her entire physical, psychological, emotional, and intellectual being, 24/7, to her children." I'm particularly struck by the portion of their argument that points out the ways in which children's developmental outcomes are seen as being entirely caused by individual parenting choices made by their mothers, for good or ill. It resonates for me with my discovery, early in pregnancy, that "pregnant women are assigned infinite responsibility for the protection of their fetuses - without, I can't help noticing, actually having much real control." Here's The Mommy Myth 's summation:

"First, the media warned mothers about the external threats to their kids from abductors and the like. Then the “family values” crowd made it clear that supporting the family was not part of the government’s responsibility. By the late 1980s, stories about welfare and crack mothers emphasized the internal threats to children from mothers themselves. And finally, the media brouhaha over the “Mommy Track” reaffirmed that businesses could not or would not budge much to accommodate the care of children. Together, and over time, these frameworks produced a prevailing common sense that only you, the individual mother, are responsible for your child’s welfare: The buck stops with you, period, and you’d better be a superstar."

Last night I was reading the chapter about "crack babies," which turns out to have been an entirely media-generated myth. No one who lived through 1980s America can fail to remember the horrific images of tiny, shriveled, wailing black infants lined up in hospital isolettes, or the grim predictions that a generation of urban babies had no future.

One psychologist told The New York Times that crack was “interfering with the central core of what it is to be human.” Charles Krauthammer, a columnist for the The Washington Post, wrote that crack babies were doomed to “a life of certain suffering, of probable deviance, of permanent inferiority.” The public braced for the day when this “biological underclass” would cripple our schools, fill our jails, and drain our social programs.

None of it turned out to be true. Some follow-up studies of cocaine-exposed children found that they were not much different from other children of similarly impoverished backgrounds. Others found subtle differences - for example, a four-and-a-half point IQ difference at age seven, or a mild increase in behavioral problems. Cocaine use during pregnancy does tend to lead to lower birthweights and perhaps a higher miscarriage rate. But no specific syndrome emerged, no set of crippling symptoms that all cocaine-exposed infants had in common. Many children turned out just fine - or were primarily harmed by the crack baby myth itself, the expectation of everyone around them that they were ruined and hopeless.

Reading that tragic account, I started to wonder about the discrepancy between the "crack baby" storyline and the media's response, or lack of response, to another prenatal and early childhood hazard: lead exposure. Lead poisoning has profound effects on children's neurological development. The blood lead level considered "safe" has been lowered four times since 1970, as doctors recognized that negative developmental effects were associated with even very small amounts of lead. Lead is associated with lower IQs (1 to 5 points for every 10 microgram-per-deciliter increase in blood lead) and with increased delinquent and violent behavior in adolescence. The research evidence is undisputed - because of it, we now have unleaded gas, lead-free paint, and government programs designed to promote lead abatement and widespread lead testing for poor children. What we haven't had is a media furor about "lead babies" potentially constituting a biologically determined underclass - even though, at the same time that the "crack baby epidemic" fueled headlines, scientists were determining that the safe blood level for lead had to be lowered yet again, and that 9% of American children had toxic levels. So why not?

One possibility is that, unlike crack cocaine, lead was not a new and sexy hazard in the 80s and 90s. Unleaded gas was introduced in 1978, and the dangers of lead paint chips in run-down urban rental housing were well-recognized in 1960s and 70s criticisms of "slumlords." But I also think the discrepancy makes sense in light of Douglas and Michaels' theory. The lead problem is complex; it implicates delinquent landlords, decaying inner city housing stock, the shift in low-income housing assistance from federally maintained properties to the Section 8 system (which relies on private landlords), and state and municipal governments. That complexity just didn't fit in with the 80s and 90s zeitgeist in which the problems of the poor were blamed on individual pathology. In contrast, the "crack baby epidemic" was about poor black women being bad mothers, individually to blame for putting their babies at risk.

Dress Rehearsal For Abu Ghraib

Two Afghan prisoners who died in American custody in Afghanistan in December 2002 were chained to the ceiling, kicked and beaten by American soldiers in sustained assaults that caused their deaths, according to Army criminal investigative reports that have not yet been made public. [...]

Private Brand, who acknowledged striking a detainee named Dilawar 37 times, was accused of having maimed and killed him over a five-day period by "destroying his leg muscle tissue with repeated unlawful knee strikes." The attacks on Mr. Dilawar were so severe that "even if he had survived, both legs would have had to be amputated," the Army report said, citing a medical examiner.

The reports, obtained by Human Rights Watch, provide the first official account of events that led to the deaths of the detainees, Mullah Habibullah and Mr. Dilawar, at the Bagram Control Point, about 40 miles north of Kabul. The deaths took place nearly a year before the abuses at Abu Ghraib prison in Iraq.

The Army CIC reports apparently make it clear that in Afghanistan, as in Iraq, prisoner abuse was widespread. It was not limited to the two prisoners who are known to have been tortured to death, or to the two enlisted soldiers - Pfc. Willie Brand and a Sgt. James Boland - who have been charged in the prisoner murders. A couple of dozen other soldiers and reservists, including at least two officers, have been recommended for criminal charges - but those recommendations were made last fall, and who knows if they'll be followed up on.

Among those recommended for criminal charges is Captain Carolyn A. Wood, the chief military intelligence officer at Bagram, who lied to investigators in order to cover up the nature and purpose of the torture techniques interrogators were using. The next step in her military career was to travel to Iraq, where, according to the New York Times, she "helped to establish the interrogation and debriefing center at Abu Ghraib. Two Defense Department reports have said that a list of interrogation procedures she drew up there, which went beyond those approved by Army commanders, may have contributed to abuses at Abu Ghraib."

Both of the officers named in the Army reports released to the Times are captains. The Respectful of Otters Military Advisory Board points out that these are relatively low-ranking officers, and that you'd expect to see the eventual charges reach higher in the chain of command. (Compare to Abu Ghraib, where Brigadier General Janice Karpinski is still under intense investigation and will almost certainly face serious charges.) The wheels of military justice seem to be grinding awfully slow, on these torture charges. I don't know whether that means that they're trying very hard to get it right and identify everyone involved - as opposed to going for a quick show trial of some prominent scapegoats - or whether it means that they're hoping the whole thing will blow over. On the one hand, the lack of widespread furor over the Gonzales confirmation suggests that Americans have been disappointingly quick to forget their moral outrage over Abu Ghraib. On the other hand, over the course of the Afghanistan and Iraq wars I have developed considerable respect for the military legal system. They've resisted the Bush Administration's plans for secret detentions and fake "trials" right down the line.

So we'll see.

For My Next Trick...

Misdirection is a tool that magicians use to focus the audience's attention on something irrelevant, so that the magician can secretly do something else. "There's nothing up my sleeve," the magician boasts, and while you're looking at his innocent forearms, the real action of the trick is going on somewhere else. Not, of course, that the use of misdirection is limited to magic.

The proposed 2006 budget that President Bush submitted to Congress this week calls for cutting funds for federal AIDS prevention and surveillance programs by $4 million, a development that drew sharp criticism from AIDS activists.

Activists said they were especially concerned that the proposed cuts came at the same time the president is calling for a $38 million increase in programs aimed at curtailing AIDS and teen pregnancy by promoting sexual abstinence until marriage.

“Programs which focus on abstinence as the sole means of preventing HIV/AIDS put our young people at tremendous risk,” said David Smith, an official with the Human Rights Campaign, a national gay political group that lobbies Congress on AIDS.

Raise your hand if your brain just went into a full-scale rant on the ineffective and dangerous nature of abstinence-only sex education for teenagers.

If your hand is raised, you just missed the palmed card. (Don't feel bad - so did David Smith of the HRC, apparently, and he should know better.)

Why? Because you've accepted "teenagers" as the implied proper target of HIV prevention services, and are only arguing about how best to serve them. Teenagers need HIV prevention education, of course. But the majority of American teenagers, like the majority of the general American population, are not at high risk of contracting HIV. Who's at high risk? Gay and bisexual men, especially young men and men of color. Drug addicts of all stripes - not just injection drug users, but anyone whose addiction might lead them to trade sex for money or drugs. Poor African-American and Latina women, especially in inner cities. Anyone low enough on the socioeconomic scale to engage in "survival sex" for food, money, protection, or a place to stay. Prisoners. Transgendered people. Homeless people. People with severe mental illnesses. Prostitutes. African, Latin American, and Caribbean immigrants - especially women, married or not.

"Abstinence-only HIV prevention" is not aimed at any of these high-risk populations. It reaches some of them incidentally - urban minority youth living in poverty, for example. But, for the most part, "we intend to concentrate HIV prevention dollars on abstinence-only programs" means "we intend to concentrate HIV prevention dollars on people who are at relatively low risk of infection." We should be arguing about the uselessness of abstinence programs, yes. But we shouldn't get so caught up in doing it that we forget to ask why funds for prevention among high-risk groups have been cut.

Well-meaning people on the left have contributed to the problem by universalizing HIV: "It's everyone's problem." "HIV doesn't discriminate." That's true, up to a point. But it's also undisputably true that HIV infection in the United States is largely concentrated among particular subpopulations. The Bush Administration is steadily bleeding money away from prevention services for those subpopulations, in favor of programs designed to encourage sixteen-year-old middle-class girls to stay virgins. That's the real scandal here.

Welcome To The New Economy

Over at Crooked Timber, John Quiggin attempted to put the bankruptcy bill in the context of the rising economic instability for American households, and the shifting of economic risks from government and business to individual workers. (The link is to an outstanding LA Times series; some of the best reporting I've seen all year.)

Predictably, the comments at Crooked Timber devolved into a shallow and anecdote-laden debate about whether people in economic distress are shiftless layabouts who make poor economic choices, or hapless victims of unforeseeable catastrophe. I got frustrated fast, because I think that John's point about instability is too important to skim over. Fortunately, I remembered that I have my own blog... neglected as it is.

Here's the key summary from the LA Times series:

In the early 1970s, the inflation-adjusted incomes of most families in the middle of the economic spectrum bobbed up and down no more than about $6,500 a year, according to statistics generated by the Los Angeles Times in cooperation with researchers at several major universities. These days, those fluctuations have nearly doubled to as much as $13,500, the newspaper's analysis shows. [...]

To help cope, many Americans have borrowed. Arguably, borrowing has become for this generation what unemployment compensation, the GI Bill and government-guaranteed mortgages were for a previous one — a way to tide over one's family during bad times and reach for a better life.

The traditional measure of household debt — calculated as a percentage of a family's after-tax income — has climbed from 62% a quarter century ago to almost 120%, according to Federal Reserve statistics. Much of that increase is from the rush of mortgage lending during the last decade. But non-mortgage debt, including credit cards and auto loans, also has risen, from 15% to almost 24% of after-tax income.

Economists and policymakers have generally applauded the growth of borrowing as a boon to the economy and a blessing for average Americans. They have portrayed the extension of credit to families further and further down the income scale as part of a sweeping democratization of finance.

Enough has been said elsewhere about the "democratization of finance," which apparently means "extending loans at usorious rates to people who won't be able to pay them back." (For example, Slacktivist's fine moral indignation can be seen here and here.) The real insanity is the idea that credit cards are my generation's unemployment compensation, GI bill, and health insurance. No wonder we're going bankrupt at unprecedented rates. As funny as we're supposed to find the phrase "I'm from the government, and I'm here to help" (and as someone who provides free government-funded health care to indigent people with HIV, I've never found it all that funny), it is far, far more ludicrous to paint MBNA America as a helping hand in times of crisis. When you're in any kind of an extended economic crisis, credit cards rarely do anything but make matters worse. My generation's unemployment compensation and GI Bill, sure - if those things actually mired you deeper in uncertainty and debt.

Americans are constantly being lectured in the press for our financial imprudence. We buy things we can't afford, we don't have enough savings to tide us over through rough times, we haven't gotten on board with the President's ownership society. But the level of income instability described in the LA Times series is not something that can be countered by simple habits of thrift.

Take "emergency savings," for example. Every basic financial advice article ever written includes the advice that people should have three months' worth of living expenses stored up in savings, in case of catastrophe. Great advice. But with the average length of a period of unemployment now 20 weeks, that prudent three-month cushion isn't going to take you very far. That's what unemployment insurance was supposed to be for - but it's been pared down from 15 months of guaranteed benefits in the mid-70s to six months today.

Conservatives love to sneer at the big TVs and minivans owned by the average debt-holding middle-class American. "If they didn't buy all those fancy things," the condescending argument goes, "they wouldn't find themselves on the verge of bankruptcy." (Then follows a long and dreary story about how the conservative's mother walked home with all their groceries because the family only had one car, and how they listened to a crummy portable radio, and they never felt deprived because they made their own fun.) But look back up at that $13,500 fluctuation in annual income. If you earned $13,500 more last year than you will this year, is the big TV you bought back then really a sign of financial improvidence? is it unreasonable to sign a car note when you're making $60,000 a year, on the off chance that you might lose your job and be out of work for six months and eventually be unable to make the payments?

We here at Respectful of Otters can relate to these questions on a deeply personal level. My household once made the mistake of assuming, based on our quaint 1990s expectations of the economic world, that an intelligent and personable individual with good work habits would be able to find a job in a major city. On the basis of that assumption, we signed a lease for an apartment which, when a job failed to materialize, we couldn't afford. Was it ridiculous for us to be paying $950 in rent with a combined annual income of somewhere around $24,000? Yes. Was it ridiculous of us to assume, when we signed the lease, that two working adults would be able to pull in more than $24,000? I don't think so. We had not adjusted our expectations to the bold new rules of the new economy, the "ownership society" in which it was our responsibility to plan ahead for such common eventualities as a year of un- and underemployment. But even if we had adjusted our expectations, it's hard to imagine what we could've done to cushion ourselves against such a severe economic shock.

What did we do instead? We borrowed money from our parents, and we maxed out my credit card. (That's my generation's version of unemployment compensation, after all.) Eventually, we fell behind in our bill payments. At that point we were flooded by new credit card offers, far more than ever before or since, all of them bearing stratospheric interest rates and enormous penalties for late payments. Five or six offers a day. We were terrible credit risks at that point, and the credit card companies were falling all over themselves to sign us up for more debt.

But they would've been shocked, shocked if we'd defaulted on our loans. We would've been one more example of why Congress needed to protect them from the economic risks of their poor decision-making. And no one would've made speeches to them about their need to take "ownership" of anything... but our assets.

Welcome to the new economy.