Compare And Contrast

Lots of complaints about Orson Scott Card's gay marriage screed are making the rounds of the blogosphere. I've got a major advantage over many of my fellow SF fans - I never thought much of Card's books, so I don't feel betrayed by someone I once admired. (At an American Psychological Association conference a few years back, I talked to a guy who uses Ender's Game in his developmental psychology class. The students are supposed to identify the inaccurate portrayals of children's developmental capacities, which must take them reams of paper. But I digress.)

Card's essay has some strange elements. He shares with many other religious conservatives the conviction that homosexuality is so much more intrinsically pleasurable than heterosexuality that everyone would be gay if there weren't rigorous strictures against it. ("Men, after all, know what men like far better than women do; women know how women think and feel far better than men do," he says, clearly not having met my ex-girlfriend.)

He also comes up with this:

In the first place, no law in any state in the United States now or ever has forbidden homosexuals to marry. The law has never asked that a man prove his heterosexuality in order to marry a woman, or a woman hers in order to marry a man.

Any homosexual man who can persuade a woman to take him as her husband can avail himself of all the rights of husbandhood under the law. And, in fact, many homosexual men have done precisely that, without any legal prejudice at all.

It occurred to me, as I read this, that I'd come across precisely the same argument before - in the Supreme Court's decision in Loving v. Virginia:

The State does not contend in its argument before this Court that its powers to regulate marriage are unlimited notwithstanding the commands of the Fourteenth Amendment. [...] Instead, the State argues that the meaning of the Equal Protection Clause, as illuminated by the statements of the Framers, is only that state penal laws containing an interracial element as part of the definition of the offense must apply equally to whites and Negroes in the sense that members of each race are punished to the same degree. Thus, the State contends that, because its miscegenation statutes punish equally both the white and the Negro participants in an interracial marriage, these statutes, despite their reliance on racial classifications, do not constitute an invidious discrimination based upon race.

The state of Virginia argued that the interracial marriage ban did not constitute discrimination because white people, as well as people of color, were banned from marrying outside their own race. That ought to sound familiar to current defenders of marriage discrimination, and they ought to be ashamed.

A Fabulous Idea In South Africa

Some ideas make so much sense, in retrospect, that it's almost hard to recognize how brilliantly innovative they are:

Kids run in a circle and push a merry-go-round faster and faster. Those who are seated on the ride, get dizzy from the speed...laughing and giddy from the force of gravity. [...]

The children push the merry-go-round again and again. As they run, a device in the ground beneath them begins to turn. With every rotation of the merry-go-round, water is pumped out of a well, up through a pipe, and into a tank high above the playground.

A few feet away from all the fun, students in uniform turn on a tap. Clean, cold drinking water pours out. [...] Field says the energy created by kids turning a merry-go-round generates enough power to supply a village of 3000 people with clean drinking water.

The technical specs, if you're interested, are here. 500 of these "Play-Pumps" have already been installed in South Africa, funded by collaborations between businesses, foundations, and the South African government. The World Bank just provided money to install forty more.

It's hard to conceive of just what a big difference this makes for poor women in South Africa, whose exclusive responsibility it is to fetch water for their families. It's not uncommon for these women to spend four hours a day carrying heavy containers of water over long distances. The Women's Environment and Development Organization says that the "inordinate burden of fetching water inhibits women's and girl's involvement in other activities such as education, income generation, cultural and political involvement, and rest and recreation." The installation of these Play-Pumps means that water is available close by, and it's efficiently pumped up and stored by children who are just having fun. What a beautiful project.

(Via Mary MacTavish)

Congress Shall Make No Law Abridging Freedom Of The Press

The Bush Administration's war on intellectual freedom marches on.

the U.S. Treasury Department’s Office of Foreign Assets Control has declared that American publishers cannot edit works authored in nations under trade embargoes, including Iran, Iraq, Sudan, Libya, and Cuba. Treasury says that although publishing the work is legal, editing is a “service,” and it’s illegal to perform services for embargoed nations. It can be punishable by fines of up to a half-million dollars or jail terms as long as 10 years.

This is from Making Light, where Teresa Nielsen Hayden is appropriately dumbfounded to hear that, as an editor, she is a Potential Enemy Of The State. But apparently I'm late in blogging this; Charles Dodgson notes that scientific and professional societies got the news last fall. Here's a quote from the Institute of Electrical and Electronics Engineers:

On 30 September, the U.S. Treasury Department (Washington, D.C.) informed the Institute of Electrical and Electronics Engineers (IEEE) that it must continue to limit members’ rights in four countries embargoed by the United States: Cuba, Iran, Libya, and Sudan. The ruling means, among other things, that the IEEE, the world’s largest engineering association (and the publisher of this magazine), cannot edit articles submitted by authors in those countries, making it effectively impossible for most such work to appear in IEEE publications.

This administration has politicized science like no other in modern U.S. history. I've blogged before about the perversion of the peer review process, and the Administration's efforts to distort or suppress government-funded research that fails to support their policies have been all over the news. (Condom effectiveness, abstinence-only education, global warming, health disparities... go to Henry Waxman's website and type in your favorite scientific topic.) Now we're moving beyond suppression of Bad Ideas to the suppression of ideas from people in Bad Places, and all by an administration and party that still somehow manages to see itself as the embodiment of "freedom."

Are conservatives really comfortable with the idea that, if someone in one of those proscribed countries comes out with a local version of Solzhenitsyn's The Gulag Archipelago, our country will punish anyone who tries to publish it? It all just seems so... Soviet.

Vaccination-Autism Study Recanted

The Lancet, the premier British medical journal, has renounced their publication of a 1998 study apparently showing a link between the measles-mumps-rubella (MMR) vaccine and autism. The author of the study, Andrew Wakefield, failed to disclose to the journal that he was being funded by lawyers hoping to demonstrate that parents of autistic children could sue vaccine manufacturers.

("But aren't pro-vaccine researchers funded by drug companies?" I hear you cry. Some of them are, yes, and they're required to disclose that when they publish scientific articles about vaccination, just as Wakefield was required to disclose his financial interest in the question.)

People who are big supporters of herbal supplements often explain to me that drug companies have a major financial interest in suppressing information about the effectiveness of herbal remedies, apparently forgetting or disregarding the fact that the multimillion-dollar herbal supplement industry has financial interests in the opposite direction. I hope that vaccine skeptics won't make the same mistake, and will evaluate Wakefield's conflicts of interest with the same scrutiny they give to members of the medical establishment.

The Shame Of The Yankees

Remember those horrible anonymous anti-Dean ads that ran in Iowa, linking Dean to Osama Bin Laden?

They were partially funded by the New York Yankees.

No, really! The YES network (the Yankees' in-house television network, of which 60% is owned and controlled by George Steinbrenner) contributed $100,000 of the $660,000 raised. So the Yankees didn't just contribute, they were major players.

Like all true baseball fans, I learned long ago that Yankee-hating is fundamental to the sport. You'd think I couldn't be shocked anymore. But you'd be wrong. Holy cow.

Major props to Rick Heller at the Centrist Coalition for breaking the story.

Flowers From The Heartland

"I'm hoping whoever got the flowers realizes how special it was for them to do that. They're doing it not only for themselves, they're doing it for a young man back here in Minnesota who looks forward to finding someone to love, to cherish and to celebrate that love in a wedding and call it marriage."

There's still time to send a bouquet.

Chick Blogging

Some great feminist writing is happening in the circle of blogs I read, this week:

Echidne of the Snakes has an excellent post about the meaning of feminism and the efforts of the right wing to redefine and distort the concept. She may be a minor Greek goddess, but there's nothing minor about her writing and analysis here.

Pen-Elayne expands expands on the media's tendency to focus on feminist involvement in culture-wars issues, like single-sex golf clubs, and to ignore the serious work feminist organizations do on "unsexy" issues like reproductive health care in developing countries.

Trish Wilson continues to be all over "father's rights" activist Lowell Jaks' kidnapping of his son Alec Jaks. She does a great job of puncturing the rhetoric of the father's rights movement, particularly when she quotes the posts they make among themselves when they think no one else is watching. Did you know that the U.S. government - wait, make that the "femerment" - is run entirely by and for women? Yeah, neither did I.

Speaking of punctured myths, Ms. Musings links to a report from a Purdue University social scientist laying the whole tired "Men are From Mars, Women Are From Venus" thing to rest. Erina MacGeorge's study title says it all: "The Myth of Gender Cultures: Similarities Outweigh Differences in Men's and Women's Provision of and Responses to Supportive Communication." I want to take a look at the actual article, because I have a sneaking suspicion that by "men and women" she means "male and female undergraduates" - who often aren't representative of the whole adult population. But her essential point can't be made often enough: the psychological "gender differences" that are made so much of usually amount to a small average difference and a huuuuge amount of overlap. Men and women are much more alike than we are different. (Which some seem to find threatening, but I digress.)

Julia at Sisyphus Shrugged brought my attention to the Slate nanny debate between Barbara Ehrenreich, Sara Mosle, and the repellent Caitlin Flanagan. I had never encountered Flanagan before, but she lost me in the first two paragraphs of the article that touched off the debate, when she talks about sneering at bad mommies who use daycare at a time when she was staying home and had a full-time nanny to do the (literal) shitwork. She repents of that, kind of, but it sets the tone for her entire discussion of the work/parenting/childcare dilemma. Her basic thesis is that "feminists" who want to have jobs oppress the lower-class women they hire to look after their children. Completely absent is any consideration of these children's fathers, who apparently bear no responsibility for their children's care. I also like the assumption that women rich enough to hire nannies are all "feminists," and therefore the feminist movement is to blame for their choices. Also completely absent is any significant discussion of the 95% of us who will never be in the position of trying to decide how we should treat our full-time servants.

The Empire Strikes Back

The New Mexico Attorney General has shut down gay marriages in Sandoval county. That was quick. It also seems - although I am not a lawyer - specious.

In Sheriff John Paul Trujillo's hand was the attorney general's advisory letter, which stated that "until the laws are changed through the legislative process or declared unconstitutional by the judicial process, the statutes limit marriage in New Mexico to a man and a woman."

So how come the Sandoval county clerk - who, incidentally, is a Republican, and the Attorney General is a Democrat - didn't know that? Because the definition of marriage in Section 40-1-1 of the New Mexico statutes doesn't specify genders at all. "Marriage is contemplated by the law as a civil contract, for which the consent of the contracting parties, capable in law of contracting, is essential." The sections describing who may and may not be married, and how marriages must be performed (40-1-2 to 40-1-17), don't specify genders either. The Attorney General's justification is section 40-1-18, which is a copy of the form couples need to fill out at the courthouse. It includes references to "male applicant" and "female applicant."

Sandoval County clerks reported that the vast majority of applicants were lesbians, including many with children. [...]

With the sheriff beside her, chief deputy clerk Susan Utegg-Pedersen told several waiting couples that the office was closing early because of the attorney general's letter.

Several persons shouted back, including two newlywed men desperately trying to file their completed license.

"We've already been married and now you're not going to record it!" Ron Hay, 52, a water utility operations manager from Belen, N.M., told the chief deputy clerk. He married his live-in partner of more than 18 years, Rick Lawyer, 48, a mental health therapist.

Eighteen years together, and not deserving of the rights and recognition that Britney Spears got herself as a joke.

Can't Put The Genie Back In The Bottle

Last summer I read the first volume of the Library of America's Reporting Civil Rights, a collection of contemporaneous newspaper and magazine articles about the Civil Rights movement from 1941-1963. I had never before read anything about that era that wasn't retrospective - that wasn't written by people who, at least to some extent, knew how things turned out. The events of the Civil Rights movement appear powerfully different without the benefit of historical perspective. At the time of the sit-ins at Southern lunch counters, ordinary people were quoted in newspaper articles estimating that it would take fifty years for white Southerners to become comfortable eating in restaurants with black people. Fifty years. They had no idea how quickly social and emotional changes would follow the forced legal changes. "You can't legislate how people feel," they argued, but by and large they were wrong.

I'm thinking about that today, of course, because of the massive, marvelous campaign of love and civil disobedience that began in San Francisco last week and looks as if it may spread to New Mexico and Chicago - if not further. Mayors in Minneapolis, Salt Lake City, and Plattsburg, NY - which, incidentally, has a Republican mayor - have spoken out in favor of the civil disobedience in San Francisco. Rhode Island is considering a law allowing gay marriage. In Massachusetts, of course, the Supreme Court has ruled that the state constitution requires it. Things are happening very, very quickly.

Of course, some people are afraid that it's too much, too soon. Those fears accompany every liberation movement. Watching events unfold moment by moment, we can't see how they will turn out. Moving forward requires that we have courage, fortitude, and persistence - but still more has been required of others in our nation's history who fought for their basic civil rights. They didn't know how it would turn out either. They thought it might take fifty years for white Americans to be comfortable eating at a lunch counter with black Americans, and yet they sat themselves down anyway.

Looking at pictures of the newly married, I feel certain that I'm in the presence of something sacred. I recognize the awed, holy, joyous look on their faces, because I've seen that expression in my own wedding pictures. The state may eventually force annulments, but these people are married. They're not going to go away, cowed and quiet, back to their rightful place as it's defined by the state. You can't put the genie back in the bottle.

(Send a bouquet to a random same-sex couple in line at San Francisco City Hall: instructions here.)

Requiem

Dean abandons White House bid.

Here's something I wrote on the night that I discovered Howard Dean, last March:

tonight I was spurred by this article at The American Prospect into taking a long look at Dean for America... and getting excited. Probably disproportionately excited, in that I wanted to sign up right away to volunteer my heart out. Dean looks really good. But I think that also, tonight, I'm desperately yearning for something political I can feel good about, some leader I'd be proud to follow, some way to work for change. It's tempting, tonight, to believe that there's someone out there who can be the fulfillment of my hopes.

I did volunteer my heart out. Two weeks after that evening in March, I went to my first Meetup. In June, I organized my first flyering-for-Dean event. By July, I was permanently in charge of registering newcomers at my local Meetup. In August, I drove eighty miles to hear him speak for the first time. In October, I started spending eight hours a week doing research for the national campaign. In January, I became a Dean precinct captain. And the more I read, the more I thought, the more I watched, the more involved I got, the more certain I was that he really was all the things I'd hoped he would be.

I wasn't wrong.

I'm still proud of my work with the Dean campaign. It's been painful watching the campaign fall apart - so painful that I couldn't really blog about it. But now that it's really, really over, I want to say this: Dean changed the tone of the campaign. Before he became a factor the race, the major candidates were trying to outdo each other in moderation and timidity. In a way, he's out of the race now because all of the other candidates became more like him. He changed Democratic strategy, and in that, his legacy will live on.

The race is over, for Dean supporters, but the fight is not. I encourage you to follow Joe Trippi's new blog, Change for America, and to continue your efforts to transform the Democratic party and the country. Yeah, we're probably going to grieve for a while - but then we'll have to pick ourselves back up and keep working in the fight against Bush. Remember the last words of Joe Hill: "Don't mourn - organize."

Suffer The Children

When last we saw Our Nation's Youth, they were being traumatized by a brief view of Janet Jackson's nipple.

You can see why so many families and churches are turning off the TV, dominated as it is by liberal Hollywood elites, and turning instead to wholesome Christian entertainment for their children. Like a movie reportedly featuring a graphic, bloody, 45-minute-long beating.

[M]any parents and church leaders plan to have kids as young as 10 see the film, which opens Feb. 25, Ash Wednesday.

"The violence is necessary to understand the sacrifice Jesus made," says First Family pastor Jerry Johnston. His Baptist church has rented out a half-dozen theaters in Kansas City, Kan., and has reserved auditoriums the night of Feb. 27 for children 11 and older.

Johnston concedes they'll be disturbed by the violence. "I hope they're disturbed enough to make their peace with Jesus."

Another pastor justifies the exposure of young children to extended close-ups of bloody violence: "a lot of kids are already mature for their age. Look at what they see on MTV." (The same MTV which produced the infamous halftime show just two weeks ago is now setting appropriate guidelines for which images Christian kids can see. Truly they have been redeemed.)

When I was ten, I talked my parents into letting me watch "The Day After" - despite widespread media warnings that it was not suitable for children under twelve. I thought I was mature enough to handle it, and I was wrong. I was terrified for weeks. I had nightmares. By all accounts, "The Passion of Christ" is much, much more graphic and realistic. What kind of parents subject their kids to that?

(Via Pandagon.)

And Now The Good News

Ben Chandler won the special election in the Kentucky 6th, a major victory for Democrats and, hopefully, a sign of things to come.

According to Kos, the original headline on that CBS news article was "Ky. Vote May Signal Nation's Mood." I suppose they changed it to avoid charges of "liberal bias," but I think the original headline was perfectly justified. This wasn't just any Congressional election - both parties targeted the election as a major priority, and both candidates presented the race as a referendum on the Bush Administration's policies:

Chandler’s opponent, the Republican state senator Alice Forgy Kerr, who has tried to turn this race into a referendum on Bush. In fact, she began airing an ad last month that said she and Bush are “cut from the same cloth.”

“In the governor’s race that Chandler just ran, he made his opposition to Bush a centerpiece,” Kerr’s campaign manager told the Associated Press earlier this month. “Senator Kerr is making an equally big centerpiece out of her support for the president in her campaign.”

Kerr had all the help she could possibly have had from the national Republican leadership, including a repellent threat from Speaker of the House Dennis Hastert that he would only support a tobacco buyout plan for Kentucky farmers if Kerr were elected. The KY 6th usually votes Republican, so it's great news for the Democrats that Kerr's alliance with the national Republican leadership seems to have hurt more than it helped. Here's Kos again:

But then the polls showed her numbers dropping, despite running in a GOP-majority district. So she was then forced to distance herself from Bush. Bush himself cancelled campaign appearances on her behalf. The "popular" president was suddenly radioactive in solid red territory.

This distancing will reach its absurd conclusion when Cheney holds a fundraiser for Kerr on Saturday, February 7th.

In Illinois.

Seems that Kerr's own internal polling showed a Cheney appearance in her district would hurt more than help.

I know a lot of Dems who are feeling fatalistic and discouraged about the upcoming election. The results in the KY 6th should be powerfully heartening: it ain't over. If a Democrat can win in Kentucky on a message of lost jobs and Bush failures, Democrats can win nationally. We can't roll over and give in now.

Enemies

My grandfather went to his grave disappointed that he only made Richard Nixon's second "enemies list."

I bring this up because, apparently, David Horowitz has created a website purporting to identify links between various members of the left. Just the beta version is up so far, so there are plenty of gaps - but you can still discover a wealth of fascinating details. Did you know that Osama Bin Laden is on the "left?" The same "left" as the Gay and Lesbian Alliance Against Defamation and the Baptist Joint Committee on Public Affairs? What fun they all must have together.

Anyway: surely America is a land in which children strive to do better than their grandparents. Surely I owe it to my grandfather to make it onto David Horowitz's first enemies list. Any suggestions for how to go about it?

Update: Horowitz took the site down. Fortunately, someone mirrored it first.

(Via Crooked Timber and Eschaton. And while you're surfing around, check out the real website of the Baptist Joint Committee on Public Affairs, whose tagline is "protecting religious liberty by keeping church and state separate.")

YOU'RE GOING TO GET CANCER!!!!!!!

The media never get tired of telling us - especially the female half of us - that something is going to make us sick. Today's example is an article in the Washington Post: "Study Links Breast Cancer to Antibiotics Use."

Antibiotic use is associated with an increased risk for breast cancer, a new study has found, raising the possibility that women who take the widely used medicines are prone to one of the most feared malignancies.

There it is, right in the first sentence: the risk is almost impossible to avoid (who hasn't taken antibiotics?), and the disease is one of the most feared (it's not the biggest killer of women, or the most lethal cancer in women, or anything like that, so they're pretty much relying on subjective dread to get our hearts pumping here).

When a report of a scientific study uses the term "association," usually they mean a correlation. Correlation simply means that two factors tend to co-occur. It doesn't tell you a thing in the world about why the two factors co-occur, which is kind of a bitch for people who want to interpret correlations in exciting ways. There are three main causal possibilities when you're dealing with a correlation: (1) Factor A could cause factor B. (2) Factor B could cause factor A. (3) A third factor (C) could cause both A and B.

Despite the shock headline of the Post article and its moral that doctors should be even yet still more careful about prescribing antibiotics to women, this story seems like a prime candidate for explanation (3). Women who take a lot of antibiotics are probably sicker than women who don't take a lot of antibiotics. If they're coming down with a lot of infections, they probably have weaker immune systems. Guess what else the immune system fights? Developing tumors.

Why didn't they control for the initial health of the women in the study, or collect measures of immune function? Because they didn't have the opportunity. This was what's called retrospective research. They had a lot of data on the health care used by women belonging to a particular health plan, and they sifted through it looking for relationships between medications and cancer. So they didn't have much information on the functioning of these women's immune systems, or on other breast cancer risk factors. The authors of the study admit as much in their abstract in the Journal of the American Medical Association, but the same information is buried in the popular press article.

We have to read through to the last paragraph to get some words of sense from the American Cancer Society:

One finding that cast doubt on the possibility that it will turn out that antibiotics increase the risk for breast cancer was that the study found the risk for all types of antibiotics, said Debbie Saslow, director of breast and gynecologic cancer for the American Cancer Society. That makes it unlikely it's the antibiotics because they different classes work in very different ways, she said.

They'll do some more research on this one, and probably they'll find out that the pills you innocently took for strep throat when you were twenty aren't going to kill you when you're seventy. But in the meantime, lots of women are being made to feel very, very afraid.

Special Valentine's Day Edition

We here at Respectful of Otters are marking this Valentine's Day with a raging case of bronchitis. (At least our antibiotics are a cheery, holiday-themed pink - albeit not heart-shaped.) But in spite of all that, I can't resist bringing you a roundup of the preposterous the-science-behind-love stories newspapers everywhere feel obliged to run on the 14th of February.

Some English researchers have discovered that the same neurochemical processes are at work in maternal and romantic love, particularly the parts in which the brain "suppresses brain activity governing critical social assessments of other people and negative emotions." Mothers have to feel that way about infants, so that they'll meet their ridiculously demanding needs without killing them. It's a bit disquieting to learn that the exact same process occurs between romantic lovers, isn't it?

The Economist has more details about the neurochemistry of love, although you have to read through quite a lot about the romantic lives of voles before you get to the human parts. It turns out that

The results were surprising. For a start, a relatively small area of the human brain is active in love, compared with that involved in, say, ordinary friendship. “It is fascinating to reflect”, the pair conclude, “that the face that launched a thousand ships should have done so through such a limited expanse of cortex.” The second surprise was that the brain areas active in love are different from the areas activated in other emotional states, such as fear and anger. Parts of the brain that are love-bitten include the one responsible for gut feelings, and the ones which generate the euphoria induced by drugs such as cocaine. So the brains of people deeply in love do not look like those of people experiencing strong emotions, but instead like those of people snorting coke.

Hands up, all who are surprised that most of the brain doesn't seem to be working when we're madly in love. But seriously, what they're saying is that romantic love activates the dopamine reward system, the major source of pleasurable and euphoric feelings in the brain. While it's true that drugs like cocaine also activate the dopamine reward system, saying that love is just like cocaine probably overstates the significance of the relationship. Love feels intensely good. Cocaine, I'm told, feels intensely good. It's therefore unsurprising that they'd activate the same parts of the brain. Although I suppose that "we're addicted to love!!!" makes a much better headline, from both a sensationalistic and a public-responsibility point of view, than "snorting cocaine will make you feel like you're in love!!!" ...which is equally true, from a scientific standpoint.

Lastly: we'll never run out of specious evolutionary psychology theories which purport to explain why our current social prejudices are biologically determined and thus fixed and unchangable. This one asserts that our true biological nature leads us to a combination of quasi-monogamous pair bonds and infidelity. The justification for this is supposedly that primitive man could only protect one family at a time from ravening predators, so despite screwing around all the time he only formed a romantic attachment to one woman. Not explained in this theory: if pair bonding is so damn natural, how come there have been so many polygamous cultures, widely dispersed across the globe and occurring throughout human history? Also not explained in this theory: given that most primitive peoples we know about have lived in extended-family bands for mutual support and protection, where did all the little nuclear families who populate this theory come from?

It never seems to strike people as oddly convenient that the somewhat anomalous relationship practices of 21st century Americans just happen to be the most natural ones. And so the general appetite for evolutionary psychology just-so stories never seems to die out.

Home, Sweet Home

I haven't seen much in the blogosphere about Bush's new proposal to make more FHA mortgage loans available with zero money down.

There are already no-down-payment mortgage programs available for people with exemplary credit. The FHA program would extend that to people with lower incomes, higher household debt ratios, and shakier credit. The down payment and closing costs would be rolled into the overall price of the loan, and the extra risk would be covered by 0.75% higher interest rates - making the program pay for itself.

At first glance, this new program looks like the American Dream Downpayment Act, Part II. The ADDA was unrolled with great fanfare last December, with Bush promising that "this legislation will authorize $200 million per year in down payment assistance to at least 40,000 low-income families." In a now-familiar pattern, though, the actual budget only called for $87.5 million, and the estimate of the number of families that would be helped by $200 million was based on the lowball expectation that each would need only a $5,000 down payment.

But trimmed though it was, the ADDA was essentially a good idea. Families who receive down payment grants have actual cash money invested in their houses, and are on their way to building equity - whereas families who are allowed to roll their down payment and closing fees into the mortgage just have greater debts.

Foreclosure rates are already climbing fast, and FHA loans are more likely to be foreclosed upon than traditional mortgages. It's hard to see how low-income homebuyers are helped by encouraging them to buy homes they ultimately can't afford. (I'm trying to avoid making the black-helicopter-theory point that the "FHA's insurance operations turn a substantial annual profit that flows into the federal treasury." Oops, I made it anyway.)

The National Consumer Law Center points out that, although homeownership is a powerful tool in the fight against poverty, it's not sufficient to just put low- or moderate-income people into houses:

Maintaining a home presents special challenges for a low-income household. Limited savings and low equity render low-income homeowners vulnerable if income or expense fluctuations lead to mortgage delinquencies. High maintenance and energy costs drive housing costs upward for low-income homeowners because they tend to live in older or less sound homes.

Low-income homeowners are often targets of consumer scams. Predatory home equity lenders drain assets from low-income neighborhoods by foreclosing on high-rate loans, made primarily to elderly and minority borrowers. [...] As more low-income people buy homes through first-time homebuyer programs, housing advocates need to learn strategies for sustaining their clients’ homeownership over the long-term.

Increasing homeownership for low-to-moderate income Americans is a laudable goal. But when Americans are already drowning in debt, it's hard to see the long-term benefits of a program that encourages people with shaky finances to take out larger and larger loans. We need to be looking at programs to encourage wealth creation for the poor, so that they can legitimately afford to buy homes. We need to offer people greater assistance in avoiding foreclosure, including stricter protections against predatory lending in low-income communities. And we need to do a vastly better job of providing affordable low-income rental housing, nationwide.

Everything Old Is New Again

My Significant Otter called my attention to this story in the Washington Post, which describes how public health officials in North Carolina managed to identify and address an outbreak of new HIV infections among black gay college students. When the first cases appeared, the health department interviewed the young men about their partners. Then they tracked those partners down, encouraged them to get tested, and got information about their partners. They were eventually able to identify 69 linked cases of HIV, some so early in the course of infection that a normal HIV test would not yet be positive. It's being lauded as a major public health advance.

What's ironic about this story is that, except for the PCR technique that diagnoses HIV prior to a positive antibody test, none of these techniques are new. Fifty years ago, that's exactly how public health officials addressed outbreaks of syphillis and gonorrhea: tracing partners of infected persons and ensuring that they got tested and treated. Those public health strategies have just never been applied to HIV on any kind of a widespread basis.

The reason boils down to what's been called "AIDS exceptionalism." When the AIDS epidemic was first identified, as those of you over thirty probably recall, outrageous discrimination against people with HIV was rampant. AIDS activists successfully argued that vigorous efforts to identify infected people - for example, by mandatory testing or contact tracing - would expose them to stigma, discrimination, even violence. So for the next twenty years, the public health approach to HIV was characterized by voluntary testing and efforts to persuade the public to reduce risk behavior.

It hasn't worked very well, so now more traditional public health methods are coming back into use and being trumpeted in the press as major innovations. We'll see if they work any better.

Euthanasia, Part 2b: Suffering

(Read the prologue, part 1, and part 2a.)

Why do people with incurable illnesses want to kill themselves? If it surprises you to hear the answer, "for the exact reasons that anyone else wants to kill themselves," that's probably because proponents of Physician Assisted Suicide (PAS) have successfully created the impression that there's a bright line of distinction between (1) crazy people, who want to commit suicide because they're depressed, irrational, and impulsive; and (2) incurably ill people, who want to commit suicide for rational reasons.

If that were the case, then it would make sense to prevent crazy people from committing suicide while offering suicide assistance to the incurably ill. But there's nothing exceptional about the suicidal wishes of people with incurable illnesses. The desire to die is associated with depression, hopelessness, feeling unsupported, and seeing oneself as a burden with nothing of value left to offer the world. That's true for both the physically ill and the physically well. And these symptoms respond to treatment, for the physically ill and the physically well alike.

We owe our clinical and scientific understanding of these phenomena to three brilliant psychiatrists who study dying people: a Canadian, Harvey Max Chochinov, an American, William Breitbart, and an Australian, David Kissane. Last spring, I was privileged to spend an afternoon at a seminar with them, and to hear about how they care for their patients as well as what their research has found. Here's what they taught me, which also fits with what I have learned from my own dying clients:

The desire to die is not universal among the incurably ill. It is strongly related to depression and the feeling of being unsupported. Among people with HIV, interest in PAS is associated with measures of psychological distress and poor social support, and not with "severity of pain, pain-related functional impairment, physical symptoms, or extent of HIV disease." Beyond the simple clinical syndrome of depression, all three of these psychiatrists have written movingly of the loss of meaning, or sense of demoralization, that can occur at the end of life as people struggle to see themselves as worthwhile and valuable to others. When people - medically ill or not - no longer feel that there's a point to their life, they often want to die.

One of the earliest pieces of clinical advice I ever received was that "if you ever find yourself agreeing with the patient that his position is hopeless, you've gotten sucked into his depression and are no longer thinking rationally." Time and again, I've found this to be true. Yet when depressed dying people are concerned, our society too easily falls into sharing their misconception that they no longer have anything of worth to offer. Their depressed and hopeless thoughts sound, to many of us, like the simple and incontrovertible truth.

Fortunately, the psychiatrists I mentioned have found successful treatments which address these problems. Breitbart's got an eight-week therapy program which focuses on restoring a sense of meaning to the lives of people who are slowly dying. Chochinov has developed what he calls "dignity psychotherapy," which in a couple of sessions at the hospital bedside can help dying people regain a sense of purpose, of usefulness, of legacy. They've both found that patients who receive these interventions lose interest in PAS, and are better able to make positive use of their last days.

The success of these interventions belies the claim that depression and loss of purpose are an inevitable component of the end of life. The argument for PAS rests on the assumption that incurably ill people who want to die are making a rational decision untainted by emotional distress which may be treatable or transient. The more we learn about the mental and emotional states of dying people, the less justifiable that assumption proves to be.

Otters Take Over The World

My Significant Otter is going to be joining the team at the fine group blog Obsidian Wings, at least temporarily. He's got a proud history as a blog commenter, so watch for great things.

More On Ritonavir

A while back I wrote about Abbott Pharmaceuticals' decision to raise the price of their drug Ritonavir.

Since then, doctors have decided to fight back:

About 200 physicians have agreed to boycott Abbott drugs in favor of alternatives whenever medically appropriate, Young said. Norvir has no equivalent, but physicians can find substitutes for other Abbott products [...] The doctors also have agreed to ban Abbott sales representatives from their offices and to refuse to participate in any new Abbott-sponsored clinical trials, until the company rescinds the price hike.

It's a particularly smooth move to boycott Abbott products in general, given that HIV management is tricky enough that no one's going to change their patients' regimens for the sake of a boycott.

In return, Abbott's offering some concessions that look good on the surface but don't seem to get to the heart of the problem. They'd already promised not to raise the price of ritonavir purchased by state AIDS Drug Assistance Programs until 2005 - now they're making that "permanent." And they're promising to make ritonavir available free of charge to anyone who doesn't have insurance. But, as I said in my earlier post, not many people take straight-up ritonavir. The real issue is the role of ritonavir in combination with other protease inhibitors (it intensifies and extends their effects). Several new drugs depend on the inclusion of ritonavir to be practical and cost-effective - only now that the price has risen 400%, the "cost-effective" part no longer applies.

Abbott's promising to make ritonavir available at the former price for research studies of new drugs. That doesn't apply to the drugs that have just hit the market now, and which depend on a ritonavir boost. And of course, it will only benefit Abbott to encourage further research into ritonavir-dependent drugs, given that once those new drugs are FDA-approved the price of their ritonavir component will bounce back up with the 400% increase, payable to Abbott.

The Attorneys General of New York (yay, Elliot Spitzer!) and Illinois are investigating Abbott for possible antitrust violations, based on the argument that the ritonavir price increase was designed to shift prescriptions to Abbott's in-house ritonavir-plus-protease-inhibitor combo, Kaletra, and away from combinations of other companies' drugs with ritonavir.

Frankly, all of the things Abbott is doing to mitigate the price increase for people who use ritonavir as an independent drug, such as freezing the price for state buying programs, just further underline the argument behind the antitrust suit. They never meant the price increase to affect anyone but people who take ritonavir in combination with another company's protease inhibitor.

Thud

I was too dilatory to blog this story ("Into the Cuckoo's Nest") while it was still up at the Guardian, but fortunately it's been archived by the Alternative News Network. Its major entertainment value is the detailed description of one of everyone's favorite psychology studies, David Rosenhan's "On Being Sane in Insane Places." Briefly, in 1972 Rosenhan and a bunch of his friends presented themselves at various psychiatric hospitals claiming to hear a voice saying "empty," "hollow," and "thud." All were hospitalized, at which point they stopped claiming to hear the voices and began to act completely normally. No one but their fellow patients ever noticed. Rosenhan's original paper can be found here, and is *well* worth reading for its chilling descriptions of how dehumanizing psychiatric treatment was in the 1970s, and how the most normal of behaviors were pathologized by staff members who thought they were observing crazy people.

The Guardian article is by a psychologist, Lauren Slater, who decided to replicate Rosenhan's experiment. Sort of. No one gets hospitalized just for hearing voices these days, and indeed, she wasn't. She went to various emergency rooms and told her story of the voice that said "thud," and each time she was diagnosed with psychotic depression or some variation thereof, and given prescriptions for antipsychotic and antidepressant drugs. She tries to spin this as evidence that psychiatry hasn't changed much in the thirty-odd years since Rosenhan, but I'm not buying it. The key element of Rosenhan's findings was not that the pseudopatients were admitted - they were, after all, faking auditory hallucinations - but that they were still judged to be ill even after they had reverted to totally normal behavior. Slater was never admitted, so the psych professionals never saw her behaving normally. They're guilty of being fooled by her lies, but they're not guilty of pathologizing normal behavior. The other key feature of Rosenhan's findings was the dreadful, dehumanizing treatment received by the pseudopatients and their fellows; Slater says she was treated with uniform kindness. (Enough so that she started to feel guilty.) So this partial attempt at replication makes a nice dramatic story, but I don't think it proves much of anything in particular.

Another point: Rosenhan and all of his fellow pseudopatients were psychologically healthy. Slater, I find in a review of one of her books, has a history of "[psychiatric] hospitalizations, suicide attempts, anorexia, and self-mutilation resulting from a variety of mental illnesses, obsessive-compulsive disorder the most recent among them." And yet we're supposed to be disturbed that the ER psychiatrists thought there was something mentally wrong with her - given her assertion in the article that "really, I'm fine now." Maybe she is fine now, but a history of severe mental illness certainly does tend to leave marks - physical and otherwise.

Some minor annoying things leap out at me upon re-reading the article now - things that Slater, as a psychologist, should've known better than to say. For example, she makes a point of saying that nowhere in psychiatric literature are there valid reports of voices saying "thud" - as if it's the content of hallucinations that matters, rather than the basic fact of hearing voices that aren't really there. (Even more annoyingly, she makes a snide comment about a patient who heard voices repeatedly saying "It's okay," saying that the symptom sounded "okay" to her. Again, as if the content of the hallucination makes it innocuous. Actual people who hallucinate tend to be disturbed by the fact that there's, you know, a voice in their head - regardless of what it's saying.) Or, for example, here:

"When will I get out?" we can imagine Rosenhan asked, his voice perhaps rising now, some panic here - what had he done, my God.

"When you are well," a doctor answered, or something to this effect. But he was well: 110 over 80, a pulse of 72, a temperature that hovered in the mid-zone of moderate, homeostatic, a machine well greased. It didn't matter. He was diagnosed with paranoid schizophrenia and kept for many days.

Lauren Slater's a psychologist, so she's got to know that blood pressure, pulse, and temperature have not a damn thing to do with whether a person has paranoid schizophrenia or not. It's like saying, "he was nondepressed and his judgment and memory were intact, but it didn't matter. He was diagnosed with pneumonia and kept for many days." Non sequitur as counter-evidence.

If I sound really pissed at Slater, that's probably because, in my experience, it's vastly more common these days to have trouble getting people in to the hospital than it is to get them out again. I've had to coach some of my clients - suicidal folks who wanted to be admitted for their own safety - on what to tell the ER doc to be sure they wouldn't just be sent home with a prescription. People hearing voices that say a lot scarier things than "thud" wind up living on the streets because there's no place for them in the system. Slater's story is sensationalistic and not really to the point, but because it's so compellingly written it deflects attention from real problems with emergency psychiatric care.

Hi There!

Welcome to all of you who have just found me through the kind words of Electrolite and Tapped. I'm a little bit stunned by the twenty-fold increase in my daily hit count, but I hope to rise to the occasion and offer you some things worth sticking around for.

(And to my older readers who are wondering: yes, I'm planning to come back to the euthanasia series. Those posts just take a lot of time to get right, and I need to be in a pretty cheerful mood to go there.)

The Flynn Effect

Crooked Timber has a post up about the Flynn effect, a subject I've always found interesting. Flynn found massive gains in IQ across time, with average children's performance increasing as much as a standard deviation in one generation. This is a shocking blow to the few remaining people who think that IQ is all about genetics, but it also raises questions about the general relations between IQ and intelligence. Clearly, the argument goes, if intelligence were rising at the rate of one SD per generation, we'd be in the middle of an intellectual Renaissance the likes of which the world has never seen.

I think the Flynn effect can be attributed to a number of things - improved nutrition, more widespread education, the spread of mass communications (there used to be a big rural-urban difference in mean IQ, which has subsequently disappeared within the U.S.), and increased opportunity for people in general to become familiar and comfortable with test-taking situations. Moreover, the kinds of tasks that appear on children's IQ tests have trickled down into the culture. Fifty years ago, a young child taking the Wechsler Intelligence Scale for Children (WISC) might be faced with solving a maze for the first time. Today, you find mazes on the backs of cereal boxes.

I don't think it's coincidental that nonverbal, puzzle-like components of IQ tests have shown much larger Flynn effect gains across time than more academically-rooted components like vocabulary and arithmetic. If the Flynn effect is driven by increased exposure to testlike elements in the general culture, you'd expect to see smaller gains on elements people have been exposed to for a very long time (like arithmetic) and larger gains on elements that have only become commonly encountered in the last generation or so (like complex pattern-matching games).

(As a sidenote: I could practically have written 75% of the Crooked Timber post's comments section without reading it first, just based on prior online arguments. No matter what opinion most people have of IQ, a lot of the things they're sure they know about IQ tests just aren't so... but that's a rant for another time.)

More Breast Issues Exposed

Sisyphus Shrugged has news of the inevitable class-action lawsuit, filed by a Tennessee woman who complains she suffered "outrage, anger, embarrassment and serious injury" from the brief sight of Janet Jackson's tit, sufficient to require three years' worth of the total revenues of CBS, MTV, and Viacom in order to assuage her pain. Heaven help her if she ever accidentally stumbles into a meeting of the La Leche League.

Skimble points out that the nipple plaintiffs are suing for considerably more money than would be offered, under Bush's tort reform plan, for the pain and suffering of a woman who received and unnecessary double mastectomy.

Wonkette provides a useful translation of Peggy Noonan's hand-wringing editorial somehow linking Boobgate to 9/11.

See? Crystal clear. You're the frog, I'm the water, Justin Timberlake is the hand that turns the flame on. . . Are you with me? [...] OK, let me explain again. Our culture is a frog. Janet Jackson is the pot and Justin Timberlake is the water. The nipple is the flame. No, wait. . . The nipple is the water, Janet is the flame and Whitney Houston is the frog. Hold on, I'm almost getting it. . .

My previous post on this issue is garnering lots of party invitations, which is nice. One hopes that they're all from people who understand that my breasts generally stay inside my clothing.

Hell Freezes Over; Otters Defend Big Pharma

I've done my fair share of bashing the pharmaceutical industry. And at first glance, this article in the New York Times seems to provide fodder for more of the same.

To sell medicines that treat schizophrenia, [drug] companies focus on a much smaller group of customers: state officials who oversee treatment for many people with serious mental illness. Those patients - in mental hospitals, at mental health clinics and on Medicaid - make states among the largest buyers of antipsychotic drugs. [...]

Since the mid-1990's, a group of drug companies, led by Johnson & Johnson, has campaigned to convince state officials that a new generation of drugs - with names like Risperdal, Zyprexa and Seroquel - is superior to older and much cheaper antipsychotics like Haldol. The campaign has led a dozen states to adopt guidelines for treating schizophrenia that make it hard for doctors to prescribe anything but the new drugs. That, in turn, has helped transform the new medicines into blockbusters.

After eleven paragraphs of marketing description, and at the bottom of the first page of the web story, we are told that the novel antipsychotics cost around $3,000 a year, compared to the $250 annual cost of an older antipsychotic. And yet states are mandating that the newer drugs be prescribed! This is obvious graft, right?

Wrong.

In the 19th paragraph there is a brief mention that "doctors widely prefer the new medications, saying that the older drugs cause a higher incidence of side effects like stiffness, trembling and uncontrollable jerks that can stigmatize patients and prompt them to stop taking the drugs." This is immediately countered by the claim, in the following paragraph, that the new drugs can increase the risk of obesity, diabetes, and high cholesterol - so comparatively, "stiffness and trembling" seem like minor complaints.

But what they're talking about when they say "trembling" is tardive dyskinesia, a form of irreversable nervous system damage. Tardive dyskinesia causes tics and twitches which may happen dozens of times an hour, which may be disfiguring, and which are almost always awkward and uncomfortable. Twenty percent of people with schizophrenia develop incurable neurological damage within five years of beginning traditional antipsychotics, and the risk increases with the duration of treatment. So in the old days, almost every chronic schizophrenic wound up with some symptoms of TD. With the new, expensive drugs, the risk of TD is ten times less.

The increased risk of diabetes with the new antipsychotics, which appears to have been included in the article for "balance," doesn't seem particularly comparable. There is a significantly greater relative risk of diabetes in people on the new antipsychotics - they're 1.17 times more likely to develop diabetes than people on the older versions. But the overall risk of diabetes in schizophrenics isn't particularly high - the incidence is only 2.5%. (Reference here; requires free registration.) So we're talking about moderately increased risk of a treatable, not-very-common side effect - compared to vastly increased risk of an incurable, common side effect, in the case of TD.

Now, the article appeared in the NYT's business section, not the medical section - so I suppose I can't expect the reporter to go through and figure out the business about relative risks and so forth. But it still seems to me that the article has an obvious slant. If you ask psychiatrists, nine out of ten will immediately tell you that the newer drugs are much better for the patient. But that doesn't come through in the article at all. Who'd the reporter talk to?

Shock, Horror

I don't normally like to do this, because I think it's a cheap shot. But you know, sometimes I'm driven to it.

I'm a psychologist in an HIV clinic. I meet people every day who have problems like, "I just found out I have HIV, and I'm seven months pregnant, and I don't have anywhere to live or enough money for food." I face common diagnostic questions like, "is this person just crazy, or has HIV irrevocably eaten away part of her brain?" I worry about things like, "Do I even want to know whether that psychotic guy brings a gun to the clinic?" 'Family values' problems in my world are things like, "Ever since I told my parents I have HIV, they make me eat off a paper plate when I visit."

I actually love my job. But it's spoiled me for modern living, because I come home from the clinic, log on to my computer and read things like this:

But strangely enough, I'm feeling another emotion besides anger. I feel overwhelmed by sadness at this most recent (and most prominent) example of the flush of our nation's cesspool we call prime-time entertainment. Sure, I was shocked and appalled by what these performers did. But I can't shake this pervasive feeling of sadness. So many people to feel sorry for, so much hurt and harm done by one tasteless, classless act on an international stage like halftime of the Super Bowl.

...and I don't know whether to laugh, cry, or go batshit crazy myself. "So much hurt and harm done." By a breast.

See, this is why people don't invite me to parties.

Anything Government Can Do, Industry Can Do Better

Halliburton-KBR has apparently vastly overcharged for meals served Iraq. They've discovered $16 million in overcharges at a single base, and are now extending the inquiry to KBR's other 50 dining facilities. The U.S. government was billed for 42,042 meals per day, but only 14,053 meals per day were served.

And what kind of food service are we paying so much extra money for?

The Pentagon repeatedly warned contractor Halliburton-KBR that the food it served to US troops in Iraq was "dirty," as were as the kitchens it was served in, NBC News reported [in mid-December]. The Pentagon reported finding "blood all over the floor," "dirty pans," "dirty grills," "dirty salad bars" and "rotting meats ... and vegetables" in four of the military messes the company operates in Iraq, NBC said, citing Pentagon documents.

Well. It's a good thing that food service in Iraq was outsourced to private corporations, instead of being left to the bloated, inefficient, incompetent public sector. Everyone knows that industry does everything government can do, but cheaper and better.