I was on NPR's "On Point" this morning, debating a lying-through-her-teeth anti-choicer (seriously, she claimed as often as she could that  post-ejaculation contraception was "abortion", an evidence-free claim whose only purpose it to muddy the waters) named Anna Franzonello, and needless to say, it was interesting. You can listen to it here; I was on for about twenty minutes. What was interesting was watching the evolution of the demands based in facetious claims of "religious liberty". Since Obama has made it so that Catholic hospitals and univerisities don't actually have to cover their employees' birth control (though they do get to enjoy the cost savings as if they did!), the argument that forcing employers to directly cover it is a violation of religious liberty is off the table. So instead, the argument has now evolved into claiming that your employer has a right to step in and prevent you from dealing directly with your insurance company to get birth control coverage. That right is justified by the fact that the employer's money was used as part of your benefits package to pay for your insurance.

I dealt with this directly, arguing that your employer doesn't own you. That's what the argument about Taco Bell owners refusing to include contraception in their health care plans is about, whether or not an employer maintains the right to control your compensation package after you earned it. I see no difference in an employer telling you that a health care package you earned can't be used for birth control because of his moral beliefs than an employer telling you that you can't buy condoms with your own money because of his moral beliefs. Once they sign the check, either to you directly or to a service provider that processes your benefits, they should not be allowed to control the money as an attempt to control you.

But when I hung up, I realized that what she was claiming was even more radical that that. She said specifically that even with the Obama compromise, it's a problem, because while Catholic universities and hospitals may not pay directly for your contraception coverage (it comes out of the insurance company's profits, in sum), because they give any money at all to the insurance company, they should have complete veto power over what it covers. 

If you step back and think about that, it's a far more radical assertion than even the Stupak amendment, which argued that any person in the entire health care system should, because a dollar that was once in their pocket is floating around in the system, have veto power over your abortion being covered. In this case, they're saying that anyone in the system anywhere should be able to veto any coverage they claim offends their morals. This is about more than the Taco Bell owner functionally fining their own employees for fucking. Franzonello was claiming that the Taco Bell owner, having paid an insurance company, should have veto power over not just his health care plan, but over any money the insurance company spends, since his money is in there, rubbing shoulders with those less pure dollars. That means that, as far as Franzonello was concerned, not only should the Taco Bell owner be able to veto contraception coverage for his direct employees, but for every single employee of every other company that contracts with the same insurance company. So the Taco Bell owner can force you, the H&R Block employee, to pay for your own contraception because you both are insured through Blue Cross/Blue Shield, and the Taco Bell employee doesn't want a dollar that was once in his pocket to ever circulate through the system and go towards your contraception, or else Jesus will cry.

And this isn't just about contraception, either. She made a broad-based argument that anyone should be able to veto anyone's coverage on any moral grounds. She claimed this would "only" affect contraception, but we know in the past that people have tried to block, on "moral" grounds, coverage for STD treatments and maternal care for single women. Since paying a single dollar into the system would give you ultimate veto power, in her estimation, it really could be anything. Anti-vaccination person buys insurance for his employees from your insurer? Good-bye vaccination coverage for everyone in the entire system. 

That's how seriously they hate women. They're basically willing to burn the entire health care system to the ground rather than let some woman somewhere have sex without paying a penalty for it. Damn. 

For some reason, this week's Newsweek was really great, with an interesting story about how sports wives and girlfriends are an easy target for fan rage and Andrew Sullivan's pretty good article on the contraception debacle, where he rehashes my theory that Obama set it up this way. (However, he still insists that abortion is different, even though anti-choicers have shown their true colors with the attacks on contraception.) But one article I found really fascinating was this brave one by Nancy Hass decrying the intense media indulgence of parental delusions attached to a bout of mass hysteria in LeRoy, New York. For those who haven't heard, a bunch of teenage girls have been overcome with a series of uncontrollable tics, much like Tourette's syndrome, and---this is critical to understanding what's going on---it's spreading. It's an open and shut case of mass hysteria: localized, no physical cause, contagious, and concentrated in teenage girls. While mass hysteria can occur in other groups, it most commonly occurs in teenage girls, probably because the stresses unique to being a teenage girl create the perfect situation for this. But the parents don't want to hear it. They want the answer to be roughly "anything else". And, according to Hass, a number of media sources are giving them a sympathetic audience to make their understandable but still deluded claims that it's something other than mass hysteria. 

There's three major issues with indulging these delusions, beyond just the obvious problem of indulging delusions. 

1) It contributes to the stigma around mental illness. What comes across loud in clear in the parents' reactions is that they can't accept the diagnosis of mental illness, because in their minds, mental illness is not "real" illness. Which is a common misconception, and I'm not especially mad at the parents for having it. They probably haven't really been educated on this or had experiences that would help fix their prejudices about mental illness. Where I am mad is at the media that treats their prejudice like it's a legitimate opinion that needs airing. I'm mad at self-styled environmentalists who are eager to use these girls' distress to raise awareness of fracking, which while certainly a bad thing, is just not the cause of this problem. The parents would probably be more willing to listen to the actual experts if there weren't so many other people---environmentalists, journalists---that also seem like authorities confusing the issue. 

Mental illness is real illness. To say that these girls are hysterical doesn't mean that their suffering isn't real, or that they don't need help. Insisting that it has to be something other than a mental illness issue simply means creating obstacles to care. It's as if someone has a sinus infection and you insist that it's actually a twisted ankle. You're not going to help them by putting a bandage on their ankle. They need antibiotics. Mental illness is the same; treating it like it's physical means you're not treating it at all. 

2) It makes concerns about fracking look like woo. Fracking is a legtimately serious concern. Sober, pro-science environmentalists agree that it's a real concern, and that there's real dangers to it. But when you attach false dangers to it, attributing problems to fracking that obviously have nothing to do with fracking, you open up your movement---for good reason!---to accusations that you're anti-science and no better than anti-vaccination idiots. Which could be used to discredit the whole thing. Which makes me wonder, as I have in the past, if Erin Brockovich is secretly working for the other side. After all, she sent an aide to test the soil in response to this mass hysteria, which ends up bringing attention to the anti-science bent of the environmentalist movement, and makes everyone involved look like an idiot. 

3) It's sexist. There's two ways to interpret the fact that mass hysterias tend to take off amongst teenage girls and young women (see: Salem witch trials, multiple personality disorder) more than anyone else. You could go with the sexist explanation, that women are inherently unstable and hysterical. Or you could go with the more nuanced, anti-sexist explanation, which is that young women are under a specific set of stresses that make this sort of thing happen. From Hass's article, it's clear that the experts in this situation are opening door #2, pointing out how hard the lives of many victims are and suggesting they cracked under pressure. I would point out that the transition from childhood to adulthood is particularly difficult for women. You go from being an adored child who lives in a sea of mother-love to being, frankly, a second class citizen whose sexuality is considered the most important and often only relevant aspect of your personality. You're expected to start stifling yourself, accept being talked down to (often by men who know less than you do about a subject), and to constantly monitor your body to make sure you're striking that perfect and impossible balance between sexually alluring and "slutty". This is especially difficult if you're a teenager, with all the attendant awkwardness and raging hormones that implies. That's the baseline of stress for basically all young women. Add to that any more stress, and no wonder teenage girls crack. 

By insisting that the symptoms must be physical and not mental, the parents and the media and everyone else involved in making this a "mystery" instead of an open-and-shut case of mass hysteria are basically engaging in a cover-up. They're ignoring the patriarchy and the damage it does to young women, probably in no small part because they're not really interested in actually challenging the social structures that caused this problem. But in doing so, as Hass suggests, they're just making it worse. They're signaling to the girls---to be clear, this is mostly subconscious---that the continued ticcing is the path to returning to that state of childhood, where you're an object of love and concern, instead of returning to your new life as a sex object. Hysterical ticcing is basically the only way for teenage girls end up getting media attention that isn't about sex, after all, and that kind of prejudice goes all the way down to the ground. What needs to happen is that teenage girls need love and support and, yes, attention for things other than what they do with their vaginas or if they're acting all crazy. Again, to be clear, I doubt very much that the girls want this. Their distress is real. Pointing out that the cause is mass hysteria---and that patriachy plays a role in mass hysteria---doesn't mean downplaying their distress. It just gives us a clear view of how to fix this and how to prevent it in the future.

Komen for the Cure's decision to break with Planned Parenthood over a Congressional investigation based on doctored videos was, all things being told, a bad one. Bad for women, bad for Komen's credibility, and, as TBogg points out, bad for Komen's future viability. 

TBogg points out that Komen's new fellow travelers are about as concerned with women's health as I am with NASCAR standings, which is part of the problem. But Komen has a deeper issue here: the impetus for those anti-choice conservatives flocking to their side in the first place.

Komen brings in substantially north of $300 million in revenue. Its grants to Planned Parenthood totalled roughly $600,000. This means that Komen's new friends were withholding support over .2% of its funding going to an organization that performed abortions with entirely separate money. Now that they've made the political decision to side with people whose main source of political knowledge is the archive of false e-mails at Snopes, there's a larger and far more precarious issue: anti-choicers' invariable tendency toward rubedom.

Within a month, there will be an e-mail or a WorldNetDaily article or a Washington Examiner column. And the column will allege, through a vastly simplified chain of events, that Komen is once again engaged in the perfidy of tangential liberalism. People for the American Way once co-sponsored a 5K, Komen let halal companies use the pink ribbon, Hillary Clinton gets mammograms; something is going to set them off.

Eventually, Komen's not going to be able to placate them, probably because the actual controversy will make no sense whatsoever. After a few weeks of trying to understand why it can't partner with Campbell's Soup, the donations rewarding this week's decision will dry up. The Planned Parenthood investigation will go away. All Komen will be left with is a vastly reduced donor pool, and a large group of former donors that either remember Komen's actual betrayal, or will spend every minute looking to manufacture betrayals.

They should've just stuck to Awareness Doritos.

I've been following the dust-up over Paula Deen finally coming clean about having diabetes after her drug endorsements were in place. I'm not keen on tearing up Deen over this, because if it wasn't her, it would just be another person holding down the extreme end when it comes to junk food and celebrity chefs. What I do find interesting is that her story seems to fit right into the standard American way of handling the problem of diabetes, which is to deal with after the disease has developed, and not a minute before. 

Now Deen is jumping on board the health-advice bandwagon. Three batter-dipped years after her diagnosis — and after three years of silence about her condition — she’s teamed with diabetes drug maker Novo Nordisk to promote the company. She and her two sons, Bobby and Jamie, are appearing in a new campaign that includes “diabetes-friendly meals” and Deen’s genteel admissions that she’s walking more and cutting back on sweet tea.

Mary Elizabeth Williams is understandably angry that it took Deen three years and a drug company endorsement deal before she started down this path, but I think it's interesting how she and we all assume that the natural rhythm of these things is to make the switch to healthier eating after you've already started to suffer problems, often incurable ones like diabetes. We don't think much about how ingrained that mentality is, but I see it all the time. For instance, I can't tell you how many times I've been drinking a Diet Coke and had someone say to me, "You don't need to drink Diet; you're not overweight." Now, I have a lot of reasons for picking Diet Coke over regular and certainly don't think it's some kind of health food, but the underlying assumption---that we should only watch what we eat if we're trying to lose weight or control a chronic condition---stuns me. I see the same thing with people taking a pass on dessert or eating something healthy; if you don't frame it as an attempt to lose weight, you often get aggressive questions. That's getting better as initiatives like Michelle Obama's are getting the word out about nutrition as prevention instead of just management, but still, this mentality persists. 

I think it's another example of American all-or-nothing thinking. The trajectory is to overeat without thinking about for years, until it catches up with you and then, as a corrective, your doctor puts you on a strict diet where you can't eat any of your favorite foods at all. There's no room for the "take two bites and leave it" mentality that allows you to have the food you like without putting yourself in a position where you're forbidden from ever touching it again. Unfortunately, there's not a lot of structural incentives to promote the moderation mentality. At every turn, capitalists profit off this trajectory. The fast food companies make a mint of Americans in their eating years, and then the drug companies make a mint off them when they're trying to control their various diseases. (Indeed, I think Deen makes everyone uncomfortable because she's profiting from both sides of the equation.) The problem with all this is that we're the ones paying for it. Diabetes and heart disease are two of the major reasons that our health care costs are skyrocketing, for one thing. But even if that could somehow be erased from the equation, the human cost in struggling with these terrible diseases is far too much for us to bear. 

Before I get into this, I want to say that I'm the first to say, from a reality-based perspective, that Americans are, in a sense, "over-medicalized". I'm no shill for doctors, and in my ideal world, we would all spend less time at the damn doctor. But the reason that we are in doctor's offices more than we should be is a complex one---if fact, it's multiple reasons. And most of them are things the medical establishment is trying to fix. A lot of the reason doctors order too many tests and prescribe too many drugs is that if they didn't do so, their patients would flip the fuck out on them---because Americans have never once really gotten behind the idea that less can sometimes be more---and since it's in a doctor's best financial interests often to do more, they aren't going to fight you as hard as they probably should. Another reason that is completely unrelated that we spend more on doctors than we ideally should is that we, as a nation, don't invest nearly enough in prevention. We let young people go uninsured, making it years and even decades that people go without just basic check-ups, so that when they do finally start seeing a doctor, illnesses that could have been caught early have festered. We eat too much and exercise too little, and then we end up spending way more on diabetes management and cholesterol drugs than we should. We underfund contraception spending and shame women for being slutty if they use contraception, resulting in high unintended pregnancy rates that lead to even more preventable health problems. 

So yes, we are over-medicalized in a sense, but it's a complex problem and Americans are simple-minded idiots. Thus, people have this vague sense that we are all at the doctor too much, and they react not by learning the ins and outs of this complex problem, but instead by embracing a knee-jerk assumption that medical science is BAD and "natural"---whatever the fuck that means---is GOOD, and that doctors are out to get you and that everything produced by Big Pharma is BAD and "chemical" and therefore toxic. And they convince themselves the problem isn't a combination of hard-to-extract social forces plus bad managment of our collective medical dollar, but instead that medical science is some Frankenstein-y evil scientist shit and that the cure for our problems lies in shopping at Whole Foods. This attitude gives birth to anti-vaccination idiots and homeopathic nonsense and GOOD magazine tricking themselves into believing that something is bad if you call it "salycic acid", but A-OK if you call it "extract of willow". (Seriously, it's time to revive the dihydrogen monoxide hoax.) And no one is more guilty than Huffington Post of promoting knee-jerk hostility to medical science in lieu of promoting actual knowledge. 

Case in point: they've run an article by a quack named Dr. Robert Kornfeld, who is.....wait for it....a "holistic" podiatrist. Who has this art on his office's homepage:

 Run away while your feet are still healthy!

In all seriousness, the Huffington Post should issue a formal apology for running this article titled "6 Medical Myths Even Your Doctor May Still Believe", since it's a sea of strawmen, shilling for just-as-corporate "alternative" medicine, and straight dangerous misinformation. Let's take it one at a time. 

Myth #1- Technology has improved healthcare

But....but....statistics!

But Dr. Kornfeld poops your stupid, irrefutable numbers. 

Statistically, since the age of technology, there has been an onslaught of increasing pathology. The amount of illness and morbidity in our society is dramatically rising. There are now more cases of cancer, heart disease, arthritis, auto-immune illnesses, endocrine disorders, developmental disorders, allergies, respiratory problems, infectious diseases, neurological problems, musculo-skeletal pathology, gastro-intestinal disorders, psychological illness, etc., than ever before.

Plus, there's so many more old people around, and they need to go to the doctor so much. Clearly, letting people get older hasn't done shit for our national health. 

In all honesty, what's particularly perverse about this is one reason U.S. life expectancy has gone up so much in the past century or so is that we've developed so many technologies that keep small children alive that would have otherwise died, with vaccines being a big one, as well as some of the simple technologies that keep troubled infants alive that would have died before we had things like, oh, respirators. 

But the biggest problem with his argument is that it's a red herring. Yes, it's true that certain illnesses are on the rise in our culture (but other fatal illnesses, such as polio, have been wiped out), but that literally has nothing to do with technology. His argument is like saying, "Cars were promised to get us places faster, but I still can't run better than an 8 minute mile." The two things are unrelated! Unless you think there's a sea of doctors out there telling patients to stuff their maw with tons of crap while never getting their heart rate above resting because, fuck it, they can get Lipitor, then this argument makes no sense at all. 

Myth #2 - Inflammation is bad

One thing about quacks is that all have one completely bizarro obsession, and this guy's argument that you should let swollen things be swollen and painful is his. I've argued before that I see connections between thinking of anti-choicers and the "natural" fetishists, even though they often fall on opposite sides of the political divide (though not only---look up the concept of a "crunchy conservative"), and this belief that suffering is inherently good for you---well, not you, but other people you would foist it on---is one of those links. I feel bad for this guy's patients, because I'm guessing if you have foot problems, the occasional use of an anti-inflammatory, even just aspirin, is probably just what you need.

Myth #3 - Genetically coded diseases are unavoidable...

Let's take a closer look at this issue. If having a gene for any illness condemns you to having that disease, then why are you not born with the disease you are coded to have? Why isn't every person who carries a gene for disease suffering at all times from that disease? The answer is that all genes do not express themselves at all times and many never do. There must be a reason why the body would call upon a gene to express itself. Otherwise, none of us would be able to survive the onslaught of genetic expression. So what is it that causes a gene to express itself? If you consider for a moment that diseases are just a complex of symptoms being incorporated by the body in an attempt to protect itself from tissue destruction and/or imminent death, you may begin to get a clearer understanding of what I am trying to say. Once we begin to pay attention to the reasons that a gene might express itself, we may be able to prevent that gene from releasing its code for illness.

He then goes into a lot of blather about "free radicals" and basically implies that eating right is all you need to do to prevent genetic illnesses from developing. This section may have bothered me the most, because it takes a grain of truth---that genes interact with the environment and can express themselves in different ways---and runs off into la-la land with it. Unfortunately, it's a la-la land where he's discouraging people from working with their doctor to learn about genetic diseases in their families and what can be done to prevent or minimize them in the real world. It's a complete and utter lie that doctors think that having a gene for something condemns you to the worst possible version of that disease, and that they won't do anything to help you prevent that from happening. For instance, I have a friend whose family has a genetic tendency towards high cholesterol, and her doctor---gasp!---put her on a diet and exercise program in order to lower her cholesterol and avoid having to control it with drugs that can sometimes be not so good for your body. He certainly didn't drag her into his office and say, "Well, let's talk about how you're inevitably going to have a heart attack before you're 35." This is a despicable misreading of how doctors use genetic information to deal with patients. Plus, Kornfeld basically claims that any genetic illness that you develop is your fault because you didn't mind your free radicals, which is an outrageous guilt-tripping of people who do get sick no matter what they do. He's basically pandering to the weird notion that we will never die and that we're in complete control at all times of our bodies, and that's simply not true.  You can do things to improve your health, sure, but you know, the clock is ticking for all of us.

Myth #4 - Medications improve health

We are, in this country, the most heavily medicated society on the planet. People are taking medications to control the symptoms of countless diseases. These medications are either prescribed by their physicians or purchased over the counter by the patient. I have seen, in my practice, thousands of elderly patients taking upward of 10 prescription medications as well as a few over-the-counter ones. If you ask the average senior how they are feeling, most will say that they feel awful in spite of their medications. How could this be? If the medications are supposedly "keeping them healthy," how come they feel so bad? There are a number of reasons for this.

Seriously, I'm beginning to wonder if this sort of thing is opening HuffPo up for a lawsuit. Look, this is about the stupidest thing I've ever read. For instance, say someone has a minor stomach upset from the birth control pill on occasion. Are they feeling less than perfect? Sure. Are they feeling better than they would be if facing an unintended pregnancy? Absolutely. (Talk about stomach distress.) He's basically trying to imply that doctors don't believe in side effects, when the contrary is true. In fact, the point of a doctor is that they're supposed to balance your competing needs to determine what treatments to give you. So yes, some drugs make you feel not so great, but the point is that if you didn't take them, you'd feel even worse. Or you wouldn't be feeling at all, due to the "dead" thing. Take Lipitor, which is a drug I return to because it's one of those that I think provokes this kind of anxiety. The medical establishment is trying to prevent people from going on Lipitor. That's why they test your blood even if you're healthy, weigh you, and otherwise promote diet and exercise. They know Lipitor has bad side effects, but the problem is that high cholesterol has worse side effects. 

Myth #5 - Childhood immunizations protect us from serious disease

I don't even know what to say. He minimizes childhood illnesses from the past, suggesting that it's no big deal to get, say, whooping cough or diptheria (which currently kills about 10% of people who get it), but then makes the usual unfounded claims that vaccines are bad for kids. I don't even want to go over this, except to refer you to this actual science-based myth-debunking about vaccines. The one thing I'll add is to ask you to look at that life expectancy chart and remember that one reason life expectancy went up so dramatically is that we were able, through medical technology, to dramatically reduce the number of infant and small children deaths, and that one of the most important technologies was vaccines. If you still don't believe this, go visit a 19th century graveyard and consider how many graves are there for children.

Myth # 6 - The double blind - placebo controlled study guarantees safety and efficacy in drug therapy

It's no surprise that quacks all over dislike double blind studies, because double blind studies tend to show that "alternative" therapies don't work at all. Which isn't to say that there aren't legitimate criticisms of the FDA standards for testing efficacy and safety. But most of those criticisms aren't coming from people who think you should stop going to real doctors and give your money to quacks instead. For a more measured, pro-science approach to this question, I recommend watching Ben Goldacre's TED Talk.

I'll repeat; on a certain level, I get it. Our health care system is in crisis. Some people are over-medicated, and some people can't get care at all. Doctors are often over-worked and not up on the latest science. We spend too much treating illnesses that could have been prevented. A lot of drugs given to people aren't the best treatment  possible, and Big Pharma actually takes pains to conceal that fact because it hurts their bottom line. All these things are true. But the solution isn't to embrace some black-and-white anti-medical science point of view, and lash out at medical science for having the nerve to exist. Medical science isn't evil, it's just in crisis. It doesn't need to be abandoned so much as improved. And if you stop wasting so much time engaging with quacks and Big Alternative Medicine (much of which is owned by Big Pharma) and pay attention to the real debates going on about how to improve medicine, you'll find it's all very fascinating and perhaps not as hard to understand as you feared. 

From an intellectual, political perspective, I really loathe anti-vaccination nuttiness. Just like with anti-choicers, I will never completely understand what compels people to support choices and policies that will objectively create health problems where none need exist. I hate the shunning of evidence for woo, and I especially hate the way parents are encouraged to substitute their own dislike for getting their children vaccinated (kids hate shots!)  for intellectual assessment of the necessity of vaccination.

But now I have one more reason to loathe anti-vaccination nuts. They made me feel kind of hot---and not in a fun, sexy way---all damn afternoon. Though I imagine it will fade in a couple of hours, I am running a slight fever, and Jenny McCarthy and the sea of yuppie no-vaccination parents are to blame. 

You see, I agreed this morning to get a Tdap, which is a combination tetanus, diptheria, and pertussis vaccine. It used to be that adults getting a booster for tetanus (every ten years, people---keep up with your shots!) or tetanus/diptheria alone, but now they toss the pertussis in with it. Pertussis is better known by the name "whooping cough". Just last year, the Advisory Committee on Immunization Practices  recommended that adults, especially those with regular exposure to small children, start getting pertussis boosters along with their tetanus shots, in response to a surge in whooping cough cases, which have resulted in at least 10 infant deaths in California alone. The reason for the surge in whooping cough cases? Anti-vaccination activists. Yep, because of paranoia about vaccinations, vaccination levels for whooping cough have fallen below herd immunity levels, causing the disease to come back. And it's an ugly one even if you don't die, I'll tell you. From this handy-dandy cheat sheet debunking the nine most prominent anti-vaccination arguments comes this description of the hell that is whooping cough:

Whooping cough is much more than “just a bad cough”. Kids often turn blue from lack of oxygen during coughing fits, they may vomit after severe attacks, and even fracture ribs. There is no cure for whooping cough – antibiotics are given to help stop the transmission to others – you just have to hope your immune system can fight it. Severe complications such as pneumonia and brain damage occur almost exclusively in unvaccinated people and in babies under 6 months of age the symptoms can be severe or life threatening. Whooping cough is also known as the 100-day cough making it a chronic and potentially fatal disease.

Frontline showed a video of a baby with whooping cough who was coughing so hard he was unable to take a breath and nearly died. It took me days to shake that horrible image from my head. Terrible stuff. So when my doctor suggested I get a Tdap, I was like, "Where do I sign up?" I'm not someone who spends a lot of time directly around children, but it still seemed to my doctor and myself like I really should get vaccinated. I live right smack dab in one of the major areas where there are both a lot of young children and a lot of yuppie parents who buy into anti-vaccination nonsense, meaning that I'm simply in an area that probably has fallen below herd immunity levels. I'm somewhat surprised that Brooklyn hasn't had an outbreak to rival the ones in yuppie-thick areas of California, in fact. So getting a shot that helps raise that herd immunity, even by a little bit, seemed like the right thing to do. But I am kind of paying for it a little right now. So I'm blaming Jenny McCarthy and putting the word out there to the adults reading this blog to get your booster shots. If you're feeling like whooping cough isn't that big a deal, please watch that episode of Frontline. And then go get vaccinated. 

Of course, I may have just run a slight fever from a tetanus shot alone, to be completely fair. And that particular vaccine? That one is just for me, because dying of lockjaw seems scarier to me than being burned alive. 

I'm a religious reader and super fan of GOOD, but once in awhile they fall into some of the more annoying yuppie-left habits, forcing me to write complaining blog posts like this one. I only gripe because I love! The sin this time came, sadly for me, amidst a challenge you all know I'm going to support whole-heartedly, a "get healthy" challenge. But to my mind, a large part of being healthy is being evidence-based in your health choices, which can do two things for your health. One, it makes your choices more effective. Two, it saves you the stress of having to attend to a lot of things that are meaningless, like whether or not something is "natural" or "homeopathic", freeing up time in your day to do things that are genuinely good for your health, such as exercising, eating right, and sleeping 8 hours a night.

Day 8 of the challenge, therefore, is getting it from me. Cord Jefferson surprised me by writing an anti-soap screed, since he recently wrote an evidence-based explanation of why you should wash your hands every time you use the bathroom. That post made me even more cognizant of times I really should be more careful about washing my hands, and reminded me that I need to get a whooping cough vaccine update in order to be a good citizen who doesn't put physically weaker people in danger of catching germs off me. So I was surprised to see him dismiss soaps and shampoos as "chemicals" that are dangerous for their, well, chemicaliness.

In January of this year, prompted by the GOOD challenge to swear off soap for a month, I stopped using soap, body wash, and shampoo on my hair, face, and most of my body. My armpits and crotch still got lathered, but the rest of me was free of all the lab-made junk that goes into our hygiene products nowadays. Eight months later, I’m still not using soap, and my skin and hair have never felt or looked better. The moral of the story: You don’t need a bunch of nonsense dreamed up by chemists to stay healthy and be happy.

This might be a good time to point out that there's a great deal of variation in how much filth people have on their bodies. Some people are greasier and hairier than others, and some people have hormone levels that cause their sweat to be extra-smelly. Some people are up to stuff that gets them dirty. If a quick rinse does it for you, good for you, but individual results may vary. I'm not fond of heavy duty anti-perspirants, but I've come to realize how much of a godsend they are for people whose body chemistry isn't quite like mine. Plus, I just really like the feeling of being squeaky clean. Don't try to guilt me out of one of these little joys in life that harms no one. And that's my next point: the argument for why soap is "bad" isn't there.

Though most people eat, drink, and use dozens of foodstuffs and products per day, the vast majority of us never actually look at the labels and ingredients lists on most of our products. We’ll read countless blog posts, but not the little square on the back of our face wash that tells us we’re rubbing acid on our cheeks every morning.....

Should you actually be putting salicylic acid near your eyes? If the answer to these questions is no, try going a day without that product and see how you feel. If the answer is still yes, that’s fine, too. At least you’ll be far more aware of what it is your putting in and on your body day in and day out.

I get that he's trying to agree that individual choices may vary, but it's clear that the "correct" answer is that one shouldn't use salicylic acid because it's a Chemical. There's no actual argument here for why it's not safe, and certainly no producing of evidence for why one should hesitate to use this chemical; it's just unnatural-sounding and an acid to boot. This is just poor reasoning, plus a really unnecessary swipe at chemists, who are no more evil a group of people than anyone else. Honestly, they're probably better on average than we journalist types.  

I blame Michael Pollan in part. He crafted some food rules that were intended to reorient people to eating healthy in a way that was less work than going through elaborate processes of educating yourself about everything that goes into food, by simply trying to push people towards simpler food that wasn't crafted in a lab in order to maximize your calorie and fat consumption. But in doing so, he reaffirmed the Cult of the Natural, i.e. the belief that because something has a chemically-sounding name, it's automatically suspicious. And we're seeing that logic taken to an extreme here.

The funny part is that salicylic acid is "natural". If you simply called it "willow bark extraction", the naturalism cult people would be eating that shit up. It's also pretty safe if used correctly, and I can attest is very good at holding off adult acne problems. But even if it wasn't "natural", the problem here is simply assuming that something is dangerous because it sounds complicated. There's no reason to assume that. I'm sorry to see such poor reasoning being passed off as health advice at GOOD. I realize filling 30 days is hard to do, but a better use of their time would be to encourage people to do things like get up and walk around more, or add more fruits and vegetables to their diets. 

People in the thread below---I suppose this was inevitable---were reverting back to the liberal argument that fast food's popularity is mainly a labor issue, as in people work too hard and resort to fast food (against their will, no doubt!) because they have no options. This argument is juiced up by anecdotal evidence of this one woman you knew once who really did save an hour a day eating fast food or that college aged service worker who could only eat a burger during lunch.  These arguments bother me for a couple of reasons. The first is they are throw-your-hands-in-the-air-and-give-up arguments. There's a whiff of making excuses for fast food's grip on America in lieu of trying to understand it so that solutions become evident.  Since we all agree---right?---that policy should be aimed at improving the nutrition of all our citizens (not just those who can afford it), we can agree---right?---that merely biting on the corners of the problem by getting rid of food desserts and perhaps even having government programs to make sure there are workable kitchens in every home aren't enough.  These are good things and will help people who are the percentage of fast food customers who are more desperate than really into the food.  

But the problem is that if the fast food industry's marketing strategy was to sell only to people with no other options, they would go bankrupt.  Kit-Kat in comments put it well:

Look, I believe people when they explain why it is they eat fast food, or imagining why someone else might prefer fast food. I don’t think that everyone who eats out is a lazy moron. But I think that we can over-excuse. There are some people for whom cooking at home is not a possibility. But all the fast food in the country is not being eaten by service industry workers who get off work at midnight and lack a functioning kitchen. A lot of it is being eaten by people who *do* have the time to cook at home and have access to a Safeway. Understanding why they choose not to is an important part of addressing the issue.

I'll point out that quite literally, if speed were the only consideration in buying fast food, most of it would not be so bad for you.  (In fact, there's only whole chain that has dedicated part of its menu to catering to people who want something fast that isn't going to wreck them---Subway. But even then, most of their menu is crap.)  The fast food industry would like us to believe that they can't help but serve mounds of grease and sugar and that this aspect of their business is unchangeable, but the reality is they sell mounds of grease and sugar because they know that's how you get more customers.  We either deal with that problem, or we continue to pretend it's not there, which is basically giving up and deciding that we accept escalating rates of diabetes and heart disease. 

I'll reiterate my points: a comprehensive understanding of why fast food sells so well involves accepting that people eat to relieve boredom and people eat to relieve stress, and fast food is perfectly pitched to achieve these ends. 

I will also point out something I pointed out in comments.  People who ride the extreme "fast food only sells because it's easy" argument tend to oversell how hard it is to cook and undersell what a pain in the ass it is to go to McDonald's. I used to eat out at fast food places (albeit, locally owned ones based in Austin that emphasized healthier choices than the major chains---but they will never get any bigger than they are because of this choice) a lot more because I bought the whole line about how eating out is easier. But gradually it dawned on me that it really wasn't.  The time spent getting dressed, driving, waiting to order, waiting for food, and driving home would have been more than enough time to cook something simple. So I started cooking more.  Which, in turn, turned on my no-doubt genetic predisposition to love cooking (or wevs, both my parents cooked at home a lot when I was a kid, so I think I was lucky to have those role models), and that's why I'm a more elaborate cook ofttimes than you need to be.  But not always. I'm the queen of the stir fry when I have work to get done. (Which in turn causes people to yell at me in comments on CSA posts for being a boring cook.  Oh irony, since the series was started in part to encourage people to talk more about simple, everyday cooking. It's worth wondering if this pressure to put out a 3-course meal every meal isn't what intimidates a lot of people out of cooking.) 

One thing that I really do think is overlooked at lot---again, because it requires acknowledging the darker aspects of daily life we prefer aren't a problem---is the whine factor, aka the emotional labor of getting the members of your family who are unashamed about their preferences for grease and sugar to sit down and eat a healthy meal without whining about it.  I got some emails from people complaining that Bittman overlooks how cooking is women's work, and I think that's somewhat unfair, for two reasons: 1) Bittman is one of the biggest voices out there encouraging people to learn how to cook 20-minute meals and if you actually listen to what he's saying, you can reduce your "women's work" workload by a lot 2) I really do think he imagines a more egalitarian distribution of work than most households enjoy.  The latter is a bit of blindness---from what I understand, he does most of his family's cooking, so he's not seeing that most men don't help much, if at all. (And this is a complex problem. A lot of women, and I include myself in this category, are so incredibly possessive of the kitchen that men can't help if they want to.) But what he's absolutely overlooking in his claims that cooking and eating are fun, communal activities is that this is only true if your whole family is on board. I think that's big time male privilege. It's much easier if you're a man who's cooking to get everyone to be supportive of your work. But women tend to have their work taken for granted, and in real world terms, that means the whine factor. 

I grew up in an extended family of people who love cooking. Even my dad cooked all the time.  And yet, we still ate plenty of shitty fast food, as did my relatives. The reason isn't that they were too overworked to cook, per se, but some times they were too overworked to tolerate us kids pulling faces and saying, "Not THAT again, we ate that LAST month." The most brilliant aspect of fast food is it's basically whine-proof---it hits you on the "comfort food" level, and everyone is going to eat it and like it. We eat to feel pleasure. McDonald's is the masturbation of food.  For the same reason someone might find that they increasingly prefer to masturbate than have partner sex---the latter takes coordination, everyone has to be on the same page, it's a lot of emotional work---someone might start making more and more of their diet fast food. 

If fast food were only about speed, then 7-11 would put Burger King and McDonald's out of business. We have to think of the problem as more complex than that, even if doing so brings up uncomfortable solutions, like demanding a redistribution of agricultural subsidies and taxing fast food so that it's not so much a cheap pleasure as it used to be.  

Today at XX Factor, I counter a lot of the reporting on a Johns Hopkins-based study of 6 sub-Saharan African nations and the factors that influence sexual frequency.  Researchers found that the more decision-making that a woman did in her household, the less frequently she reported having sexual intercourse. For those of us who spend a lot of time reading about public health research, this study read like many, many others that are like it, which are looking at the intra-personal politics in areas where there's a lot of negative health consequences related to sex (high maternal mortality and HIV transmission are the biggies), with an eye towards developing interventions that will reduce the incidences of these kinds of problems.  For instance, what someone might take away from this study is that women who have a lot of power in non-sexual negotiations at home probably has more power when it comes to sexual negotiations, which can in turn make it easier for a woman to prevent HIV transmission and time her pregnancies.  

What this wasn't was an evolutionary psychology study, as far as I can tell. But, as I report at XX Factor, that's exactly how it was read by many journalists.  Reporter after reporter decided to spin this as if it were researchers suggesting that not only do "bossy" women get laid less, but that the researchers were suggesting that this is due to an evolved, genetic response in men to abhor assertive women. The Huffington Post even went so far as to compare this research to some bullshit nonsense being asserted without evidence by a evo psych devotee at Florida State. (He found evidence that greater gender equality leads to women having more sex in various countries, but he did not actually establish evidence for his convulted theory that this shows women are hurt by feminism because it forces them to put out more---which he asserts, evidence-free, women don't like to do.)  There's nothing in the comments from the researchers I've read that suggest that they were saying such a thing, or that they were interested in extrapolating genetic theories from their research at all. The head of the Johns Hopkins study is Michelle Hindin from the department of population and family health at Johns Hopkins Bloomberg School of Public Health---I'm guessing a public health researcher who has no relationship whatsoever to evolutionary psychology, because she's probably too busy doing real research.

As I note at XX Factor, what this study probably shows even more is that sexual choice-making is highly influenced by culture and circumstance, because these women, living in areas where HIV prevalence is way higher than here and where it's primarily transmitted through straight sex, have a different environment than empowered women in countries where women have lower risks. I suspect strongly this influences their idea of how much and what kind of sex is good for them. 

So why was this study touted as some kind of evo psych bullshit "proving" that men lose their hard-ons when women start making decisions, and that this is inborn and not something anyone can change by changing society?  Well, I think it's because there's such a constant stream of such bullshit evo psych research being sent to newspapers in chipper press releases that this has become the dominant model of reporting on science looking at sex and gender. Evo psych ideologues don't even need to spell out their claims that most to all sex-and-gender choices are programmed genetically and unchangeable.  They've trained (oh irony!) journalists to fill in that assumption themselves.  So much so that when a study that has no relationship to evolutionary psychology comes across reporters desks, they apply the "men are like this, women are like that" evo psych model of assuming that misogynist stereotypes are biological facts, and they run with it. 

It's really disturbing to see the 21st century version of phrenology  get so much play in the mainstream media. But now it's gobbling up real science coverage.  That's fucked up.

With all that in mind, I'd like to invite anyone that's going to be in Brooklyn tomorrow night to come to Union Hall for the next installment of the Story Collider series. Story Collider is a story-telling series that focuses on stories about the personal impact that science has had on the lives of the story tellers.  I'm honored to say I've been invited to tell a story, and I'm going to write about how being a critic of evolutionary psychology made me more interested, as a writer, in science overall.  The headliner is Carl Zimmer, and he'll be joined by Anna North, Mark Katz, Bora Zivkovic, Tricia Rose Burt and myself. Buy your tickets in advance, if you can, because it often sells out. 

Via Roy Edroso, I see that at least one wingnut has risen to the bait of defending the Tea Partiers who bellowed their approval at the idea of letting an uninsured man died. John Hawkins of Right Wing News rose to the bait, by pointing out that Blitzer was asking about someone with a good job who can afford insurance but simply doesn't pay it.  Of course, John ignores that "The Left" was doing more than simply disagreeing with people who say that someone in that situation should be left to die---though I am surprised at how few people have pointed out that they often are left to die---but that we were appalled at the bloodthirsty love of needless death on display at the debate.  It wasn't just that someone made a somber argument for the necessity of letting some people fall through the cracks (which again, is the status quo---emergency rooms are required to care for you regardless of ability to pay, but in the situation Blitzer describes, the man would actually be taken off life support), it was the foot-stomping glee that the Tea Partiers had at the idea of death. You get the impression that if Ron Paul suggested that they send a squad of people to his house to rape his wife and beat his kids, you know, to "send a message" about not buying your own insurance, the audience would have gone nuts with approval. That, I think, more than the argument, is the concern here. 

But I'm honestly surprised more wingnuts haven't risen to the bait like Hawkins, because the way Blitzer asked about this question was a complete and utter red herring. Red herrings are a favorite argument technique of conservatives---which is why I suppose Blitzer is fond of them, rat bastard that he is---but they have no place in a presidential debate.  A common red herring, for instance, is for anti-choicers to invoke the specter of someone who is 9 months pregnant, wakes up and says, "You know, childbirth doesn't seem like a good idea after all," and waltzes into a Planned Parenthood to have an abortion.  This never happens. But the reason wingnuts bring it up is because they can't win the argument on real world grounds, so they make up fairy tales to debate instead.  That's why having a so-called journalist do this during a debate instead of asking a real question is utter bullshit. You're just eating up time that could be spent on discussing real-world concerns.  

Let's revisit Blitzer's question:

A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I’m not going to spend $200 or $300 a month for health insurance because I’m healthy, I don’t need it. But something terrible happens, all of a sudden he needs it.

Your average American can see immediately at least one major problem with this question. There is no such thing as  "good job" that doesn't have insurance benefits.  He might as well have said, "So you have this 30-year-old who can shoot lasers out of his eyeballs, and he figures that he doesn't need a police force. Should he be able to opt out of the percentage of his taxes that go to pay them?"  Blitzer should be ashamed of himself for concocting a myth and throwing it out there like it matters.  And sure enough, Hawkins---dishonest fuck that he is---laps that shit right up, claiming that millions of Americans who are going without insurance could totally have it if they wanted. Sure, if they quit paying their rent, but let's be real here.  The notion that there are 30-year-olds who are like, "La di dah, I could totally pay for insurance with my vast fortune, but I choose not to because ha ha, the federal government's got my back!" is asinine.  It just doesn't happen, as most working uninsured work part time (aka, in not-good jobs).  And if you can find that one example somewhere in the mists of time---you heard from a friend of a friend about this person---so what?  We really shouldn't be making broad policy decisions that affect the entire nation because of one guy someone heard about somewhere. 

Now, there is the exception, I suppose, of entrepeneurs.  There are a lot of freelancers and entrepeneurs who take their chances with going uninsured, because money is tight and also because insurance is more expensive than Blitzer is letting on.  But that's just one more reason that universal health care is such a good idea! Right now, many creative and interesting people are stuck in jobs (jobs that someone else would probably like to have, especially in this economy!) that don't use their taients, and one of the major reasons is health care. I know a lot of people who are 30-year-old entrepeneurs of various sorts, and their attitude towards health care is not the cavalier one Blitzer describes. It's actually better-described as "desperate". Good health care that actually provides is simply too expensive for most people, and so the holy grail of this world is getting a contract with someone who values your contribution enough to offer health care on top of what they're paying you.  Universal health care reform will pay out many long-term economic dividends in this way, by encouraging more people to go with the small business ideas of their dreams, many of which will be successful and create more jobs....with health care. 

In fact, I would argue that this is a major reason so many corporate interests oppose health care reform. For all the blather out there about "free markets", much of modern day conservatism is about squelching actual free markets, where people with fresh ideas can actually compete with big businesses. The last thing big business interests want is to encourage entrepeneurs. Big business doesn't want to innovate or work hard; they just want to sit around collecting obscene profits off over-priced goods, safe in the knowledge that many of the people who could compete with them if set free are instead tied to desk jobs, in no small part because they want health insurance. Republicans are the protectors of entrenched corporate interests, and that's why, regardless of their poses, they oppose anything that would encourage genuine entrepeneurship. 

I think I'm mildly obsessed with the HPV vaccination and the resistance to it.  The whole thing is a perfect storm of important issues for me: science and skepticism, feminism, public health policy, sexual health, religious delusions, the power that folk beliefs have over human choices, emotional vs. rational decision-making, and the ideological conflict between reality-based policy and aspirational policy.  (Not that I think that conservative aspirations towards a sexual system where every human being has one other they touch in a sexual way---including hand-holding and kissing---and no more is a good aspiration. It's creepy.)  I wish the conflict over this vaccine got more attention from wonky sorts, who I think are mildly wary of the sex thing, because it's really a perfect example of the various forces coming into conflict in our culture. I wrote about it again today for XX Factor, and was pleased to finally see a criticism of my point of view that wasn't coming from a place of squeamishness about sex, weirdness about preventive health, or just illogic.  KJ at XX Factor argued that we shouldn't rush into making the vaccine mandatory (she does think it should be mandated eventually), because there would be a backlash, and that if we wait until it's become more normal, it will be easier to pass mandates.  That's a reasonable position and she may be right.   That is a typical pattern for many vaccine roll-outs, though not all of them. I tend to think that the HPV vaccine's reputation as the "sex shot" may make it a special case, and that we need to address often unspoken fears about female sexuality as much as we do unwarranted fears of the vaccine's safety. Some times what it takes to get over these fears is seeing with our own eyes that positive choices about sexual health in minors don't result in more sexual risk-taking.  But I admit that we're all just guessing here; I've never seen any empirical proof either way that mandating a specific vaccine erodes opposition to it faster than an education campaign can. 

Some more thoughts on this as the whole issue has gotten more coverage after Bachmann's glaringly stupid remarks:

*For a lot of conservative Christians, disease really is a judgment from god.  Not always, but they really put a lot of energy into what they perceive are the supernatural causes of disease instead of boring old germ theory. This is how they can convince themselves that condoms don't work even though it never even occurs to them to question why therefore health care and food workers wear latex gloves.  Bachmann's claim that the HPV vaccine can cause mental retardation comes directly from this way of thinking; it's that god allows it to happen as judgment for trying to prevent a disease he invented to control female sexuality. 

*Anti-vax liberals actually have a not-dissimiliar point of view, though. When I was on MPR's morning show discussing this issue, a woman called in and basically explained her theory that she didn't have HPV any longer because she cured herself through diet and exercise. I don't want to say with 100% certainty, but I will say it with 99% certainty that she's wrong.  HPV actually works itself out in the majority of cases, and from what I understand, age is a bigger factor than any other.  (The older you are, the better your body is at killing the virus, though in some cases it sticks around for a long time.)  You see this attitude with a lot of anti-vaccine liberals, that they don't need medical interventions to prevent disease because they can do it with organic food and yoga.  It's a liberal version of the Christian right rejection of the germ theory of disease, but in this case your moral goodness is measured by your nutrition instead of your sexual choices (though I've found a LOT of liberal anti-vaccination folks get shockingly prudish about the fact that HPV is an STI).  In reality, you cannot "boost your immunity" through organic food or praying/not sinning. 

*:People's responses to this debate really oversell the idea that celibacy is an option. The "two virgins could marry each other and be free of HPV" argument is favored by conservatives, but it's a red herring.  We could also wipe out deaths from car crashes if all Americans chose to quit driving and revert to a horse-and-buggy transportation system, but so what?  I wish liberals would react to that argument by laughing wildly instead of coming up with rather irrelevant rejoinders like, "If your daughter stayed a virgin, she could still be raped or marry a man who isn't a virgin."  Okay, sure, but she's not going to stay a virgin until she's married. So why are we talking about it like it's a real option?  

*Seriously, it's not a real option. Fundamentalist Christians should stop preening like their daughters don't need the mandatory vaccinations in junior high school, because in reality, their daughters need it more.  Evangelical Christians actually have younger ages of sexual initiation than pretty much any other religious group.  Your average fundie 10th grader is a lot more likely to be fucking than your average atheist 10th grader, in part because research has shown that kids who get accurate, comprehensive sex education from their parents are more likely to delay having intercourse. (I'll leave it to you to speculate why---my theory is that it's a combination of willingness to use non-intercourse behaviors to stall the urge for intercourse and a sense that sex is something you really have to plan for, which discourages spontaneous sexual intercourse.)  It's irresponsible to engage in speculation that their daughters could wait until marriage, because not only will they not be doing that, they'll be having sex at much younger ages.  And with more partners; nearly 14 percent of evangelicals have 3 or more partners by 18, whereas only 9 percent of mainline Protestants do.  

*Did you know that kissing with tongue raises the chance you'll get HPV? The requirements for being a "virgin who marries a virgin" in order to prevent the disease are so high that probably no Americans actually reach them.

*I think the most important conversation this country needs to have is one about how it's not a big moral deal if you get an STI.  Viruses and other infections aren't moral agents, casting judgment on your sluttiness.  They're just germs. That your odds of getting an STI go up the more people you sleep with---all other things being equal, that is---is as remarkable as pointing out that your odds of getting the flu go up the more people you shake hands with.  Part of the problem is that sexual shaming has been an aspect of STI public health campaigns in the past.  What we need are public health campaigns that treat it as completely normal that one would have more than one partner in a lifetime, because you almost certainly will. A lifetime is a long fucking time, you know.  It's not enough to promote condom usage.  We have to treat someone who has a lot of partners with the same moral neutrality as we'd treat someone who gets a job in a public school around a bunch of kids who can give them the flu.  They have an elevated risk, but that's part of the price they pay to live the life that they want. 

Cord at GOOD has a post up about this visualization of your average American's food consumption in a year. 

I'm genuinely surprised at how much dairy we consume.  What's that about?  Do people just straight up drink milk?  That's really weird. 

Anyway, Cord's big concern is the amount of high fructose corn syrup people are consuming, which some studies indicate may be even worse for you than other sugars.

The American Heart Association recommends that women consume no more than six teaspoons of added sugar per day and that men consume no more than nine, which amounts to about 100 and 150 calories, respectively. Forty-two pounds is the equivalent of 3,865 teaspoons of corn syrup, or almost 11 per day. Nobody should be eating that much added sugar.

Exacerbating the problem is that high-fructose corn syrup has been shown to be worse than other sweeteners when it comes to weight gain. Last year, researchers at Princeton University discovered that rats supplied with corn syrup got significantly fatter than rats fed regular sugar, even when caloric intake between the groups was the same. What makes that particularly frightening is how frequently food brands have begun using corn syrup in place of real sugar, which is more expensive.

I'm somewhat skeptical about the research, because it's only been done on rats.  But I do think there's reason to believe a person who eats something sweetened with HFCS might eat more of it than something with the same amount of sweetener that is in sugar form, because HFCS just tastes less substantial, causing you to eat more in hopes of feeling satisfied.  

Regardless of where the sugar is coming from, however, it's just way too much damn sugar.  What's particularly troubling to me is that the "average" amount of sugar eaten doesn't even tell us enough about the problem.  There's a lot of people who don't really eat that many sweets and they're pulling down the average.  What these numbers say to me is that a lot of people are eating a lot of sweets---I'm guessing the average person who eats more than the recommended maximum of sugar on a regular basis is getting way more than 11 tablespoons.  I'm guessing a lot of people are getting a shockingly high percentage of their calories from processed sugar, especially since it's cheap and easy to get.  No wonder diabetes rates are soaring. 

Sorry for late-ish posting today.  But I've been kind of monitoring the news a lot this morning, I think because I'm still a little anxious about the debt ceiling situation.  Still, I was reassured enough last night that it's not going to fall through that I filed a piece that assumed it's a deal, which you can read here at RH Reality Check. My argument is that abortion caused the debt ceiling.  Okay, that's actually just the hook, but the real argument is that our right wing populist movement was built on sex panic (and race panic), and they have been able to use sex panic to grow their power and numbers until they were nearly able to derail the entire world economy.  The implication is that either we start taking the Fetus People seriously now, or next time they may have even more seats in Congress and no amount of Wall Street pleading will stop them from doing something world-destroying stupid. 

Anyway, the news that the country's not going to come crashing down around our ears but instead is going to continue its slow decline into becoming a banana republic will overwhelm today's actual, for-real good news: the HHS announced that birth control is going to start being free to women with insurance.  When it starts being free to you depends on when your insurance plan begins---it could be as late as 2013 for many women---but still.  Free birth control.  And by birth control, I don't just mean the pill or the ring.  You will also be able to get your tubes tied, an IUD installed, or an implant put in....all for free.  No co-pay for any contraception.  Free pills is a good thing and should reduce unintended pregnancies, but the free long-term birth control methods may be a bigger deal.  A lot of women would prefer to have these kinds of birth control, but the up front costs are just too daunting.  Preliminary research shows that women who have access to free long-acting birth control both are far more likely to use these methods and, unsurprisingly, have fewer abortions. 

So, hard as it is to believe, today is actually going to be somewhere between "not as bad as we feared" and even a good day. 

So, Mary Elizabeth Williams has called me hysterical and claimed I'm ruining feminism with my supposed irrationality because, on Twitter, I criticized a piece she wrote about her pediatrician accidentally giving her daughter the first dose of HPV instead of the scheduled meningitis shot.  When a cascade of people attacked me, I defended my point of view, both that the heavy drama surrounding this was unnecessary and, far more importantly, that Williams' choice to treat the HPV shot as somehow separate and more fraught than every other vaccine fed a very dangerous narrative about this vaccine, and she should have been more responsible.  Her response minimized and distorted her original piece, and overplayed my reaction, in my opinion.  But let's take my objections one at a time, for clarity's sake. 

Objection #1: Dramatics

This one's on me.  I accused Williams of being overdramatic by turning a minor mistake into a big deal that upset her daughter so much that she was, in Williams' words "scared and sobbing and, on a very primal level, angry and betrayed."  Even though Williams swears she was calm and acknowledges mistakes happen, she describes wanting to "throttle" the nurse, and claimed her daughter was "robbed" not just of a childhood so far free of minor medical errors, but of her right to make choices about her own sexuality.  

I was raised in a "suck it up" culture, and my first inclination in situations like this would be to remember that medical errors are incredibly common, and be grateful that when my number came up, the worst thing that would happen to me is that I have a significantly reduced chance of dying of cervical cancer.  But I fully admit this is a personal choice.  There are good and bad sides to the chilled-out approach and good and bad sides to making a big deal out of stuff.  My irritation at the dramatics was unfair; I should apply the "suck it up" mentality to other people's dramatics and say, "No big deal. That's just how they are."  

Objection #2: Toxic narratives about the HPV vaccine

In fact, sucking it up when someone else's dramatics irritate me is usually what I do, with a side dose of reminding myself that dramatic people often stand up against everyday injustices to the betterment of us all.  But the reason this pissed me off was that Williams juiced up her story by invoking a toxic narrative about the HPV vaccine, that it's the "sex shot" and therefore is unique amongst all other vaccinations, requiring a lot of hand-wringing about personal choice.  My problem with this narrative is that it feeds the notion that sexual health is separate from other kinds of health, and that continues the politicization of it and feeds right wing narratives that sexual health care is morally corrupt in a way that other health care isn't. 

I think that responsible journalists should not add to the pile.  STIs are not different than other diseases; the only difference is political, not biological.  HPV in particular is ridiculous to politicize, since it's so common that it's wise to treat getting it as an inevitability if you don't get the vaccination. Indeed, the most important difference between the HPV vaccination and other vaccination isn't the sex stuff, but the fact that you probably get more individual protection from the HPV vaccination.  Most people have measles and whooping cough vaccines, offering the unvaccinated herd immunity.  But with the HPV vaccine, there's only 11% compliance, meaning that your unvaccinated kid's chance of getting HPV as an adult should still be treated as an inevitability.  Sadly, we'll be seeing 4,000 deaths and 12,000 cases of cervical cancer a year for some time yet.  

If you read that link, you'll see that there are many reasons for the low vaccination rate, including cost and ignorance.  However, the perception that this is the "sex shot" has a lot to do with it.  The belief that getitng the vaccination has some sort of sexual implications for your child makes people uncomfortable and unwilling to engage; Williams added to the pile by using the sex aspects of the shot to turn up the interest in her story. 

This particular criticism stung, I'm guessing, since Williams objected to it on Twitter and engaged in a little retcon about the sex stuff, claiming that this is solely about the fact that the HPV vaccine is "optional".  She minimized the way that she treated the HPV vaccine as somehow fundamentally different than other vaccines, and in her follow-up piece, continued to minimize and imply that she treats all "optional" medical decisions as belonging to an 11-year-old and not her parents.  

But that is  not how the original story read.  Let's start with Williams' attitude towards vaccinations that prevent non-sexual infections. 

Meanwhile, she still needs to get that meningitis shot, and I'm going to make damn sure that's the shot she gets.

Light, fluffy, no big deal, right?   Vaccinations are something responsible parents make "damn sure" that their kids get, because responsible parents understand not just the importance of preventive health care, but also that their kids are members of a large community and owe it to that community to do their part in providing herd immunity.  You, as a responsible parent, would never consider skipping the MMR or the meningitis shot, because duh, vaccinations are a private and public good.  

Interestingly, this common sense approach was in the same paragraph as this language about the HPV vaccination:

While my daughter and I are not ruling out changing pediatricians, she has decided to proceed with the course of vaccination. She didn't come to it lightly; she slept on it and shyly told me her wishes the next day. She is a serious girl, and treated this is a serious choice.

I'm sure Williams was completely consistent and also had her daughter sleep on the serious decision of whether or not to take her chances with meningitis.

Williams' claim was that she treated these shots differently because the HPV vaccine is optional and meningitis is not.  On Twitter I pointed out that the HPV vaccine should be mandatory, and the only reason it's not is sex hysteria.  When things aren't mandated because of political bullshit, but should be mandated, it's different than something that can be considered truly optional.  When I was a kid, it was legal to ride in a car without a seatbelt, but my parents didn't believe it was optional in our house, because they believed it should be the law.  I imagine if  conservatives get their way and public schooling stops being mandatory, Williams would also keep sending her kids to school.  

In a sense, all this is irrelevant, because in the original story, the fact that HPV is the "sex shot" loomed large as to why it had to be a big deal.  A telling quote:

And though I believe in the logic of getting the HPV vaccine, I have also long felt strongly that any decision involving their future sexual lives should be theirs to make.

That's the major problem. The choice of whether or  not to get HPV as an adult is more about your future health than your future sex life.  (And that's setting aside the logic of giving an 11-year-old the right to decide for her 20-year-old self whether or not to invite the possibility genital warts, cervical scrapings, infertility and even cancer into her life.)  Government officials and drug developers designed and regulated the vaccine to minimize the psychological association between the shot and having sex.  Part of that is scheduling the first vaccination years before the average girl starts having sex, in part to get complete coverage, but also so that it's not fraught like the conversation of whether or not to put a girl on birth control.  You just start getting the shots at 12; if you have sex at 14 or 21, it doesn't matter.  The choice to have sex and choice not to get HPV are decoupled.  And this is how it should be, since virginity is politically loaded, but that women shouldn't die or lose their fertility to cervical cancer should be completely apolitical.  

To be fair, I don't know if Williams treats all vaccinations with this gravity.  As I noted, perhaps her daughter was also expected to sleep on the decision of getting the meningitis shot, in order to make sure she knows that she could always have the option not to spend time around people who are sneezing or wiping their mouths.  Perhaps the tetanus shot was only administered after her daughter spent a day thinking about her future life around rusty metal and biting insects; after all, we don't want to presume for her that she wouldn't consider simply avoiding the easily identifiable situations where you can get tetanus (rusty objects, hiking, tubing, outdoor barbeques).  

To be clear, the emphasis on the "sex" aspect of the shot was heavy in this story.  It wasn't just the one strange sentence about her future sex life.  

And then I'd had to, with all the calm I could muster, have a lengthy conversation about how the doctor had made a mistake, but it was OK, and everything was fine, and now we were going to talk about sexually transmitted diseases.

My daughters know the facts of life. They know where babies come from, and how people can get AIDS. Often, their knowledge hasn't come from carefully planned birds-and-bees heart-to-hearts but from spontaneous opportunities -- a confusing scene in a movie, a rumor a kid spread on the playground. Life does not always keep children in a bubble until both you and they are at your optimum moment of emotional preparedness. Stuff happens, and being a parent means being there to talk about it. It wasn't the conversation I minded having. It was the harrowing realization of how easily a sloppy mistake, from someone we trusted implicitly, could have meant something far more serious than what we'd just experienced. It was being robbed of choice. Not mine. Hers.

Look, I get that talking about sex with kids is a big deal.  I really do.  I'm 100% sure Williams is responsible and tries to be natural about this stuff.  I think the HPV vaccine is just as good a time as any to have this discussion. 

But this isn't about child-rearing practices.  This is about responsible journalism about important public health issues.  Williams did more than link sex and this shot with her daughter---which again, I can see arguments for it---but she reinforced the link the public mind.  That's another ball of wax.  When discussing the HPV vaccine, we have two frames to work with: "sexual choices" or "routine health care".  The first is a loaded frame that allows right wing narratives about choice to seep in.  If you're working with the "sexual choices" framework, it's easy for people to say that X isn't really health care, because the proper choice is to abstain from sex, and there should be consequences for those who make the "wrong" choice.  In fact, as I pointed out over and over again on Twitter, the fact that the vaccine is characterized as a sexual choice is a major reason it's not mandatory.  People are looking at it with the same nervous eye that they look at putting their kids on birth control with.  The sexual choice frame allows people to think that withholding the shot signals sexual values.

I prefer the "routine health care" frame, which is incidentally the typical frame used in handling the effects of how widespread HPV is.  When you get a Pap smear, for instance, it's not really treated like a matter of sexual choice-making, but more like getting your oil changed, just part of being female.  Once you characterize a form of health care as being about sexual choice-making, you start to have people not get the routine care they should, because they perceive that care as being something that's only necessary if you're a "slut".  Which is, incidentally, a big reason that a lot of women lose their fertility to chlamydia, because they don't get care in a timely fashion due to unwillingness to believe STDs can happen to good girls like themselves. 

And that is, above all other things, my main concern.  Whatever private decision-making looks like in the Williams' household is certainly not my business.  But once you write something and publish it, it's a matter of public concern.  Endorsing the "sexual choices" frame of HPV over the "routine health care" frame is a highly political choice.  You personally may not weigh one sexual choice more heavily than another, but that's simply not true of most of the public, where the belief that women should avoid "sluttiness" is still the strongly-held majority opinion, as is the belief that STDs are indicative of immoral sexual choice-making. 

In addition, in both of Williams' pieces, she didn't do a scrap of reporting on the actual safety and efficacy of the vaccination, just noting that there are "pros and cons", without noting something important, such as the pros way outweighing the cons (with the cons mainly being it's expensive and it hurts to get a shot).  She mentions that she's been "following" its evolution, but doesn't mention that both the FDA and the CDC report that the vaccine is very safe, and that the only verifiable side effects of the vaccine are common to all vaccines---basically a reaction to getting a shot, like when squeamish adolescents faint in the doctor's office.  She didn't note the widespread medical opinion that vaccinations are very safe, and in fact, invoked negative reactions to penicillin, as if the two were comparable, even though in terms of risk, penicillin is much more dangerous than vaccines.   If we care about the health of the next generation, we should be more thoughtful than this.  While most people who get HPV are fine and the infection clears up on its own, there are enough adverse effects that we shouldn't be cavalier about this: 4,000 deaths a year from cervical cancer, 12,000 cases of cervical cancer.  And that's on top of all the various miseries women have to endure so they don't become a statistic, including having to endure cervical biopsies and having cervical scrapings of pre-cancerous cells.  Incidentally, those scrapings sometimes also cause infertility in cases where aggressive treatment to prevent cancer is the only real option. A woman who has to choose between not getting cancer and not having babies in the future is someone whose choice has truly been robbed from her---and all because she didn't get to have the HPV vaccine when she was a kid as part of her routine medical care. 

I don't say that lightly; there are many dumbasses in the world.  But this clip really puts O'Reilly over the top.  He makes, in quick order, three mind-boggling claims:

1) That the Institute of Medicine recommended that the HHS use tax dollars to pay for every woman's birth control. 

2) That free birth control won't reduce unwanted pregnancy rates, because the reason women get pregnant is they're "blasted" and don't use birth control.

3) The third claim is implicit, and it's that the birth control that's under discussion---he specifically mentions the pill---requires you to remember to use it while you're having the kind of wild, drunken sex O'Reilly has failed to invite into his life with loofah references.  If he can't get any, ladies, neither can you!

Anyway, all of these claims are manifestly stupid.  Let's take them one at a time.

1) Actually, the IOM recommended that the HHS classify contraception as preventive medicine.  This would not affect taxpayer dollars at all, because what it would do is require insurance companies to cover contraception without a co-pay.  I  have no idea where this stupid $4 billion figure he's bandying around comes from, but it's irrelevant.  The move is universally understood by serious people to be one that will save money in the short and long term, with the hopes that it will lower costs overall to the consumer.  The reason is pills, IUDs, etc. are cheap, but childbirth and babies are expensive.  Even though it would benefit consumers and insurance companies over the long run to cover prevention completely, the reason it's not done is insurance companies gamble that some other company will have you when you get diabetes/have an unwanted pregnancy/have a stroke.  So the government will just regulate it, and that takes that problem away.  But the takeaway is this: he's lying about the government paying for it, and that it will cost money. It will actually save money.

2) This is basically a moral claim.  O'Reilly is framing unwanted pregnancy as a woman's just punishment for being a dirty, drunken slut.  He doesn't, however, explain why he thinks it's such a great idea to have women he considers irresponsible, slutty drunks put in charge of raising the next generation.  This is typical anti-choice thinking---putting punishing "dirty girls" above all other concerns, including the well-being of children.

Anyway, there's no reason to believe that his claim has any basis in reality.  O'Reilly may only get laid on New Year's Eve after some heavy drinking, but most Americans have sex on average of a little over twice a week.  His implication that we're a nation of mostly celibate people who get trashed and then give into temptation doesn't fit the realities.  

3) But even if this were true, it wouldn't matter.  O'Reilly clearly doesn't understand how the birth control pill works.  His statement only makes sense if you assume that the pill works by a woman taking it right before or during  sex to prevent conception, which is why being drunk might make you forget it.  But in reality, that's not how the pill works at all, as roughly everyone in the world over 10 years old that isn't Bill O'Reilly understands.  You just take it during the day and it covers you for having sex roughly whenever, as long as you're up on your pills. If you haven't been taking your pills and you take one right before sex, it doesn't offer any protection.

O'Reilly's lies about the IOM recommendations and about how only drunk sluts get pregnant are toxic.  But beyond all that, I want to emphasize this: Bill  O'Reilly is 61 years old.  He has been on this planet for 61 years, and he knows so little about female biology and sexuality he literally thinks you have to use the birth control pill during sex for it to work.  O'Reilly has both a wife and a daughter, and yet he's so ignorant about female biology, I bet you could tell him that women get their periods out of their urethras and he'd probably believe you.  But despite knowing less about female biology than your average 6th grader, O'Reilly feels entitled to rail on and on about abortion, birth control, reproductive rights, women's sexuality, and health care.  This is in part due to our toxic culture that treats white men like authorities, even when they're so stupid you have a strong feeling they need their wives to tie their shoes for them in the morning.