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. 

Did you hear that Michelle Obama ordered a single meal that was unhealthy?  I know!  This is quite possibly the worst bout of hypocrisy ever from a major political figure and certainly reason for her to shut up forever about how kids should eat their vegetables.  By the way, telling kids to eat their vegetables has magically, throw the magical corrupting power of touching the Obamas, gone from something that was about as uncontroversial as telling kids to pick up their room to quite possibly the worst thing a human being could ever do.  I suppose now patriotic Americans should not let their kids eat anything that comes directly from the ground at all, just to be safe.  Yeah, that zucchini looks harmless enough on the plate, but I've heard that consuming that shit will turn you into a liberal, and better dead than red and all that. 

Sure, some may say that Obama has, in the past, never once suggested that occasional treats are forbidden to herself or her family, or even that occasional treats are bad for you.  In fact, some might point out that her "everything in moderation" attitude closely resembles the advice offered by medical professionals when it comes to eating healthy.  Some even suggest that the occasional treat keeps you from feeling deprived, and allows you to maintain a most-of-the-time healthy diet.  

But those people are nuts!  Everyone knows that this is America, and in America, it's all or nothing.  Your weight should be either ballooning rapidly or you should be losing dramatic amounts of weight in short periods of time, a la "The Biggest Loser".  Screw this "healthy lifestyle" crap.  Only hippies do that.  You should either be eating the typical American diet of junk food all the time, until one day you vow to lose weight, go on a fad diet, lose a bunch of weight while being angry and undernourished and deprived, slip up one day and eat a donut, decide you're a terrible sinner and give up completely on eating well and instead go right back to eating crap three meals a day.  Anything else is un-American.  

Which is why all these wingnuts are up in arms.  Michelle Obama is breaking the rules!  The only way to feel after you eat a treat is to beat yourself up, decide that you're a sinner beyond redemption, and give up trying to eat healthy forevermore.  But Obama doesn't seem to play that game.  She occasionally has a treat and then goes right back to promoting healthy eating.  She planted a vegetable garden at the White House, and the White House chef uses it for all the big state dinners and what not they have going on there.  It was fun reading some of the menus! I read about potato and eggplant salad, red lentil soup,chopped salad, tuna tartare, petite filet, pea salad, ravioli, wild ramp puree, pear salad, orange glaze carrots with mushrooms, roasted potato dumplings (what a good way to reduce the fat in them!), chick peas and okra, green curry prawns, jicama with oranges, herb green ceviche, and beef with mole. All very tasty sounding, but alas, not a chocolate shake or French fry to be seen.  

It was actually kind of fun for me, would-be foodie that I am, to watch some of the videos of White House chef Cris Comerford  prepare state dinners.  This one was cool:

I have a sneaking suspicion that Michelle Obama is who she says she is: someone who takes exercise and nutrition seriously, and because she takes it seriously, allows herself the occasional treat and shuns the binge-and-purge norm that's foisted on us by the junk food and diet industries.  I suspect she doesn't eat hamburgers every day.  I suspect all this because as a member in good standing of the liberal elite, I know my people.  And that's just how we are.  I'm not only like that, but a whole bunch of my friends are, too.  We eat crap on occasion, and it's okay, because we mostly eat well.  I also suspect it because, let's face it, Michelle Obama looks like she's a frequent gym attendee.  In theory, one could be hitting the gym as much as she clearly does while eating like crap.  But I'm really hard-pressed to see how, especially at her age.  I'm a lot younger than her, and I've eaten junk food for three meals a day for even just two to three days, and even that was enough to make the return to the gym less than ideal.  

In fact, I'd argue that Obama is a really good model for getting out of the toxic American binge-and-purge approach to food.  She's modeling what non-disordered eating looks like.  I think the reason it's so shocking is that Americans have such a disordered approach to food that we can't even deal with it when we see someone who lives the "healthy most of the time, treats occasionally" lifestyle recommended by, oh, every science-based nutrition program imaginable.  

This is one of the best---maybe the best---video I've ever seen that breaks down the role of choice-making and rationality when it comes to public health policy.  If that sounds boring, it's really not!  The whole video is about fucking and injecting drugs, the epidemiologist Elizabeth Pisani who gives the talk roots as much of it as possible in vernacular English, choosing slang terms over medical terms (using the terms "junk" and "smack" instead of "heroin", for instance) as possible, which keeps it warm and lively.  It's about why people do stupid things that get them infected with HIV, or, more specifically, it's about why decisions that look stupid to outsiders (like having unprotected sex or sharing needles) are actually the most rational decision for people in some circumstances.  Less than 20 minutes, and you'll probably have a profoundly better understanding of how to evaluate public healthy policy claims that are about people's decision-making.  

I bring it up, because Tracy Clark-Flory had a thoughtful piece up about why the new, grotesque pictures of lung cancer on the sides of cigarette boxes will not work to make anyone quit.  And she's right!  Watch the video; Pisani explains how a heroin addict will sit and watch 21 people shoot up with the same needle before him, and watch that needle get blood-drenched and dull and all he can think is, "I hope there's enough for me."  And he's being rational, in a way.  The thing is that often what is irrational in the long term is perfectly rational in the short term, and in his case the short term decision to get high is really obvious.  Smokers aren't unaware of the long-term problems related to smoking anymore than heroin users are unaware of the threat of AIDS.  They probably think about it a lot more than non-addicts do!  The notion that someone will quit because the cigarettes gross them out is really naive.

That said, I'm not entirely unconvinced that the packaging couldn't prevent new smokers from starting up.  The rational reasons people have for picking up smoking is a) it's relaxing and b) it makes you look cool.  The packaging might damage both desires.  It might also remind you that not all smokers are the cool kids hanging out by the school, but some are craggy old addicts.  You might even do better by putting pictures of old people smoking cigarettes through trachael tubes on the packaging, just to put some distance between cigarettes and coolness. 

But even then, I'm largely unconvinced, I have to admit.  People will start to tune the pictures out, but the appeal of cigarettes to newbies will remain, and of course addicts have their own set of problems.  The problem with initiatives like this is that they don't address why people smoke at all, and that's what Tracy was getting at---the initiatives assume that lack of education on the dangers of smoking is the problem.  In reality, it's because the short term benefits to smoking still outstrip the long term benefits to not-smoking for a whole lot of people.  Also, as Tracy's post shows, these initiatives don't even have clear goals in mind.  Are they there to help current smokers quit or to prevent new smokers? These are entirely different groups and need to be addressed through different means. 

I'm personally of the opinion that anti-smoking efforts (or similar public health initiatives) probably work best if you approach the whole situation like you do a cat you're trying to get to stop scratching a chair.  Frustrate the undesired behavior, replace with an alternative that works for everyone.  That's why clean needle programs work if implemented correctly (i.e. with no punishments for needle carrying or use of the program to round up users).  It's how seat belt wearing became widespread---it was a combination of making it a bad idea to not wear one plus, and this is critical, making it super easy to wear one.  Cars that beep at you if you don't wear one are the best, since they offer a direct disincentive not to wear a seat belt.  

With that in mind, I think that the best bet still to stop new smokers is to make it expensive to buy cigarettes and, probably most importantly, make it really hard to smoke in places that are associated with being cool.  The decline in smoking that accompanied banning it in bars has made me, somewhat reluctantly, come around to supporting the ban.  You could probably do more to curtail smoking with high school students by making the smoking lounge in the principal's office than banishing them across the street.  Stuff like that.  Removing the incentives to smoke can go a long way towards curtailing the behavior.  

Gregory Conko writes the worst sort of logical fallacy today: about how we can't make decisions for the common good because someone really special might suffer.  The FDA is decertifying Avastin as a treatment for breast cancer, largely because it has a few side effects:

The agency is making this recommendation after reviewing the results of four clinical studies of Avastin in women with breast cancer and determining that the data indicate that the drug does not prolong overall survival in breast cancer patients or provide a sufficient benefit in slowing disease progression to outweigh the significant risk to patients. These risks include severe high blood pressure; bleeding and hemorrhage; the development of perforations (or “holes”) in the body, including in the nose, stomach, and intestines; and heart attack or heart failure.

Of course, you already have holes in your nose, stomach, and intestines - how else are you supposed to get air or food or poo?  Someone in the Obamunist government didn't think that one through at all, the lazy Trotskyite.

The hard part about these decisions is that there are always people who don't experience side effects and for whom the treatment is effective, much the same way you always have that one asshole who manages to not get food poisoning from the steam tray food at the reception.  The argument that Conko lays out:

The weakness of the FDA's reasoning here is that averages ignore that individual patients respond differently to treatments. Particularly with life-threatening illnesses, where the downside of any treatment is relatively small, average or median survivability too often masks the fact that some patients respond very well.

When well-known scientist Stephen Jay Gould was diagnosed with a rare form of lung cancer in July 1982, he was told the diagnosis meant a median survival time of just eight months. His doctor gave up on him. But he lived another 20 years.

"Means and medians are the abstractions," he wrote in Discover magazine in 1985. "Therefore, I looked at the mesothelioma statistics quite differently—and not only because I am an optimist . . . but primarily because I know that variation itself is the reality."

For the sake of argument, we're going to pretend that Gould's doctor talking about about average survivability based on a diagnosis (which is what Gould's essay was about - .pdf link) is the same thing as average response to and risk from a treatment.  Actually, wait, no.  We're not.  They're different things.  

Gould's essay is a paean to the fact that cancer (and, by extension, illness) is an individual struggle, with statistics on your survival gleaned from the aggregated experiences of the masses.  What it's not is an argument that we are all Randian supermen and women who should escape the oppressive dictation of the state on what is or isn't an effective treatment.  

The purpose of the FDA isn't to provide individual recommendations on the efficacy of each treatment for each patient, because they aren't doctors or patients - they're a regulatory agency.  Their threshold isn't Gould's, because the FDA doesn't just serve Stephen Jay Gould (or tomorrow's version) - it serves everyone in that distribution curve.  By arguing that we should only serve the Goulds (or those on the rightward side of the distribution, as he would have put it), we tend to ignore those on the leftward side of the curve. 

I understand that women with hemmorhaging stomach holes who are about to die of breast cancer aren't as compelling as charmingly literate science writers with tales of perseverance and determination, but someone should be looking out for them as well.  It's nice that the FDA does.  

I want to run a little thought experiment by you:

Let's say I know a guy name John.  John is really popular amongst our social networks, because he's a nice guy and always there for you.  But I hate John, because John stands for everything I despise (perhaps he's a Dave Matthews fan), and that makes his popularity extremely threatening to me.  If only there was no John, I start to think.  Then people wouldn't be so quick to dismiss my radical anti-Dave Matthews feelings by saying, "Well, John likes them...."  I start to go a little mad from the hatred.  And then one day, John really seals his popularity by having a birthday  party that's considered the party of the year.  My jealousy and rage causes me to snap.  I follow John home one night, murder him, and dump his body in the sea.  

I then get a cardboard cutout of John and start trying to pass it off as John.  Our friends are outraged and want to know where John is. I'm eventually arrested for his murder.  At my trial, I argue that it's unfair to say I killed John, because (pointing to the cardboard cutout), there's John right there.  

I go to jail, right?  

Apparently not if Glenn Kessler of the Washington Post or Uwe Reinhart is on the jury. They would say the prosecution has no case, because what I did was radically alter John---I may have killed John as we know him---but since there's still a cardboard cutout named "John" in the world, he can't be really said to be killed. To say that I "killed" John is to be a big, fat liar, worthy of four Washington Post Pinoccios.

Ridiculous, right?  But sadly, that's where the discourse on Medicare stands.  The eagerness to believe that Republican aren't as bad as they really are has driven even so-called fact-checkers to a place where they're whining that destryong Medicare and replacing it with coupons can't be said to be killing it.  Even though, in a sense, Medicare is even more dead than the John of our story, since most parts of John are currently here---he's just not animated---but everything about Medicare but its name would basically be gone.

Some rare-ish good news: the USDA has finally caved to pressure from health advocates (including Michelle Obama) and switched from the misleading food pyramid to a far more health-centric pie chart called the "food plate".

Here's the old food pyramid:

This new food plate is a big improvement in many ways:

1) Visually.  It's less confusing and gives the viewer a much better idea of how much of each kind of food to eat.  The pyramid was a bit confusing on this front. 

2) Accuracy.  The food pyramid overrated certain foods over the actual health recommendations, mostly because of pressure from various industries.  

3) Putting dairy in its place.  One of the major problems with the food pyramid is it implied that not only is dairy a necessary part of a healthy diet, but that it was just as important as the protein category (and separate from it). This was heavily criticized, not just by vegans but by lactose intolerant people and equality-advocacy groups that pointed out, rightly, that the assumption of lactose tolerance is casually white dominated, since European-descended people tend to digest lactose on average better than everyone else.  I eat dairy because I like it, but it's not an essential part of the diet by any means. The nutrients you get from it are available elsewhere and are often better absorbed from other sources.  By putting dairy off to the side, the plate visually represents how we should approach it.

4) Vegetarian and vegan-friendly.  The pyramid implied you need meat to live.  This new food plate is more clear that you just need protein, which comes from a variety of sources.

5) The elimination of "fat and sugar".  Even though the pyramid said to "use sparingly", the inclusion of fats and sugars was a cave to the junk food industry.  It's not that you shouldn't have any fat or sugar, but there's more than enough of both in a regular diet that relies mainly on plants, whole grains, and lean proteins.  Instead of seeing fats and sugars as part of the diet,they should be relegated to treats.  

The website that the USDA put together for this is also a big shift in the right direction. In the past, attempts to tell people to "eat less" were killed off by industry lobbyists.  But right on the front page you have "Enjoy your food, but eat less."  

Now, I realize a lot of people are going to roll their eyes at this and wonder who gives a fuck.  And that's a good question; most people don't even come close to following the USDA dietary guidelines.  Even the old, inferior guidelines were leaps and bounds beyond how the majority of Americans eat.  This is just a brutal fact; most people eat way more meat than they need to, way more sweets than they should, not even close to enough vegetables, and they guzzle sugary drinks. But that doesn't mean the USDA diet recommendations are useless. For one thing, they can be used to exert pressure for healthier school lunches.  They also have cultural impacts.  For instance, as any vegetarian can tell you, a lot of people really do think you need meat to live, and part of the reason is that it's in the food pyramid and treated like its own food group.  (Yes, beans are in it, but have always been shoved to the back at the request of the meat industry.)  Same story with dairy; Americans eat way more dairy than is really healthy, but we don't realize that because our very own government has been telling us for decades that it's normal and expected to eat a lot of dairy products.  In reality, if more people simply cut their dairy consumption in half, they'd probably start feeling better pretty quickly.  Most adult humans are lactose intolerant to certain degrees, and plus, you know, that stuff clogs you up.  I eat dairy, like I said, but I try to relegate it to a dressing or a treat, and not a substantive part of my diet.  

So, kudos to the USDA and Michelle Obama for finally getting this done.  It's been a long time coming. This does shore up my suspicion that health care reform is going to inspire government agencies that touch on health-related issues, such as diet, to do a better job at promoting prevention. 

The House just passed HR3, which was misnamed the No Taxpayer Funding For Abortion Act.  In reality, the law has nothing to do with taxpayer funding.  What it does is revokes the tax credit or deduction for health care for any individual or employer who purchases private insurance that covers abortion.  It also has an amendment allowing emergency rooms to turn away women who need life-saving care that could endanger the pregnancy or will require a termination.  Here's Nancy Pelosi explaining what's up:

The redefinition of rape to exclude raped teenage girls that was included in the bill and then taken out and then snuck back in has gotten most of the attention.  But there are two other aspects of HR3 that are even more frightening.  This is a radical piece of legislation, folks.

1) Lots more dead women. The legislators who wrote HR3 really, really like the idea of pregnant women paying for fucking with their lives.  The bill attacks the lives of pregnant women in two major ways.  First of all, the bill will force all insurance companies in the country to drop abortion coverage.  For women getting first trimester abortions of choice, this will be a burden, but since this is more of an attack on women who already have insurance, they're likely to be in a slightly better financial situation than the women who get screwed daily by the Hyde Amendment, and therefore more likely to be able to get the $500 together for an abortion.

Not so for women who are 20 weeks along, develop eclampsia or cancer, and need an abortion or they'll die.  That procedure can costs thousands of dollars, well out of the reach of many women who need it.  So they'd be screwed. 

More than that, you have the amendment to the bill that would allow hospitals to turn away women who need emergency terminations.  If you have an ectopic pregnancy, for instance, they would be able to turn you away. Some times women who miscarry don't miscarry all the way, and they need to get D&Cs at the hospital in order not to die of blood poisoning.  Hospitals would now be able to turn them away.

2) Drastic expansion of federal powers to control your money. The logic of HR3 is kind of complicated, but basically they're arguing that if you get a tax credit or deduction, all of your money---all of it---is "federal" funds, and the government can limit how you spend it. Right now, they're defining that narrowly to say they'll take your tax credit or deduction if you use your private funds to pay for abortion or for an insurance package that could cover abortion.  But there's no reason they have to stop there, as David Waldman explains:

Frankly, I'm not sure why, under this theory, individuals should even be eligible for federal tax deductions, credits, etc. if they make private purchases from such a targeted company. After all, all money being fungible, it could well be said that you're using "federal dollars" that are in your pocket by virtue of any tax deduction you take (whether related to health care or not) when you buy products from such a company, and that those "federal dollars" are going into the coffers of a company that uses them fungibly with the dollars they're using to pay for their health care plan.

So, they are opening a door to denying you the deductions and credits you take if you do things with your own money they don't like.  Situations like denying mortgage deductions if you use your home for purposes they don't like, or denying your charity deductions if they don't approve of the charities, or just taking away your standard deduction if you pay union dues, or denying you the right to claim your children if you spend money on educating them on things like the realities of global warming. The door is wide open here. 

Reading this dizzying array of Fox News attacks on various initiatives to promote healthy eating, I think it’s time for an expanded theory on the right wing War on Health.  I mean, on one level, this is just pure culture war.  Healthy food and exercise have been relegated to “hippie” behavior, and sitting on your ass stuffing fried food in your face has been associated with “Real America”, and so even the most innocuous reference to healthy habits causes a knee-jerk culture war reaction.  It’s a lot like the ridiculous temper tantrum over energy efficient light bulbs.  (The most comical version of this fight in my direct experience was when I was on Bloggingheads, and my conservative debate opponent decided to rationalize this silly culture war tantrum with the usual aesthetic arguments.  Sadly for her, I actually had one of the demonized light bulbs directly on my face—-we were buying energy efficient light bulbs before it was the law, man—-and was able to address her argument directly.  The aesthetic argument is a favorite because people usually don’t have the direct evidence on hand to refute it, but alas, Mollie didn’t get lucky that day.)  But the War on Health is particularly ridiculous because it seems so self-defeating for the people who buy in to it. 

I think my favorite example from this long list has got to be Fox News throwing a fit because the New York City Health Department issued health guidelines for its employees that discouraged serving fried food at work events.  And that’s in a list that includes a fit thrown because Michelle Obama had an exercise theme for the annual White House egg roll.  It’s the futility of the fit-throwing that amazes me.  There is no real downside to discouraging fried food at work events, and all upside.  In fact, I would recommend that work places serve only healthy food with a vegetarian option at work events for employee morale.  When you present a pile of sugared food and fried food and there’s nothing for vegetarians, it can be disheartening for a large percentage of your employees.  People who are diets are excluded,* vegetarians are excluded, health nuts are excluded, and people who have restricted diets under a doctor’s orders are excluded.  If your doctor told you that you really must watch your diet, and your work event is serving fried chicken and ice cream, you’re going to feel punished.  Salads, make-your-own sandwich plates, fruit plates, grilled chicken, that sort of thing?  Much easier to accommodate everyone. Until it became a culture war issue, everyone liked fruit and sandwiches. 

I think part of the problem here is that wingnuts got themselves worked up into such a frenzy over health care reform that health itself started to be demonized through guilt by association.  The words “health” and “healthy” have joined the long list of hot button words that set the wingnut brain into Hate Liberals Urg mode.  It’s more a free association thing at this point.  An Obama + the word “health” = Fascist Death Panels Abortion Taxes.  It’s concerning, since this stuff tends to feed itself.  I worry that soon there will be right wing theories that eating vegetables will kill you, a sort of internal death panels thing, or maybe a broccoli abortion.

*Yes, I know that it’s bad to be “on a diet”, but the solution for that is critical analysis of the diet industry, not bullying people in the workplace or making them feel excluded.

Urban legends: They’re the lifeblood of right wing nuttery.  Liberals crunch facts and figures, demonstrate inequalities and propose policy solutions rooted in core values such as believing that nations as wealthy as ours shouldn’t have the streets clogged with orphans begging for food.  Conservatives talk about how they heard somewhere that someone did something they don’t approve of, such as make an irresponsible decision or get a benefit/salary that someone with that skin color/gender/family background somehow doesn’t deserve.  These stories can be conversation stoppers, because they both have questionable veracity and they smuggle in a bunch of assumptions that liberals don’t agree with.  So how do you handle it when presented with a wingnut urban legend? 

Well, I have a three-pronged approach I’d like to share with you.  These are offered not in the order they should be used—-often you only need one of these approaches, or you need to bring in two or all three, but not in the same order.  These are more questions you ask yourself to get you to place to argue this crap down.

Today’s tall tale is from Haley Barbour.

Mississippi Gov. Haley Barbour(R) said states should also be free, for instance, to compel Medicaid patients to pay for part of their medicine, saying, “We have people pull up at the pharmacy window in a BMW and say they can’t afford their co-payment.”

This has all the markings of a wingnut urban legend.  The big red flag is what urban legend researchers call the FOAF, i.e. “friend of a friend” aspect.

In some social sciences, the phrase is used as a half-joking shorthand for the fact that much of the information on which people act comes from distant sources (as in “It happened to a friend of a friend of mine”) and cannot be confirmed. It is probably best known from urban legend studies, where it was popularized by Jan Harold Brunvand.

Barbour doesn’t actually mention the relationship he has with the person who told this story, but it’s implied that it’s pretty far removed.  Barbour certainly isn’t an eyewitness to this event; he’s not working a pharmacy drive-through.  He probably also doesn’t know the person who filled the prescription.  At best, Barbour knows the guy who owns the pharmacy, which means that this story is 4 to 5 people away from the supposed event.  One should be skeptical of stories that happened to friends of friends.  Even if the person claims to be only two relationships removed from the person being discussed, it’s well-known in the urban legend world that every time a story is passed, the number of people it had to pass through to get to the person retelling it drops.  So, I hear a story that supposedly happened to a friend of a friend of mine.  When I retell it, it just happened to a friend of a friend, when actually, I was led to believe it happened to a friend of a friend of a friend.  So you see the problem here. 

Anyway, here’s the three-pronged approach when I hear a wingnut urban legend.

1) Is it even true?  As noted previously, many stories get circulated as wingnut urban legends that literally cannot be true.  If you’re in the pro-choice world, you run up against this a lot, with urban legends about abortion and birth control that are physically impossible or disproved.  (My favorite is a story that circulates about a baby being born holding an IUD.) Much of the time, a cursory examination of “too good to be true” wingnut urban legends will demonstrate that they’re not true, which is why, believe it or not, my best weapon in arguing with conservative friends online is Snopes. In fact, Ronald Reagan’s story about “welfare queens” driving Cadillacs—-which is the direct precursor to this story—-has been demonstrated to be completely untrue.  Did Reagan himself make it up?  Maybe.  But it’s also possible he heard it from a friend of a friend of a friend, and each telling—-as it was in the hands of people who believe that there shouldn’t be welfare at all—-was one where it got exaggerated and exaggerated.  Maybe there was once a woman who had a bicycle and was on welfare, and it turned into a garage full of Cadillacs when Reagan heard it.  Which leads me to the next point.

2) Are there details being left out?  Say you want to give this story the benefit of the doubt.  Maybe there’s a grain of truth.  Maybe you can’t marshal sufficient proof that it’s a lie.  Maybe it sounds plausible, which in this case, it does.  It’s plausible that there are people who have BMWs and no source of income, especially with 10% unemployment.  But are there details being left out?  For instance, let’s say there is a pharmacy worker that saw this somewhere.  Do we know how old the BMW is?  Do we know how much the person paid for it?  Do we know if they bought it when they thought they had a secure job, and then they lost that job a year ago and haven’t found one since?  Is that BMW the only thing they own?  Are they living in the BMW?  If you’re working a paycheck-to-paycheck job that makes it impossible for you to save up three years worth of living expenses, buying a BMW might still be the most fiscally responsible thing you can do.  Let’s start with the assumption that you need a car, which you do in Mississippi.  Here is a 2001 BMW for $10,000.  Here’s a 2004 BMW for $12,000.  Both of those are cheaper than even the cheapest new car you can buy, and they’re BMWs, so it’s quite likely you’re getting more car for your money, and possibly saving yourself repair costs down the road, especially if they’re still under warranty.  But needless, to say, the car payment for these falls well into what can be afforded by someone with a lower middle income.  Now, imagine that person losing their job.  They don’t have any income and can’t pay for their medication. Should they sell the car?  They’re not going to get what they paid for it, and what they could buy off the profits probably breaks down a lot, incurring more costs.  Could they go without a car?  Maybe, but that means they can’t go to job interviews that would lead to them not having to be on Medicaid anymore. 

This sort of shit happens all the time.  It’s more likely than not this is what happened, if this even happened at all.  What Barbour wants you to believe—-that this is a rich person making payments on a brand new Beamer—-is far less likely, since you have to be making below a certain amount to qualify for Medicaid.

3) Do the conclusions the conservative wants you to draw follow from this anecdotal evidence?  Imagine, if you will, that a single bank concocts a scheme to make a bunch of money by signing off a series of really bad loans, and then using fancy accounting, paper-shuffling, and selling those loans to other people to keep from showing the emptiness of their investments on their books.  Does the conservative in question believe this requires shutting down the banking system?  What if pretty much every bank in the system did it?  What then?

So why should it follow that Medicaid should be torn up and everyone on it forced to come up with money they don’t have because you heard that one person somewhere may have been cheating the system?

Let’s assume for a moment that this story is exactly what Barbour is selling it as—-some guy somewhere makes enough money to pay for a BMW that’s brand new, but he frauded Medicaid to get his monthly supply of Viagra for free.  Let’s assume the worst about a man we don’t know and have never met.  Does it follow that because this one man cheats Medicaid that all the thousands of desperately poor people on Medicaid in Mississippi should be forced to pay for his fraud?  Should, for instance, a single mother who feeds her three kids on food stamps because she can’t find a job die and leave her children orphans because she can’t afford the new requirement that she pay for her heart medication/insulin/whatever lifesaving drug you can think of?  Should her children go into foster care and develop many of the emotional and psychological problems that often accompany being bounced from home to home, which makes them less likely to get an education and pull themselves out of poverty?  Should the taxpayers take on the further burdens all this creates?  Should all this happen because someone heard from someone who heard from someone that they saw someone through a window who may be cheating the system, but could also just be down on his luck?

These are the questions I ask myself when confronted with a wingnut urban legend, and I try to craft my response accordingly. Like I said, sometimes you can shut it down simply by disproving the story, or by complicating it with realistic possibilities they haven’t thought of.  And sometimes it’s good to attack the conclusions.  Or all three.  Depends on the situation.

This article at Salon exposing Proactiv as a sham made my morning, as I’m sure it will any of you who, for whatever reason, are exposed to a lot of cable television and therefore relentless ads for Proactiv.  (In my case, it’s mostly because Marc is a soccer fan, and every time some game is on, we have to endure the ads.  If you were judging on ads alone, you’d think that most soccer fans are suffering epic amounts of acne.)  I mostly hate the ads because they’re relentless and the worst kind of celebrity endorsement, but I always suspected that they’re selling overpriced crap that you can get for cheap at the drugstore.  And sure enough:

Make a few clicks around Proactiv’s website and you’ll find out the active compound is benzoyl peroxide. That’s the same stuff in Stridex, Clearasil and just about every nonprescription acne medication available in drugstore aisles across America. A tube of the same compound costs $5.25 at my local pharmacy.

Since writing about this stuff invariably brings out a true believer or two or a dozen in comments, I will add that the doctor who wrote this, Rahul Parikh, doesn’t disagree that some times it works better than the cheap stuff, but not because it is better.  It’s because the expense and the “system” they create gets clients to be more consistent with use.  Spend less money, but contribute the same diligence and Clearasil would work just as well.  (I’m a fan of Neutrogena’s stuff, just because it’s less thick, but not because it’s better in any chemical sense.)  As a perennially cheap person, I figured out the trick to flip stuff over and check the ingredient list a long time ago, much to the dismay of anyone trying to sell any of the various products that cost four or five times as much for exactly the same stuff.  Right now, a big scam is glycolic acid, which is the active ingredient in a lot of first rate exfoliating masks.  I’ve seen places like Bath and Body Works try to sell tubes of the stuff for $60-$100, which you could get it from Oil of Olay for $20.  (I’ve looked for it even cheaper than that, but sadly, there does seem to be a bottom in this department that’s set awfully high.) 

For some reason, exploiting people’s anxieties about their skin to sell them overpriced products pisses me off more than most scam-y things like it.  I think it’s because having bad skin makes you especially vulnerable to hucksters, because it’s so hard to conceal and it’s the first thing people notice about you, since it’s on your face and all.  People with bad skin will take drastic measures to have nice skin, and therefore they’re easy to convince that drastic measures—-like spending tons of money—-are necessary when they’re not.  To make it worse, unlike other appearance-based problems, like bad hair, bad skin doesn’t even go away once it goes away!  You can fix the zits, but you still have the scars.  Proactiv ads are especially vicious in this department, with the exploitative lighting and the glowing skin of heavily-made-up celebrities.  You’d have to be made out of stone not to look at that and feel a tug of envy and desire, especially if you struggle with bad skin.  Just the hope that this could happen for you has got to weigh heavily.  They must be making a ton of money, too.  According to this article, the company that owns Proactiv spends $12-$15 million a year on celebrity endorsements alone. 

Thank you, Whiskey Fire, for digging up this piece of outstanding wingnuttery from Austin Hill at Townhall, who was apparently so shaken by Justin Bieber cutting through the crap* and describing Canada’s health services how Canadians usually do—-as if they were just common sense, which they are—-that he lost his mind and decided to argue against the existence of public services through the heavy use of scare quotes.

Here’s what Bieber said:

You guys are evil,” Bieber joked to the American magazine writers, “Canada’s the best country in the world….We go to the doctor and we don’t need to worry about paying him, but here (in the United States), your whole life, you’re broke because of medical bills.” He continued, “My bodyguard’s baby was premature, and now he has to pay for it. In Canada, if your baby’s premature, he stays in the hospital as long as he needs to, and then you go home.”

That’s quoted from Hill’s article, and he’s going to show his contempt for Rolling Stone and the kids these days with their filthy Rock and Roll music by refusing to name it.  This is Hill’s response, and it’s beautiful in its inanity:

What a wonderful little fantasy, wouldn’t you say? America is so “evil” that when one goes to “see the Doctor,” one has to fuss with something so trivial as “paying him.” How terrible it is that a highly trained professional like a Medical Doctor must be compensated for his or her work.

Yes, he just suggested that Canadian doctors don’t get paid, because anyone in a government-funded system must work for free.  He must be crapping his pants for real about Wisconsin.  “What is this ‘pay the teachers’ crap? I thought everyone who in the public sector did it for free!”  Actually, that would explain a lot of the wingnut reaction.

But this is where his piece gets really amazing:

Yet how beautiful it is that in Canada, “the Doctor” just provides services, the patient just receives those services – as much as he or she needs – and the Doctor apparently doesn’t need to be paid. Or at least the patient doesn’t have to worry about it, right? Isn’t that the way it goes in Canada? Somehow, because of the magic of government, Doctors and nurses and everyone “at the hospital” in Canada just simply perform their jobs, patients just simply “get” what they need, and everybody’s happy. And Canadians don’t have to face that devastating threat of long-term medical bills.

I expect such childlike silliness from, well, children.

Between the words “childlike” and “fantasy”, I get the strong impression that Hill thinks Canada, with its national health care system, isn’t a real place, but a fictional land in a sci-fi novel written by socialists as propaganda.  I hate to break it to him, but Bieber wasn’t talking about some mythical land he read about in a fantasy book, but an actual nation state called “Canada”, and they are really close to the U.S., so if you’re still skeptical, you can go visit and satisfy yourself that they really exist.  They’re as real as Obama’s birth certificate. 

But I think my favorite part of it is that he describes a system where everyone gets what they need and no one is ruined forever just because they get sick, and just assumes you’ll be horrified at the idea. Which is kind of amusing, like writing, “Boston is a land where people just walk by old ladies laying in the street in need of help, and instead of kicking them, they pick them up and get them help,” and expecting your audience to clutch their pearls and vow never to set foot in that dystopia Boston.  But I thought it would be fun to play his game with social services that Americans are more familiar and fond of, just to drive home how weird he’s being. 

Read All...

Still playing catch-up, but I wanted to draw attention to this link that I only saw because of Ta-Nehisi: the USDA actually told people to eat less for health in their latest round of recommendations.  So, health care reform has definitely influenced policy outside of just medicine, as expected.  Or that’s my guess, anyway, because in the past the possibility that the USDA would actually tell people to restrict how much food they ate seemed remote to impossible.  But with a renewed interest in saving money because of health care reform, the equation almost surely changed, and now the USDA had financial pressures coming not just from the food industry, but from health care sectors that have to find ways to cut costs or else. 

The NY Times article doesn’t even begin to address how big a deal this is.  The USDA has been stymied and blocked at every turn for decades on this front.  At best, they’ve been able to say you should eat more fruits and vegetables, and they just sort of hoped you took a hint and therefore ate less of everything else.  Marion Nestle’s entire book Food Politics was basically a reaction to her experiences with the USDA and the FDA, and how the food industry was able to manipulate all the recommendations to send the message that people should be eating more, especially eating more meat, dairy, and refined foods. The only thing the government got past these powerful lobbies were recommendations to eat sugar and fat sparingly; the meat industry felt they could take advantage of those particular recommendations, and that’s basically why. 

I don’t know how much this sort of thing actually impacts people, but the food industry is clearly scared to death of government recommendations to eat less.  I think it’s actually because, believe it or not, such a recommendation undermines the dieting mentality.  Right now, our culture is one where people are basically encouraged to stuff themselves all the time, and then when they feel they’ve gained too much weight, go on highly restrictive diets to lose it, which they can’t wait to go off of and go back to “normal”, where they gain it all back. This obviously benefits the food industry in multiple ways—-they can feed you the food that makes you gain weight, and then feed you diet products, rinse and repeat.  The notion that we should be eating less than the current average as a matter of course hurts the food industry. But the notion of having a lifestyle instead of going on a diet is growing in popularity already; maybe this will help it along. 

There’s something kind of awesome about listening to Rush Limbaugh kick and scream like a 4-year-old child being told to eat his spinach instead of shovel cookies into his face.  This entire bit is hilarious, listening to him whine and cry about how terrible and disgusting it is to put OMG actual plant matter in your mouth.  While it’s funny listening to him be a little baby about this, though, there’s more to be concerned about here.  Limbaugh has taken to suggesting that the advice to eat fruits and vegetables (and to exercise) is conspiracy organized by scientists that are hiding the truth, for nefarious purposes.  It’s hard not to wonder if he’s trying to kill his listeners by ranting at them about how their diet should be nothing but junk food and their physical activity levels shouldn’t exceed picking up the remote control and pressing buttons.

He cites an article in the Daily Mail that said the fruits and veggies thing is a myth. Here’s a general rule of thumb to follow: the Daily Mail is not a reliable news source.  This goes double for anything with a whiff of gender anxiety to it, and certainly the hardcore wingnut press against fruit and veggies has more than a whiff of gender anxiety to it, in the same way anti-cat ranting often does, because plant-based food (and cats) are coded feminine. 

Indeed, the story from the Daily Mail is some fucked-up science reporting. The study they cite shows that people who ate 8 more more servings of fruit or vegetables a day and a 22% lower chance of dying of heart disease.  The Daily Mail glides right past this, though, denying that it had any real effect at all, and then claiming that the advice to eat fruit and veggies is a corporate scheme cooked up to sell more product., as if the far more extensive marketing push to get people to eat more fat and animal products didn’t exist.  When you actually run a search for more reliable reporting on this study, you find that it tells a far different story than the Daily Mail claims:

Even among those who couldn’t manage the eight servings, more fruits and veggies consistently meant a lower risk; for every additional serving above two per day, researchers observed a four percent decrease in the rate of heart disease deaths.

Oh, and this:

“This is probably the largest study of its type and should convince even the greatest skeptic of the value of fruits and veggies,” said Dr. Randall Zusman, director of the division of hypertension at Massachusetts General Hospital.

Part of it probably has to do with the fact that eating more fruit and vegetables often means eating less of the bad stuff, of course, but that doesn’t negate the results of this study, as much as Limbaugh and the Daily Mail would like to believe it does.

What makes this entire rant of Limbaugh’s even weirder is that he then references the recent passing of fitness guru Jack LaLane as “proof” that eating right and exercise don’t have any good health benefits. Problem with this is that Jack LaLane was 96 years old.  Granted, reading LaLanne’s profile, I have to say the man took it way too far—-eating is one of the most consistent pleasures that people get and his advice not to enjoy your food is just not really sustainable or life-affirming—-but that’s beside the point. As are some of the unscientific claims he made.  The point is that you don’t do much better than 96, in terms of longevity, and he was working out until close to the end, which is basically about as much as any of us could ever hope from life.  One man’s life and death isn’t really proof for or against the health claims about exercise and vegetables—-what matters is the aggregate data, which points to the benefits of a healthy diet—-but it’s weird to point to someone who basically lived the most extreme promises successfully.  As far as I know, no one has ever promised immortality.  Plus, there’s more to health than just mortality rates; there’s also questions about quality of life, which nutrition can dramatically affect as you age.  Diabetes, heart disease, and mobility problems are all manageable under modern health care, but I dare say the people who have these problems would probably have a lot less trouble, expense, and stress in their life if they didn’t have to deal with these problems.  And nutrition and exercise can be preventive in many cases.

My feeling about this is that one of Limbaugh’s talents is to take his own psychological issues and to project them out into political rants that rationalize himself to himself, and this tends to work because a lot of what makes him such a pathetic figure affects members of his audience.  See the post I wrote earlier about this, and how resentment and self-delusion are major components of right wing fantasies. It’s incredibly depressing, because it indicates that hopelessness is fueling this mad dash to the right the country is taking.  There’s a giving up quality to this rant, and to others from Limbaugh.  Discouraging people from trying to take care of their health?  Lying to people about the benefits of prevention?  He’s basically trying to convince you that it’s all futile and you should just give up even trying to care about yourself or your family.  Which, in turn, just encourages more resentment and more lashing out at the “liberal elite”, who are increasingly set up as envy/hatred objects for many reasons, but now including for eating vegetables and walking around.  It’s depressing as hell, so much so that it makes me actually long for the irritatingly bright “go girl” mentality of someone like Oprah Winfrey.  Isn’t there much of a middle ground anymore, between giving up before you even try and this sort of over-privileged earnestness that doesn’t acknowledge that there are some things out of control?  Can’t there be a muted optimism that acknowledges the structural problems and the reality of bad luck, but suggests we should try to do better as a society anyway? 

Appropriate for this occasion:

FDA Official: “Just Eat A Goddamn Vegetable”