How to Cope with the Albuquerque Mosquito Plague of 2022

I’m sick of seeing closeups of mosquitoes in the act of biting someone’s arm. Here’s a winsome cave cricket instead.

It’s a bit late in the season to start giving advice about mosquitoes, but I’m hoping that this information I’ve spent a lot of time gathering will be of some use to people around here.

Around the beginning of August, here in Albuquerque lots of us began to find big, itchy, even painful red welts on our legs and arms. For me, they spread into patches of red rashy dots two or more inches across, especially on my ankles. This was not a normal experience.

We wondered about mosquito bites, but we were not seeing or hearing any mosquitoes, and this was happening in broad daylight, not at dusk. Eventually it dawned on me that we must have a new and different species of mosquito invading the area. Readers living in other parts of the world may be laughing at my ignorance, but I had never even heard of day-flying mosquitoes in New Mexico. Or at all, really.

By this time, the matter was getting some press attention. It turned out that yes, we now have Aedes aegypti living with us, not just our classic old-school Culex species that mainly fly at night. Oh joy, the yellow fever mosquito! Smaller, faster, quieter, stealthier about evading our attention and thus our swats, perfectly adapted to attacking humans, its main prey. And super aggressive, often biting multiple times on the same body part. They do have one happier trait: they’re not a major vector for West Nile virus like the Culex family.

Here’s how screwed we are: 
https://sourcenm.com/2022/09/12/a-new-mosquito-is-stalking-new-mexico-is-the-state-ready/

These buggers have been around since 2018, but they didn’t become the scourge they are now until this year’s exceptionally wet monsoon season. I remember saying in 2021 that I hadn’t seen a single mosquito. That was true— I never saw them— but I now realize that the two bouts of what I thought were severe, unexplained hives were actually caused by marauding Aedes. I don’t know where I ran into them. We weren’t getting hit at home, and kept blissfully and obliviously hanging out under our newly-built patio roof.

This year, there seemed to be nowhere to hide. What to do?

I read everything I could find about bug repellents, a subject I hadn’t had to think about much since my youth back east. The essential oil spray I already had was doing nothing, though some people seem to have success with some oils against some mosquitoes. DEET works well, but will eat plastics and synthetic clothing, making it fairly impractical. It also smells and feels unpleasant. Picaridin is sold as a safer alternative for kids (though DEET is considered safe too) and doesn’t have these drawbacks. Oil of lemon eucalyptus (which is not the same as lemon eucalyptus essential oil) was said to be as effective as DEET, according to the FDA, and the smell isn’t bad.

I spritzed, probably not thoroughly enough, and still got some bites. Long pants and sleeves worked but were too hot and were not foolproof, since the critters can sometimes bite through clothes.

I ordered a concentrated garlic product to spray around the yard, which was supposed to kill mosquitoes it hit and deter others, without killing other bugs wholesale.  Little or nothing happened.  The small sprayer I had may not have been adequate.

To deal with the bites I hadn’t been able to avoid, I found the Bug Bite Thing, a small suction device that is meant to pull insect saliva or venom out of the skin.  It has to be used soon after the bite is inflicted, but it does meaningfully reduce the itching.  It doesn’t completely stop a welt from forming or keep itching from showing up later, but it helps.  It’s supposed to work on bee or wasp stings as well; fortunately I haven’t had a chance to test it on those.

I got to thinking about adding mosquito netting to our patio, but that sounded difficult, limited, and probably expensive. It hit me that one could make clothing out of mosquito netting, and then, that someone must have done that already. Yes, they have indeed. There are many brands, but here is one that’s made in the US and decent quality: 
https://www.bugbaffler.com/collections/insect-protection

I ordered a shirt and pants right away, and they arrived very quickly. They don’t make for the most fashionable outfit, but they make it possible to have a nice breakfast on the patio without becoming breakfast oneself. They aren’t as hot as regular clothing and there’s no toxicity or nasty smell. They also keep other insects out, and can even be used by beekeepers.

We already had netting covering our rain barrels, but we added oil on the surface of the water as well. This is a major means of control, as it keeps any larvae that hatch in the water from breathing. It’s possible that some females had gotten past our netting in the beginning. Aedes aegypti are considered weak flyers and tend to stay near the area where they hatched, and we had no other water in our yard, so the barrels were suspect. We don’t know what sources of standing water our close neighbors may have, but it doesn’t take much.

Hearing that city government was suggesting that we call them about spraying to kill mosquitoes, I checked their website. There wasn’t a word about the new skeeter situation. I figured that the traditional evening spraying of pesticides would be inappropriate for Aedes, since they’re active when bees and other innocent bystanders are around, but called to find out whether there might be some kind of help I was unaware of.

The pleasant man at the Environmental Health Department, Nick Pederson, confirmed my suspicions about pesticide spraying being a bad strategy for combating Aedes species. The spray has to hit them when they’re flying, he told me, so it would have to be applied during the day and would indeed kill other insects. He said his department was trying to get a Bt (Bacillus thuringiensis) product to spray over neighborhoods in hopes of it wafting into water where the bugs can breed, but they had been hampered by the supply chain problems that seem to be everywhere these days. Otherwise he had very little to offer, except for the hope that people would spread the word about getting rid of every bit of standing water in their yards.

He confirmed what I had read about insect repellents, and added the detail that oil of lemon eucalyptus works well, but you have to use a lot of it and apply it often.

A patient who has also been hit badly sent me information about mosquito traps, which I was not aware of. They can be used for official monitoring and research as well as to reduce populations around homes. If we have another bad season next year, I’m thinking in terms of getting one to add to our arsenal, but apparently they’re limited in how much they can do to stop bites, and they may even lure in more females which will then attack any available humans. 
Here’s an excellent article on traps: https://www.consumerreports.org/health/insect-repellent/mosquito-traps-lures-bug-zappers-a6094812568/

The spike in the mosquito population this year has been life-changing, in a restrictive and nerve-racking and health-damaging way. Yet a number of other insects have gone AWOL. I haven’t personally seen or heard a single cicada, and the grasshoppers that usually pop up everywhere we step at this time of year are mostly absent. There have been a few crickets, but only a few, and no significant cricking to drive us crazy. We didn’t have the usual spring onslaught of big brown miller moths; that’s not too strange, as the population level varies a lot, but I don’t think I saw any.

I would be very worried about all that, except that multiple species of bees, hornets, butterflies, small moths, and ants seem to be doing better than ever. And gnats, so many gnats! I wonder what to make of it all. Climate change must be a factor, but there hasn’t been a dramatic enough rise in temperature from last year to this to explain such a sudden shift in populations. We did have a dry spring and a much wetter summer than average, but was that enough to make the difference? And are people in other neighborhoods seeing the same species in their yards as I? I’ve heard that cicadas have been singing in other parts of town, but everyone seems to be noting an absence of grasshoppers.

If anyone reading this has insights into entomology in central New Mexico, I would love to hear from you. Our state is big on bugs, including some really big bugs, but there are some mysterious absences. I’m particularly curious about what happened to the elm beetles and cave crickets that were our constant companions in the ‘80s and early ‘90s. I bet I haven’t seen an elm beetle in 20 years, but they used to be legion, and the same trees are still present to host them. It’s possible that measures intended to get rid of them were successful and that’s why they’re gone. Not that I miss them, but something is fishy about this.

I do sort of miss cave crickets, which are cute as insects go, and do no harm to us. They used to frequently become snacks for our cats— who delicately avoided the long legs and left them strewn about— but local felines alive now may never have encountered one. I hope none of this means catastrophe is on the way, that is, worse catastrophe than we were already expecting.

Reports from around the world say that insect populations are declining precipitously and that this threatens all life on Earth. In our yard, with gnats and flies buzzing around one’s head and pollinators energetically zipping between flowers, it’s hard to imagine, but it’s true in so many places. In this context, the increasing success of mosquitoes is a maddening irony. Yet another new normal, one more thing to keep us off balance and uneasy in this alternate-reality world we now inhabit.

We do have more birds in our yard than I’ve ever seen before, so something must be going right. Maybe some of those insect-eating bird species who have lost supplies of their favorite foods will adapt to eat mosquitoes. Maybe the blood-sucking midges (yesss!) that prey on mosquitoes will provide some cosmic balance and damp down their numbers. Maybe local humans will be bothered enough to work consistently at control measures. If any of those things happen, they will take time. Meanwhile, I’m going to look funny in my mesh bug suit.

Photo source: The greenj   https://commons.wikimedia.org/wiki/File:Ceuthophiluscricket.jpg

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Filed under animal behavior, health and healing, nature, science

Reblog: Not Left or Right but Up

https://elenedom.wordpress.com/2016/08/03/not-left-or-right-but-up-the-undivine-comedy-and-our-comedy-of-errors/
Not Left or Right but Up: The “Undivine Comedy” and Our Comedy of Errors

I have been thinking so often lately of this old post. When I wrote it back in 2016, I could hardly have imagined the insanity that would befall our country in the ensuing years.  But as usual, plus ça change….

The enduring, worsening division is not surprising, but I would not have expected the incredible persistence of the Big Lie or the general inability and unwillingness of so many to engage with reality. It’s far more fundamental than a simple left/right philosophical conflict, which could be dealt with by honest communication between people of good will. More and more I find myself in despair. I still have no better solution than the one outlined here: to rise above the current appearance of hopeless and eternal warfare and operate within a higher reality.

I’m reminded again, too, of the concept that our planet is going to split into two Earths, energetically speaking, with humans literally living in two different worlds— something that seems entirely too true. https://elenedom.wordpress.com/2020/10/04/sorting-medical-fact-from-fiction-part-i-the-two-earths/
“We’re often told that if we stay centered and calm, keep our minds on our spiritual values and on love rather than fear, and consume a solid information diet instead of mental junk food, we are a lot harder to manipulate.”

Some of my patients have also been talking about the necessity of connecting with a higher spirituality in order to cope with our extremely challenging time. I hope a great many people are thinking this way and that we will manage to make a meaningful shift.

The original post from August 2016:
In 1833, the young poet and playwright Zygmunt Krasiński penned Nie-Boska Komedia, the “Undivine Comedy,” which is still an icon of Polish literature.  Krasiński was a one-percenter who was acutely aware that things could not go on as they were in his intensely inequitable society. In the play, the fed-up 99%, led by the charismatic but cruel and unbalanced Pankracy, rises against the ruling class. Count Henryk, a character who has much in common with the author, is the central figure on the aristocrats’ side.

An apocalyptic battle ensues, taking place in a Dantesque, fantastical setting that could not be fully realized on a physical stage at the time. Henryk and his cohorts represent a tradition that has fallen away from its noble ideals and become vain and selfish. The revolutionaries are an unsavory rabble who espouse justice and equality, but are willing to destroy everyone and everything in their way. Neither side is worthy to lead the country into the future.

In the end, the revolutionary forces win the battle, Henryk dies, and Pankracy orders the execution of the remaining aristocrats. Suddenly he is overtaken by a brilliant vision of Christ, so brilliant that it paralyzes him and blinds him to all else. In the vision, the clearly displeased Christ is leaning on his cross as if on a sword, and lightning flashes from his crown of thorns. Pankracy cries out “Galileae vicisti!” (“Galilean, you have won!”) and drops dead on the spot. The end.

When I first read a translation, many years ago, I thought it was the most facile, brainless deus ex machina ending anyone could ever have come up with. Krasiński was only 21 at the time, I thought, and he was trying to deal with hopelessly intractable social problems; he must have just thrown up his hands and walked away. I couldn’t get this crazy, surreal story out of my mind, though. Eventually it percolated through my head long enough that Krasiński’s insight got through to me.

You may have figured this out a lot faster than I did. Krasiński was saying that humans cannot mend the injustices in their world through conflict, and that no human point of view is entirely right or deserving of victory. Only a spiritual awakening can bring about the needed transformation, and that can only happen within the individual.

Well. Obviously we are not there yet. It’s going to be a while before enlightenment strikes every human heart.

Krasiński wrote in a time of fundamental dissolution and transition. Poland had been obliterated as a nation by the Russians, and many of his compatriots had emigrated to form a sort of country in exile, rather as has happened with Tibet under Chinese rule. Poland had been in shaky positions before, but now it had officially ceased to exist. It must have seemed as if nothing could ever be normal again. Yet Romantic-period sensibilities included a robust belief that a utopian world could be created (at least on a small scale), along with a willingness to imagine the wildest of possibilities. We are not there, either. We are cynical and disillusioned and far beyond the naivety of the 19th century.

Despite his pessimistic portrayal of Henryk and his followers, Krasiński held to the view that an educated, cultured elite, steeped in old-fashioned values and Christian ideals, would be best suited to run society. He was bitterly opposed to the Tsar’s regime, but also opposed to radicalism and insurgency. He distrusted the disorderly mass of the 99%, preferring at least the possibility of a redeemed 1%.

In this dark moment we have our own kind of Pankracy, an uncouth, uncontrolled pseudo-revolutionary who claims (falsely!) to be an outsider and populist, and who has already succeeded in blowing apart longstanding power structures. On the other side we have an establishment figure who embodies the American version of aristocracy. Those of us who identify with the educated and cultured elite are horrified that anyone would even momentarily choose the former. We are appalled at his utter disregard for civility and for reality itself. Like Krasiński, we would much rather have one of our own in charge, someone with solid intelligence and broad knowledge of the world. But as in his time, hallowed power structures have become calcified and disconnected from the ideals they were originally intended to serve, and we no longer trust those who have found success within them, no matter how competent they show themselves to be.  So we have widespread frustration and discontent.

We find ourselves watching a drama as lurid as anything the Romantics dreamed up, rapt and hypnotized, unable to tear ourselves away. The only path out of this, I think, is not left or right but up. Awakening is the only possible solution to the national nightmare. And it is most difficult to achieve, requiring us to pull the beams from our own eyes when we would rather pay attention to the motes in the eyes of others.

May all our eyes open.

Here is a quick overview of Krasiński’s career: http://culture.pl/en/artist/zygmunt-krasinski

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Filed under history, politics, spirituality

It’s Still Mainly Medical, Not Moral

“If we are going to debate abortion in every state, given how fractured and angry America is today, we need caution and epistemic humility to guide our approach.” — Peter Wehner in The Atlantic

I showed up for one of the many Bans Off Our Bodies rallies across the country on May 14. It was the least I could do. It wasn’t enough. I’m not sure what will be.

Some Black folks on Twitter were shaking their heads at the stupidity of people who officially signed up to go to these things, wore recognizable T-shirts, shared photos, and in general made themselves obvious. They knew from bitter experience that being identifiable at a protest can lead to unpleasant consequences. In Albuquerque, going to an event like this is a pretty mainstream thing to do, and my old white lady self had little to worry about, but that was a wake-up call. I know it’s not so easy everywhere or for everyone.

Why is it always framed only as a women’s issue?

The closest thing to a threat I noticed was a tall, heavyset guy, a rather imposing figure, wearing a shirt that bore a childishly offensive message intended to incense Democrats, yelling anti-abortion insults nonstop through a megaphone. He was the only visible representative of his side, and he certainly did nothing to help their cause.  He was also failing to get the attention he apparently wanted.  Everyone was ignoring him.

“It’s not what people want.”

The other day one of my patients, a lady in her late 60s, told me that her husband is extremely angry about Justice Samuel Alito’s draft that shows the court plans to overturn Roe v Wade and throw the country further into red/blue chaos. She is not angry herself, she said, because, as she stated with total confidence, “It’s not going to happen.” I asked her why she would say that. “It’s not what people want,” she replied.
 Her pronouncement was like an incantation. It felt incontrovertibly true and immediately real. Perhaps, since about ¾ of Americans do think Roe should remain, she will be proven correct. After a lot of pain, death, and waste, I fear.

It must be stated firmly that no one is “pro-abortion.” That is not at all what people mean when they express the importance of keeping abortion available. This morning I read a local news story that referred to a pro-abortion student group. What terrible reporting, and worse messaging. It feeds into the false narrative that Democrats want to allow abortion up till the moment of birth. It intensifies polarization and makes rational communication all the harder.

Most Americans express middle-of-the-road, nuanced, pragmatic, compassionate views on abortion. They know it’s complicated and that every situation is unique. They want it to remain legal, but they are comfortable with a certain degree of restriction. That’s what poll after poll tells us. The ‘90s mantra of “safe, legal, and rare” seems to describe the mainstream attitude well.

No one wants to find themselves in the position of needing an abortion. No one hopes or plans that someday they will terminate a pregnancy. The very fact that someone is looking to do that means that something, somehow has gone wrong. Maybe horrifyingly wrong.

Even in a perfect world in which every pregnancy was wanted and celebrated, in which rape and incest did not exist, in which every family was confident that they could support every child who came along, there would still be cases in which abortion was needed for medical reasons. More of them than you might expect. That could happen, has happened, to people who desperately wanted that child to grow and be born. It could happen, has happened, to people who believed abortion was wrong and never in a million years expected to need one. Nature doesn’t care about our religious beliefs or political attitudes, or our desires or our convenience. Nature follows her own laws.

This is the point I want to drive home today, that abortion is medical care and that it must remain available to save lives and prevent great harm. It was over 10 years ago that I wrote the post I’ve copied below, “It’s Mainly Medical, Not Moral.” At the time, the big war was over coverage for contraception under the Affordable Care Act. Note this well: despite Justice Alito’s assurances that the Supremes are only talking about abortion, not contraception, LGBTQ rights, or anything else, the right wing has been fighting against access to contraception all this time. It absolutely is a target and they will come after it.

As an LGBTQ person, I’m very nervous about where this is going. As a woman, I’m anxious, even though I’ve been out of the reproductive game for decades. As a health care professional, I’m afraid for all the doctors and other providers who have to care for their patients while trying not to run afoul of laws that make no sense. And as a person who wants democracy to be a reality in the United States, I’m terrified.

A couple of days ago I was spinning down into a maelstrom of fear and depression. Then I realized what should have been obvious: They want me to be afraid. They want us all to be paralyzed by fear and unable to get ourselves together to oppose them. Let’s not give them that.

Catch-22s all over

One would think that since effective contraception leads to far fewer abortions, anti-abortion folk would be much in favor of it. And one would be wrong, at least in the case of the more extreme elements of their movement. This is what I find most incomprehensible of all. There is a clear path to reducing the number of abortions: reduce unwanted pregnancies. Yet the same states that want to outlaw abortion also refuse to expand Medicaid, and work in every other way they can to limit access to birth control. Under this regimen, people can’t prevent pregnancy, can’t terminate it, can’t afford to get prenatal care or give birth, can’t afford care for the baby while they go to work, and can’t afford to stay home to do child care themselves. Especially for the poor, it’s hard to see what the option is supposed to be. (Breed babies for the rich to adopt, perhaps? That’s what Justice Coney Barrett’s flippant and heartless rhetoric suggests.)

It’s been pointed out that if we as a country really cared about babies, we’d do more to provide health care, child care, decent wages, and so forth, and obviously we don’t do that. There are some fervently anti-choice organizations that do try to support pregnant women in distress and those with newborns. I personally know two families that have taken young, financially stressed pregnant women into their homes and literally supported them. However, these efforts are far from state policy and are not remotely adequate to handle the thousands of individuals and families in difficult situations as a result of pregnancies.

A world in which abortion is criminalized means that some women will be arrested and jailed after having miscarriages or stillbirths. That’s been going on in El Salvador for many years, and despite a push to free women who have been imprisoned under such circumstances, it has just happened again. A woman who had an obstetric emergency and sought care at a hospital, as any of us would have done, was convicted of homicide after losing the baby. She has already been in pretrial detention for two years.
https://www.vice.com/en/article/k7wd9n/a-woman-just-got-30-years-for-homicide-after-losing-her-baby
https://abcnews.go.com/International/wireStory/el-salvador-woman-accused-abortion-30-years-prison-84630286

But this is not just something that happens in faraway lands— it has already been happening here, for quite a while, even with Roe still in place. And not only do women risk arrest if their pregnancy goes awry, they may be unable to get medications that are commonly used to treat miscarriages, because those can be associated with abortion. https://www.npr.org/sections/health-shots/2022/05/10/1097734167/in-texas-abortion-laws-inhibit-care-for-miscarriages

A miscarriage is medically indistinguishable from a medication abortion, so anyone who has had one is potentially vulnerable to prosecution under such draconian laws. This means that the totally normal, sensible act of going to a hospital can put a person in grave danger. And of course when one is bleeding heavily, avoiding going to a hospital is not a very safe choice either.

This is not what most people want our country to be like. We know that a strong majority of Americans, including a majority of Republicans, want Roe v Wade to stand. We know that most Americans want to see, at the very least, exceptions for rape and incest, exceptions that the farthest-right state legislatures no longer wish to allow. It’s astonishing that a policy so widely opposed by people all across the political and social spectrum can even be considered as law.

Welcome to the age of minority rule.

Should we rage?

The forces arrayed against reproductive rights have had passion and long-term commitment on their side. Those wanting to keep abortion and contraception available have been more complacent— for so long, there seemed to be little reason to scream about rights that everyone, even certain Supreme Court nominees, recognized as “settled law.” (What patsies we were.)

So now we are beginning a “Summer of Rage,” in which protests will be loud and persistent. I don’t know whether this is the best course. We can’t be complacent anymore, and this is a genuine emergency that deserves every effort to hammer it into the public consciousness. Would we be better off with a more rational, conversational approach? That would be my way of doing things, but I can’t say that it’s worked particularly well so far, so maybe hot pink rage really is the ticket right now.

Medical hazards and crises

At any rate, in this post I would like to speak to the typical person and bypass extreme rhetoric. I want to again point out some of the dire medical reasons a pregnancy may need to be terminated, no matter what the ideology of the mother, the health care personnel, the state, or anyone else. There are many more that I won’t get around to here.

First, the likelihood, or should I say certainty, of young girls being impregnated by relatives or others. Incest is far more common than we like to think. All too often this happens to a child who is too young and small to safely carry a baby to term and give birth. Beyond the sheer cruelty of putting a child through this— how can anyone justify sacrificing one child to save another, especially another who was unlikely to survive to begin with? There have been famous cases like this in countries where abortion was totally banned. There are guaranteed to be more.

Even before the current era of extreme state laws, some states commanded that minors would have to have permission from their parents to get abortions. Right-wing forces tend to hold a rosy picture of caring parents in nurturing families in which a confused teenager might be lovingly guided to make good choices, but obviously that is not always the reality. What if, in fact, the parent is the perpetrator? Are we really going to require girls to give birth to their siblings? Does that make either medical or legal sense?

Pregnancy and birth are not only dangerous for the youngest girls, though; they’re hazardous for everyone with a uterus. You probably already know that the US has an embarrassing level of postpartum deaths, and that the rate is worst for Black women. (Poorer women get worse care in general, but even wealthy Black women face increased risks.) The people most impacted by draconian laws against abortion are also the ones who are less likely to get through pregnancy and birth safely.

In addition to the fundamental, “normal” risks of pregnancy and childbirth, there are the many unforeseen tragedies that can befall a fetus during gestation and that can threaten the mother’s health and/or life. Laws that purport to make exception for saving the life of the mother but are written without medical understanding, and without details about what is actually allowed, tie the hands of doctors in emergencies and lead to unnecessary deaths. When this happened to Savita Halappanavar in Ireland, the country responded to the outrageous situation by changing its laws. The same kind of deaths will no doubt occur here. It’s just a matter of time.
https://www.irishcentral.com/opinion/niallodowd/savita-halappanavar-abortion

In fact, last week I read about a woman who had a similar problem to Ms. Halappanavar’s— her water broke, it was too early for the fetus to survive outside the womb, sepsis was likely. And she lived in Texas. Because the mother’s life wasn’t in danger at that very moment, even though it probably would have been in the very near future, the doctors felt unable to terminate the doomed pregnancy— as they would have before the new law kicked in. The mother ended up being driven about 8 hours by ambulance to a neighboring state, a stressful, dangerous, expensive, and totally unnecessary trip. This is craziness.

Don’t understand why doctors would be prevented by law from saving a woman in such circumstances? Let a real OB-GYN explain how incredibly fraught and confusing an emergency can become:
https://www.youtube.com/watch?v=zjB5Jakytyc

We have to remember that suicide is also a major risk to the life of a distressed pregnant person. Here is an anecdote from another OB-GYN:
“During medical school in Florida, my first experience with abortion was with a 19-year-old woman who had been gang raped and was now pregnant; she was suicidal and placed in the behavioral unit. Our team saw she was devastated; she did not want to continue the pregnancy. It was simple; this traumatic, unforgivable experience would ruin her life. I was disappointed to see the reluctance to offer the care she needed. Only one physician, a newly graduated physician who trained in LA, immediately offered her care. His care could change her future and offer her some peace of mind for her mental and physical turmoil. I wanted to become the physician that would not back down, would show up and would be present for a patient in her time of need. When I applied to residency, I knew I wanted a program that offers training in abortion care.”
https://abq.news/2021/09/op-ed-we-stand-with-texas-patients-against-the-sb8-abortion-ban/

It’s not my purpose here to try to list every kind of medical crisis that could occur during a pregnancy and make termination the best or only choice. There are so many heartbreaking things that can happen to either the mother or the fetus, and each one requires its own unique response. Things that go horribly wrong often do so late in pregnancy, well after the 6 weeks Texas allows and even after the or 15 or 20 some other states have wrangled over. (Savita Halappanavar developed sepsis at 17 weeks.) Pregnant people, their families, and their doctors need the flexibility to make the right decisions in the moment, often with very little time available. Legislators making rigid, blanket pronouncements cannot possibly cover all the contingencies that have to be dealt with in the complex reality of reproductive health care.

Ten Years Ago— Plus Ça Change

When I wrote “It’s Mainly Medical, Not Moral” on 2/20/12, the big battle was over the Affordable Care Act’s provision to cover birth control. We have only gone backwards since. Here is the text of that post.
https://elenedom.wordpress.com/2012/02/20/its-mainly-medical-not-moral/

It’s Mainly Medical, Not Moral

You’re probably sick of hearing about the war over insurance coverage for contraception under the Affordable Care Act, but I think I have a few useful points to make that haven’t been brought up elsewhere.

For those of you who live elsewhere, let me catch you up on this only-in-America craziness.  The Affordable Care Act, otherwise known as the health care reform law, mandates that contraception must be covered by insurers without co-pays (direct costs at the time of service) to the patient, and that employee health plans must provide this coverage.  While there is an exception for employees of churches and other places of worship, hospitals, universities, and other institutions owned by religious sects are included in this mandate.  A number of right-wing forces have complained that this tramples upon religious freedom.  After being thoroughly raked over the coals, the President and his advisors worked out a compromise: the religious groups would not have to pay for the coverage, and it would be provided directly by the insurance companies, so that those who object could keep their sense of purity.  Insurers have agreed to this because providing contraception saves them money (and is expected to save money for the entire health-care system as well as for individual families).  The war is still raging as I write this, with the self-styled guardians of freedom insisting that the government is still overstepping its bounds.

On the front lines of this trumped-up battle, we find none other than the Conference of Catholic Bishops, the same fine folks who protected us from the evil, dangerous practice of Reiki by banning it in all Catholic hospitals and other institutions.  (See my post “Attack of the Bishops.”)  Need I state the obvious?  These ideas are being promulgated largely by partnerless elderly men.  These are not people who have any need to prevent pregnancy or any understanding of what that issue is like for those who do, including the 98% of Catholic women who use birth control at some point in their lives.  This outrage is compounded by the fact that Viagra is covered and the bishops have no problem with that.

A letter I wrote about this recently was published in the Albuquerque Journal on Sunday 2/12/12, before the President backpedaled, and before Rep. Darrell Issa convened a panel of ALL MALE religious leaders, Catholic and otherwise, to testify before Congress.  Issa and his Religious Right cohorts have managed to make it crystal clear that their agenda has little or nothing to do with religious freedom, and is really about a) attacking the president and killing the Affordable Care Act any way they can, and b) controlling women.  They’ve abundantly shown that they want to get rid of not only abortion but all forms of contraception.  And while wailing about the government infringing upon their freedom, they’ve shown that they have no problem with curtailing the freedom of others– especially if those others happen to have pairs of X chromosomes.

Here’s my letter:

“In all the indignation-filled rants I’ve heard about the Obama administration requiring religious institutions to include contraception in employees’ health insurance coverage, there has been one glaring omission:  No one has mentioned the fact that quite often, hormonal contraceptives (the Pill, patches, or implants) are used for medical reasons that have nothing to do with birth control.    Many women take the Pill, etc. for conditions like polycystic ovary syndrome or severely painful periods.  Many of those women are not even sexually active, or not sexually active with men.  I’ve seen this quite a bit with my own patients.  Whatever one thinks about contraception, it’s hard to imagine even the staunchest Catholic objecting to legitimate medical treatment for such conditions.

“I’d just as soon see women use natural alternatives, but in many cases hormonal birth control really changes their lives for the better.  The costs of these medications can be quite substantial, however, and that can put them out of reach for students and low-paid workers.  The costs of the conditions they treat can be substantial, too, as when a woman must miss work because of debilitating pain.  We would not ask an employee to forgo painkillers for arthritis or inhalers for asthma.  How is this different?

“The President may have lost some votes with this decision, but there are quite a few of us who are relieved to see him standing up for women and for what makes medical sense.  Try as I might, I can’t see this as primarily an issue of religious freedom or of morality.  Women who object to contraceptives are still free not to use them.  Morality means doing the best we can for everyone in our society, and that includes medical care, which includes birth control.”

I didn’t want to get all confessional in the newspaper, and I wanted to focus on a single point for impact, without bringing in other aspects of the situation, but I have a personal story that I think sheds particular light on the complexity of this issue and the reasons a total ban by religious “authorities” is not only ludicrous but cruel.

When I was about 25, I developed severe cervical dysplasia, well on the way toward cancer.  This was treated with cryosurgery to remove the diseased cells, which was a standard treatment back then; no one realized at the time that cryosurgery would only mask the problem, which would resurface later on.  My primary care doctor told me I should have a hysterectomy, which showed a remarkable ignorance on his part, it seemed to me, as the precancerous cells were not invasive and might never be.  I had not yet had a child, and was determined to be able to do so.  After I healed from the cryosurgery, I did get pregnant, and my daughter was born when I was 27.  Over the next couple of years I became allergic to or unable to tolerate most forms of birth control, and so, with my husband and my very small daughter in agreement (Lenore’s opinion was “We have enough babies around”), I had a tubal ligation.  Which was covered by insurance, by the way, because my husband is one of those awful, greedy public employees, a teacher that is, and he gets all those totally undeserved benefits.

That was not the end of the medical story.  I had a number of years of clear Pap smears, then skipped a year, because it didn’t seem critical to have one at that point.  The next Pap showed carcinoma in situ.  The tissue underneath the layer affected by the cryosurgery had been stealthily developing toward cancer the whole time, and it had simply taken that long to show up on the surface.  By that time, most of my cervix consisted of abnormal cells, and I was noticeably ill.  To deal with this, my OB-GYN did a cone biopsy to remove all that– they use the word “biopsy,” since it does have a diagnostic aspect, but it’s a far larger matter than the word suggests.

The hospital personnel wanted to do a pregnancy test.  I explained that I’d had my tubes tied.  They impressed on me repeatedly that after this procedure my cervix could not support a pregnancy, and that I needed to be OK with that.  I reassured them again, and the surgery was done.  The pathologist found that there were still diseased cells around the edges of the cone, so a few months later I went through the whole thing again, nearly bleeding to death afterward, and ending up with even less of a cervix.  I emerged from the process weakened but cancer-free.

I often thought about what would happen if a woman in this condition did get pregnant.  Surely it has happened many times.  An embryo would start to grow, everything going fine, and at some point it would lose its moorings in its mother’s womb and essentially fall to its death.  I wondered how far developed the poor creature would be when that happened.  It seems horribly sad, doesn’t it?  The child would be doomed from the start.  The mother would suffer both mentally and physically for nothing.  And all of that could be prevented with the use of reliable contraception, or with my chosen option, sterilization.  If it could not be prevented for some reason, it seems very clear to me that abortion would be a far kinder choice than allowing the baby to keep growing until its inevitable demise, possibly till it could begin to feel something, and certainly exposing the mother to greater risks and discomforts.

I have always wondered how very observant Catholics would find their way through this dilemma, since there would be no way to avoid pain and tragedy, only to minimize it.*  The Church’s official stance, I suppose, would be simply “Don’t have sex.”  Ever again, or at least not until menopause, so that such a tragic pregnancy could never get started.

And of course there are also medical situations where pregnancy would be life-threatening or seriously health-threatening for the mother.  These women need their contraception to be as effective as possible, and depriving them of it verges on criminality, I would say.  Birth control advocates tend to mean hormonal drugs when they speak of “effective” contraception, and that has been the focus of much of the fighting.  I certainly think women should have access to these medications, but I don’t want to come across as a wholehearted fan of the Pill and its cousins.  The Pill, patch, and implant can be problematic for many women, and they can have dangerous side effects, especially as women age.

A friend of mine who cannot use these drugs was put in a ludicrous position by our local Presbyterian Health Plan, on purely ideological rather than medical grounds.  Having been unable to tolerate the type of IUD that releases hormones into the body, she and her doctor decided that she should try the old-fashioned, non-hormonal IUD.  Presbyterian refused to cover that, saying that it’s an abortifacient rather than a contraceptive, and therefore not morally acceptable.**  They were happy to cover the hormonal IUD, which they insisted my friend should use despite the fact that it was already proven to be unsuitable and harmful for her.  The patient’s medical needs meant absolutely nothing.  Let me repeat that, because this is how our system works, and we need to be clear about it:  The patient’s medical needs meant absolutely nothing.  Her own beliefs and moral convictions also meant absolutely nothing.  Fortunately, although she was a college student doing low-paid restaurant work, this young woman was able to get the money together to pay for the IUD herself.

And that is what we face when religion, and only some people’s religion at that, is allowed to determine our medical care.  If the bills currently being proposed by certain members of Congress were to become law, any employer could refuse to cover any type of treatment for any reason.  I don’t think that will come to pass, but stranger things have happened, and we need to stay on top of this situation.  I can only hope that American women will continue to get more and more engaged and will work to hold the ground we’ve gained– and that men have gained along with us– over the past few decades.

I promise to get back to more spiritual matters in my next post.

*Despite 12 years of Catholic school and being good friends with a nun, I still can’t answer this.  Odd situations like this never came up in the typical anti-abortion rhetoric.  And by the way, I don’t remember Catholics railing against birth control back in the ’70s the way it’s happening now.  Maybe I just didn’t notice.
**The common scientific view is that pregnancy begins with implantation, not with conception.  The IUD prevents implantation.

For some other current perspectives:
http://msmagazine.com/blog/blog/2012/02/13/hervotes-americas-supposed-war-on-religion-and-the-actual-war-on-birth-control/

http://msmagazine.com/blog/blog/2012/02/14/conservative-war-on-contraception-is-nothing-new/

A Few More Things to Consider

“I am not pro-abortion.

“Like nearly all pro-choice human beings, I never rejoice over or celebrate these decisions, because I know that they are ones reached after arduous deliberation and great pain; that they are often born out of emotional trauma, physical assault, or dire medical news.
“I know that abortions are not chosen impulsively or without careful or prayer wrestling.
I believe in education and in birth control and in doing everything possible not to create an unwanted pregnancy. All pro-choice people I know believe these things.

“…There is a sad irony at play when I realize that a pro-life woman arguing with a pro-choice man like myself,  is essentially relinquishing control over her destiny to other men and I am saying she deserves better.” — Pastor John Pavlovitz
https://johnpavlovitz.com/2022/05/11/a-pro-choice-man-grieving-pro-life-women/

“[George H.W.] Bush would remain a staunch advocate of reproductive freedom for women until political considerations during the 1980 presidential elections, when he was on the ticket with Ronald Reagan, accounted for one of the most dramatic and cynical public policy reversals in modern American politics.”

“Reagan had supported California’s liberal policies on contraception and abortion as governor, and Bush as Richard Nixon’s Ambassador to the United Nations had helped shape the UN’s population programs. But Republican operatives in 1980 saw a potential fissure in the traditional New Deal coalition among Catholics uncomfortable with the new legitimacy given to abortion after Roe v. Wade and white southern Christians being lured away from the Democrats around the issue of affirmative action and other racial preferences. Opposition to abortion instantly became a GOP litmus test, and both presidential hopefuls officially changed stripes.”
https://msmagazine.com/2012/02/14/conservative-war-on-contraception-is-nothing-new/

Faced with the lowest and slimiest of Twitter trolls, one woman retorted, “I’ll ask my rapist nicely to wear a condom.”

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Putin’s Plaything, TFG

I started gathering the links and quotes in this post in response to a friend who has long been skeptical of any substantial connection between ex-pres Agent Orange and the Russian government and financial system.  She didn’t believe Russia had been involved with T winning the 2016 election, and had pooh-poohed the Mueller investigation, making all that clear many times.  What got me to dig into the evidence of their entanglement up to this point, though, was that she insisted Putin wouldn’t have invaded Ukraine if he were still president, and that Biden’s “weakness” was to blame.  This is a typical right-wing talking point that I found very odd coming from someone who is not remotely a supporter of TFG– so much so that I felt I had to counter it, and wanted to be sure I had a solid basis to do so.

Since then, we’ve had the revelations about top Republicans who were briefly willing to get rid of That Man after his incitement of the January 6 insurrection, showing that even his biggest enablers were quite aware of the deeply corrupt, lawless nature of his conduct.  Senate Minority Leader Mitch McConnell famously said, “The Democrats are going to take care of the son of a bitch for us,” by way of impeachment.  House Speaker Kevin McCarthy asked about the 25th Amendment and said he would recommend that the president resign, fuming, “I’ve had it with this guy.”  Here’s one of many sources for those damning statements (to both the speakers and their subject).  https://www.politico.com/newsletters/playbook/2022/04/21/the-democrats-are-going-to-take-care-of-the-son-of-a-bitch-for-us-00026822

And yet, here we are, with those same legislative power brokers swearing they will vote for him again if he runs in 2024.  (And secretly hoping he does not run, I’m sure, so that they don’t have to actually do that.)  It still behooves us to understand the deep ties between this man who cares about nothing but money and power and the regime that is causing so much horror and suffering to its neighbor and thus to much of the world.  Neither appears to be going away anytime soon, but the more their crimes can be exposed, the better chances we have to defend against further destruction.

I thought I had a fair understanding of these matters, but it turned out that there were still some shockers.  In particular, it was quite a surprise to find out that he wanted to be the ambassador to the Soviet Union way back in the ’80s!  He had the idea that since he was such a fantastic negotiator, he should go there to negotiate nuclear disarmament.  Although this sounds like his usual self-aggrandizement and his assumption that he knows more about everything than anybody else, there may have been a teensy smidgen of altruism in there somewhere– buried under the towering edifice of ego.

I first read about that here:
https://www.nbcnews.com/think/opinion/trump-has-made-putin-gop-s-problem-ncna1291965
‘He sought not only to become a plenipotentiary ambassador to Moscow in 1985 (true story, according to Nobel Peace Prize winner Dr. Bernard Lown), but he’s also been unabashed about his desire to build a Trump Tower there for decades….’
‘His litany of transgressions involving Putin and Russia is too lengthy to list here, but many would argue his 2018 Helsinki trip, during which he repeated an authoritarian trope calling the free press the true “enemy of the people,” and a joint press conference with Putin, where he threw U.S. intelligence agencies under the bus in favor of Putin’s word over theirs, was his worst.
‘At the time, Sen. John McCain of Arizona called it “one of the most disgraceful performances by an American president in recent memory,” and said Trump had “abased himself … abjectly before a tyrant.” Unfortunately, that behavior has continued on to the present day.’

… and followed up here:
https://www.hollywoodreporter.com/news/politics-news/donald-trump-angled-soviet-posting-1980s-says-nobel-prize-winner-1006312/
‘The Post‘s Lois Romano asked Trump for specifics about how he would approach a U.S.-Soviet deal, and recounted how he demurred (using terms familiar to those who followed the 2016 presidential campaign): “‘I wouldn’t want to make my opinions public,’ he says. ‘I’d rather keep those thoughts to myself or save them for whoever else is chosen. … It’s something that somebody should do that knows how to negotiate and not the kind of representatives that I have seen in the past.’ He could learn about missiles, quickly, he says. ‘It would take an hour and a half to learn everything there is to learn about missiles. … I think I know most of it anyway. [Bolds are mine.] You’re talking about just getting updated on a situation.’

So it seems that over and above his interest in making money through business dealings with Russia, he had interest in the Soviet Union/Russia itself over many years.

There is quite a lot about his connections to Russian oligarchs and organized crime figures.  Here is one source, which also explains a little of how those oligarchs got where they are.  Teri Kanefield is a lawyer who has been posting analyses of the Jan. 6 prosecutions, among other things.  (For some reason the fonts came out weird in this blog entry of hers– that’s not usual.)  I recommend following her to get some understanding of the way the Justice Department works, the way democracy works in general, and what we can do to keep it functioning.

The Renewed Relevance of the Great Fox-Trump-Putin Love Affair

‘The Trump-Putin love affair begins with Semion Mogilevich. Mogilevich got his start as a young man in the Soviet Union scamming his fellow countrymen who wanted to emigrate. He offered to sell their assets & send them the money, but instead, he pocketed their money. His victims had left the country so they couldn’t do anything. By the mid-1980s, he had millions and needed to launder it. (Money laundering just means putting illegally obtained money through a few complicated transactions to hide the origins of the money.)

‘Mogilevich knew it made no sense for a young man in the Soviet Union to have millions—so in 1986, he sent his operative to buy 6 luxury condos in Trump Tower. Foreigners, by this time, discovered that money could easily be laundered through US luxury real estate.

‘It should have occurred to Trump that a man in the Soviet Union hadn’t come by $6 million in cash legally—but he asked no questions. He permitted anonymous buyers to purchase his condos, so he was a magnet for dirty money. He personally attended the closing of Mogilevich’s condos.

‘During the Soviet regime, the government owned all resources and industries. When the Soviet Union broke up, the Russian Federation was established as a constitutional republic with a president and parliament chosen by free elections. But democracy never took hold. Before rule of law was in place, there was a wild rush to control the nation’s industries and resources. A few people became billionaires (by stealing what belonged to the people). Democracy never took hold. Leaders were picked by the new billionaires.

‘Thus Russia went from communism to oligarchy.

‘One of the new billionaires was Mogilevich, who was soon at the top of the Russian mafia and on the FBI’s Ten Top Most Wanted List (for a scam in Pennsylvania). As the oligarchs’ wealth grew (mostly through scams) they looked for ways to launder the money….

‘By the late 1990s, Trump was considered uncreditworthy and bankrupt. He owed $4 billion to more than 70 banks, and showed no inclination or capacity to repay the money.

‘Basically, Trump needed money and the Russian bandits had money they needed to launder. It was a match made in heaven.

‘Russians, through shell companies, bought his condos and propped him up. In 2002, after Trump went belly up in Atlantic City, he was bailed out by Bayrock, a real estate development company with ties to Mogilevich. Bayrock moved into Trump Tower. Felix Sater, a convicted Russian mobster and money launderer, was senior advisor to the Trump Org. and partnered with Bayrock.

‘Russian billionaire Dmitry Rybolovlev bought a house from Trump, paying $55 million more than Trump paid (a way to pump money to Trump).

‘In 2006 Russians financed building Trump SoHo & gave Trump 18% of the profits, though he did nothing.

‘“Russians make up a pretty disproportionate cross-section of our assets. We see a lot of money pouring in from Russia,” said Trump Jr.’

*************************************************************

Discussion of the Trump Jr quote can be found here: https://www.businessinsider.com/donald-trump-jr-said-money-pouring-in-from-russia-2018-2 *  ‘”In terms of high-end product influx into the US, Russians make up a pretty disproportionate cross-section of a lot of our assets,” Donald Trump Jr. said at a New York real-estate conference that year. “Say, in Dubai, and certainly with our project in SoHo, and anywhere in New York. We see a lot of money pouring in from Russia.”‘

There’s lots more in Kanefield’s post, including a discussion of the history of autocracy in the US.  She refers to Heather Cox Richardson, a historian who links present events to the past and makes them far more understandable, and whose posts I read nightly.  (Right now it seems we are largely reliving the 1870s.)

Last but not least:

https://www.newsweek.com/second-trump-term-would-not-have-stopped-putin-invading-ukraine-opinion-1682807

‘Putin’s decision to invade Ukraine therefore rests, in no small part, on the fear that Ukraine could join said alliance and annihilate its long standing hold over Eastern Europe. Trump was, at best, outwardly indifferent to Ukraine joining NATO. President Joe Biden, on the other hand, openly told Ukraine not even three months ago that membership was essentially theirs for the taking. If anything, it is precisely because Biden took this stronger stance that cuts against Russian interests that Putin felt he had no choice but to take Ukraine by force now, before it enjoyed a powerful shield of protection from the United States and Western Europe.

‘…Lest we forget, we indisputably know that Trump held up military aid to Ukraine as he sought to extort the president thereof into kickstarting an investigation into President Biden’s son. In point of fact, it’s the reason Trump was impeached, for his first time. Ukraine, like most everything else in Trump’s life, was never more than a tool to further his own interests.’

*The New York Times broke the story about McConnell and McCarthy, I think. If you are able to access it, it’s worth a look: https://www.nytimes.com/2022/04/21/us/politics/trump-mitch-mcconnell-kevin-mccarthy.html

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Ukraine; Advice for Would-Be Emperors

The Great Gate of Kiev by Victor Hartmann, the painting Mussorgsky had in mind

 

I started this on March 1— Chopin’s birthday, by the way— with a lot of thoughts about the war in Ukraine that have since been expressed ad nauseam in a range of publications, like the parallels with the Iraq war. You’ve heard all that already, so I’ll move on.

As I sit here with a yellow flower for Ukraine pinned to my shirt, worrying, I’m also wondering what’s happening in the other war zones in the world. Has there been any improvement in getting aid to starving kids in Yemen? Are things any better with the horrors in Ethiopia? How are people managing in Syria, since we’ve turned our attention away from there? And Afghanistan— we know how bad that is. Perhaps our witnessing of the destruction in Ukraine, in real time on the screens we carry with us, will help us remember the suffering going on elsewhere. And maybe do something about it.

I’m not Ukrainian, but I’m kind of a cousin and neighbor. My mother’s family came from far eastern Slovakia, just west of the border with Ukraine. It’s quite possible that I have relatives who actually live and/or work in Ukraine right now. The woman I have apparent memories of from the 19th century, Delfina Potocka, was born in Podolia, which then was part of Poland but now is in Ukraine.

I am hyper-aware of the long history of Russia taking over these regions and even declaring that independent countries no longer exist, as it did with Poland a couple of centuries ago. Vladimir Putin appears to be driven by a vision of recreating that old imperial Russia, and I feel that my Slovak relatives, along with the Poles and the Hungarians and the Lithuanians and the Azerbaijanis and the rest, all have targets on their backs. I feel almost that I have a target on my own back— even more so knowing that Putin will try to crush the LGBTQ+ community. There is no reason to expect that he will stop at any other border if he is allowed to take Ukraine.

The situation is changing by the hour, and by the time you read this, lord only knows where we will all be. 


There has been a lot of discussion of Putin’s mental health. I referred to him as a madman the other day and got some pushback. Let me explain, though. I didn’t mean that his behavior was necessarily irrational, though people who knew him when he first came to power say he is very different now and may not be all there anymore. Taking the premises he started with into account, his current path is logical and part of a very long-range plan, even though right now it’s clear that he’s bitten off more than he can chew. 

However, I submit that the whole idea of invading a country one wants to control with such brutal tactics, destroying human lives, infrastructure, farmlands, everything in the process, is intrinsically insane. It’s the old saw about “destroying the village to save it.” I’ve never understood how these despots think. Assad is perhaps the ultimate example— he wants to remain the ruler of Syria, but he’s left so little of the country intact, what is there to rule? Wouldn’t it have been better to leave the people alive, with their homes and factories and farms, and rule over a prosperous and proud nation? What has he gained?

Putin seems to be going in a similar direction, with his own country as well as the coveted one being brought to its knees economically and perhaps morally. He may well be able to hang on to his position, but he could have had so much more.  Compared to his long, insidious, cunning takeover of Russia, this venture has been shockingly ill-conceived.  Only a leader isolated from reality and surrounded by nothing by yes-men could have expected that Ukrainians would immediately capitulate and even welcome his troops with flowers.  I can’t help but think of George W. Bush’s infamous “Mission Accomplished” banner.

I mean, that is insanity.

 

My advice to these would-be emperors is very simple, sure-fire, and unlike war, not particularly expensive. It’s also something they would never consider.


It is this: Be nice.

Think about it. Say you’re a dictator with a big country of your own, but you are feeling threatened by nations a bit off to the west of your border. You want a buffer between you and them, and the nice big juicy country next door looks awfully tempting. You could try beating them into submission, but suddenly you realize that you don’t have to.

The neighbors share a similar culture with yours, and some of them even speak your language, so it’s easy to get started. You’re kind of ticked that they split off from your empire a few decades ago, but you decide to be magnanimous and look past that. “Brothers and sisters,” you proclaim, “let us begin a new era of friendship and cooperation!”

They’re a little skeptical, but they like the new trade deal you propose. You start a big cultural exchange program, too, and send your best musicians and dancers to tour the place. Your soccer teams play each other. You go on like this for quite a while, flattering, ingratiating, and investing. At every moment you make it clear that you have the greatest possible respect for their majestic nation and history, and that you would never, never do anything to threaten their sovereignty and self-determination, so that they don’t get interested in rebelling. All the while you’re pursuing joint ventures that make their smaller economy more and more dependent on yours.

You wanted their land, their stuff, and their loyalty. You get access to all of that without firing a shot.

In a few years, the neighbors are every bit as entwined with your side of the border as they had been when they were part of your empire. They have no reason to join other alliances against you, since associating with you has brought so many advantages. Your people enjoy the fruits of both country’s labors, and you do very nicely with what you skim off the top. War would have drained your coffers, but instead you’ve made a profit. You settle into your cushy palace and name yourself President for Life, and nobody minds. You have all the power you could possibly want. Someone could still put poison in your tea, but you’re relatively insulated because wealth and influence are spread around, and those who have them have good reasons to leave your regime in place.

I’m serious. I bet this would work, and unless you truly enjoy blowing things up and massacring families, it would be a lot more fun and a lot less stress. I’m pretty sure that something like it has even been done at times, though I can’t remember where it might have been. It would be completely reasonable, even to someone who cares only about himself, completely compatible with self-interest.

It’s just not how human minds work, at least not the power-hungry ones.


Ukrainian pianist Alexander Gavrylyuk played with the New Mexico Philharmonic on February 26. The planned program included Rachmaninov’s Piano Concerto #2, but it was changed at the last minute to Prokofiev’s first piano concerto, Prokofiev having been born in the Donetsk region of what is now Ukraine.

Maestro Roberto Minczuk introduced the program along with Gavrylyuk. Although Minczuk is from Brazil, he has distant family in Ukraine, so he is feeling deeply connected with the horrors there. The two gave a heartfelt talk about the situation and the program they had chosen. They mentioned that there had been a cancellation at Carnegie Hall and Gavrylyuk had been asked to play there, but he had said, “No, I’m playing with the New Mexico Philharmonic that day.” So now I love him all the more.

The audience went berserk. We whooped and hollered, and someone in the back of the hall yelled “VIVA UKRAINE.” The orchestra members were wearing blue and yellow ribbons. It was A Happening.

The concert began in an unusual way, with a set of piano solos. Gavrylyuk started with Kocsis’ complex and difficult arrangement of Rachmaninov’s haunting “Vocalise.” Then he played the end of Mussorgsky’s “Pictures at an Exhibition,” with an incredibly powerful rendition of the “Great Gate of Kiev” theme that I swear they must have heard in Moscow. Not that it was so terribly loud, but every molecule in his body was totally focused on producing this resounding effect, and the hundreds of people in the hall seemed to be one organism all concentrated on the stage.

Here’s a little bit of the flavor of the Mussorgsky. It’s nothing like the experience that blew me away in my seat in the second row, but you’ll get the idea: https://www.youtube.com/watch?v=zyMiIAwUHcU “The Great Gate of Kiev” is getting a lot of play these days.

As far as I could tell, the whole audience stayed fired up throughout the rest of the concert. But then, as I was walking out, I heard a woman ask her companion how she’d liked the show. “I thought it was long and boring,” replied the other woman. “I kept falling asleep.” I could not imagine that.

The fantastic Steinway that Gavrylyuk played, the best I’ve ever heard, was picked out just a few months ago by the Russian expat pianist Olga Kern, who has adopted Albuquerque and located her piano competition here. She has a special relationship with Rachmaninov, and I’ve been practicing some of his work myself lately. It’s complicated.

By the way, there is no actual Great Gate of Kiev. It was only a painting of a proposed structure that was never built, and was intended to commemorate Tsar Alexander II’s escape from an assassination attempt in 1866.  The Russian eagle tops the cupola.  Like I said, it’s complicated.

VIVA UKRAINE.

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Three Conversations

The war against misinformation continues. I’ve been trying to frame it as something other than a war. But I don’t feel able to leave the field. How do I do my job of health education effectively and without being a jerk? How do any of us talk with folks who have become untethered from reality? Should we even try, since we aren’t likely to get through to them?

I’m trying to cut down on reacting, but at times it feels necessary. A couple of weeks ago I wrote comments to a blog belonging to a person I used to respect greatly, an MD who has really gone off the deep end. I hated to jeopardize the connection I have with him, but what he had written was so egregious and harmful that I felt I had to say “no farther.” I cringed a bit while awaiting the result. He replied that he was interested in hearing from people with completely different worldviews, and while he didn’t think I was right in the least, he listened amicably. It was not horrible.

Later, I received a message from someone I didn’t know, thanking me for standing up that way. Was it worth jumping in? She thought so.

Sometimes skirmishes show up unexpectedly. Sometimes they lead to some fascinating meetings of minds. Other times there seems to be no possible good outcome. Maybe writing this won’t bring any better outcomes, either, but I guess I need to think on the page for a bit. I would be very interested in hearing about your own experiences along these lines.

Conversation One

I volunteered with Albuquerque Mayor Tim Keller’s reelection campaign. On Election Day, I arrived at the polling place, a middle school, to wave a sign around and present a friendly face to voters. I got there late in the day and found the earlier volunteer still walking up and down the sidewalk with her own sign. We got to talking, and it turned out that she was a nurse doing some interesting community work.

A forty-something man approached us. I expected that he would have some normal sort of voter question. Instead, he started one of the most abnormal conversations I have ever been a part of. He wanted to tell us why he was not voting for Mayor Keller, even though he liked him and was generally in favor of his policies, except for one crucial issue. For some reason I never came to understand, he felt it was important to explain and justify his decision to us.

He told us that he had been away from Albuquerque for quite a while and hadn’t heard much of anything about the candidates. There was just one thing he had heard from GOP candidate Eddy Aragon, and that was that if a vaccine mandate were imposed, he wouldn’t enforce it. So our voter planned to give his vote to Aragon.

Aragon had shown himself to be way out there in debates, one of those far-right defenders of “freedom” who refused not only vaccines but masks and public health restrictions of all kinds— even supporting a restaurant that was refusing regular health inspections as well as the mask requirement. He was in every way the antithesis of Tim Keller (except that they had both played football at St. Pius High!). I told our voter that if he liked Keller’s policies overall, he really wouldn’t like Aragon’s, and he might want to find out more and give some more thought to his decision. He insisted that the vaccine issue outweighed everything else. I reminded him that the city didn’t even have a vaccine mandate. He was unmoved.

That was when things started to get very unusual. This was already getting to be a fairly long conversation, but the voter showed no signs of moving on into the building. He continued to explain his point of view, seeming to be looking for validation. I warned him, just so that he wouldn’t waste his time, that we were both health care professionals and were disposed toward wanting people to be vaccinated. He was undeterred.

He told us that he follows the Shinto religion and that this includes intensive purification practices. Now, he isn’t Japanese, and I’ve never heard of the kind of extreme practices he described being part of Shinto, but maybe there is some sect that’s like this. No alcohol ever, he said (though Shinto uses sake for ritual purposes). No medications of any kind. When he broke his leg, he said, UNM Hospital wouldn’t treat him without an X-ray, and he wouldn’t allow radiation to be applied to his pristine body, so he went home and recovered on his own. I have no idea how he managed that, and I can’t see how any religion would require it, but that’s what he said.

He also reported that he had been through a case of COVID and therefore had less need of a vaccine. He was masking and being sensible otherwise. He appeared totally sincere.

If all that is true, his health strategy was inadvisable at best, but a person whose belief is strong enough to cause him to refuse a cast for a broken leg has a serious case for a religious exemption. And he said he was trying to get one, because he was working for UNM as an engineer, and they were requiring all employees to be vaccinated.

“Not only am I losing my job, they’re losing a good engineer,” he added. He then told us about his sister, who left a high-paying job with an airline that required vaccination, threw away her retirement, sold her house, and moved to Georgia.

I find this to be a strange hill to die on, but they have staked it out as theirs. I doubt there are very many people with this particular religious point of view, not enough of the population to have much effect on the pandemic. If we give religious exemptions to anyone, it seems to me that these purportedly Shinto folk deserve them. I would suppose that their horror of impurity would keep them vigilant against contagion, for whatever that’s worth.

Eventually the man finished saying his piece and moved on to cast his vote. For Eddy Aragon, I assume. Who had no chance of winning.

The nurse said, “Wow, you confronted him. I would never have done that.” I didn’t, exactly; I just quietly stated some facts, and I didn’t argue with him about his health— or point out that an engineer should be able to understand X-rays more clearly. Keeping a conversation going allowed me to find out about his unique point of view. And even though we volunteers had no special influence on city policies, I wanted to convey the sense that the campaign and the mayor himself valued him and were willing to listen. I’ve seen Mayor Tim treat people exactly that way. It didn’t occur to me till after the nurse’s comment that he could have done something dangerous. He didn’t seem like a person who wanted to cause trouble. He just seemed to want to be heard— and in a way, to apologize.

Conversation Two

A month later, we had an unusually mild day, and I took advantage of it to swim at Midtown Sports and Wellness, where they have only an outdoor pool but they keep it nice and warm. I had a blissful time with the pool and then the hot tub all to myself for a little while. Who would have expected a fun outdoor swim in early December? It was a real treat.

Then an older Hispanic man showed up to use the hot tub. We got to chatting about the just-passed Thanksgiving holiday, during which he’d gone to visit his daughter in San Diego. I commented that it was great to be able to do things like that again, unlike last year. Somehow in the process, vaccines came up.

The conversation remained cordial, but included such pronouncements as “[dismissive snort] Fauci doesn’t know anything.” (OK, only 40 years of experience heading a major medical organization… no opportunities to learn… whatever.) I knew playing the “I’m a health care provider and I know things” card wasn’t going to get me anywhere, so I kept that to a minimum.

He went on with typical right-wing talking points, including the classic “I did my own research.” None of it was surprising, though it was dismaying.

We were having a somewhat useful exchange when a friend of his came along. As he lowered himself into the bubbles, the friend said, “The way to solve all of this is to invite Jesus Christ into your heart.”

I did not try to tell him that I have a personal relationship with Jesus. I did mention that I had been raised Catholic, which was relevant to some point in the conversation that I don’t remember.

The first guy told me something that shed a little light on the attitude of evangelicals toward authorities and establishments. His mother, he said, had been Catholic, and she was brought up to do whatever the priest said and never think for herself nor read the Bible on her own. She had rejected this. I told him that the Catholicism I’d experienced had been much groovier and more open-minded, but that I’d heard about the kind of stifling situation his mother had grown up with and wouldn’t like it one bit.

I can easily understand why someone would want to leave that behind. It’s just that so many trade the conformity of the Catholic church for the same thing in an evangelical sect that is at least as rigid and paternalistic, if not more so.

This gentleman was toeing the party line in every way, but he did seem to have put thought into his point of view. Like so many Americans, he insisted that he was against mandates, not necessarily against vaccines. I keep wanting to tell them, “If more people would do what they’re supposed to, there wouldn’t be any need for mandates.” I can totally understand their discomfort with being told what to do, or possibly coerced, but I also think coercion could easily have been avoided.

To find his way through the conflicting advice, he was trying to use intuition.  “You know in your heart what’s true.”  This struck me as important and a sticky point.  I can’t really argue with it, as I feel my way along intuitively as well.   However, when facts staring me in the face don’t match my intuition, I’m going to look further.  The Q and militant-antivax people say similar things to justify themselves– trust yourself to know what’s best for yourself and your kids.  It’s also a very evangelical point of view, to lead with the heart instead of the head. I’d rather listen to both.

Along these lines, he started to tell me that there was an awakening going on among many groups of people. “Even the Moslems [sic],” he added. I didn’t get to hear any more of what he thought about that, and would have been curious to know what he meant. It may have been the typical Q sort of balderdash, but he seemed like a serious sort of person and he may have had something more profound in mind.

A young man came in and settled into the tub. After a few minutes of listening to the ongoing discussion, he asked us very politely to shut up. He just wanted to relax, he said, and we were making that impossible. I didn’t blame him for breaking in. The two evangelicals kept talking, and the unwilling listener cupped his hands over his heart to block out the discord. I tried to wrap up the conversation, acknowledging that a person who wanted to relax in a quiet space should be allowed to do so, and pointing out that we were causing him to feel a need to shield himself. I got up, saying, “I’ll leave, and that will end the controversy.” I hope they left the young guy alone after that. I apologized to him on the way out.

It was… exotic.

Conversation Three

Last week, I became that guy, the one asking someone to STFU in the tub. Interesting how that showed up. It was a different, indoor facility, and a different kind of discussion. Unlike the polite and affable evangelicals, this problem person was loud and vehement, went on nonstop, lectured instead of discussing, and was literally in someone’s face.

The someone was a young mother with a toddler boy playing next to her and an infant girl in a carrier nearby. I had already interacted with her a little earlier by sharing my lane in the pool with her and her son, and I felt a little connected with her.

There were a couple of other people in the tub as well, individual and silent. The rushing sound of the jets muffled conversation, but gradually I noticed that this 70-ish guy was going on and on with great intensity, and words like “variant” and “omicron” wafted through to me, in a strong German accent. He appeared to be expounding a mostly toxic mix of misinformation with a few actual facts sprinkled in.

Then I heard him make a pronouncement to the mom that she should definitely not get the current vaccine, but should wait for one that worked against omicron.

So. This was not my conversation and not my fight. I tried to size things up. The young mother appeared to be backed up against the side of the tub and quite uncomfortable, while the man was almost shouting at her from maybe a foot away. She wasn’t trying to counter what he was saying or get out of there, though. Was she engaging with him on purpose and OK with the whole thing, or was she too polite or too timid to tell him to leave her alone? It looked to me like the latter. And it looked like a kind of assault.

I would be wrong in some way whether I spoke up or not. I decided to go ahead and intervene, damn the torpedoes. “That’s bad advice, I’d say, speaking as a health care professional.”

Immediately the torpedoes were aimed at me. I replied, as nonconfrontationally as I could, that I was there to relax in the tub, as were the other people present, and didn’t want to argue with him, but that it would be nice if he would let us have some quiet. He said I didn’t have to listen— but in that environment, of course we were all forced to listen. He pulled out a collection of tired and debunked talking points, even insisting that over 18,000 people have been killed by the vaccines. I just kept repeating, “That’s not true.”

He shouted, “You believe all the bullshit!” and stormed out in a huff. The hot tub returned to tranquillity. Of course I didn’t feel particularly tranquil, and wondered if I had done a bad thing.

On the way out, the mom and I had another friendly exchange. At least she wasn’t upset with me.

It only occurred to me later that the German guy was masklessly spewing his possibly viral breath at the two unvaccinated little ones as well as their mom. So, so very not OK. Masks aren’t practical in the water, but most people are sensible enough not to yell in someone’s face without one (or at all). I thought, at least I helped limit their exposure. The area was well-ventilated, but such close-up and intense interactions don’t seem like a good idea.

And yet, chances are, he saw himself as a good and helpful person trying to save the mom and/or her kids from some terrible health consequence. The vehemence likely came from sincere, if misguided, care for others.

Glad I wasn’t part of this one….

The owners of another membership-based business where my husband and I are regulars reported an odd, rather disturbing situation. A woman inquired about becoming a member, and stated that she was not vaccinated and would absolutely not wear a mask in the building. She was told that she could not come in without a mask, because the business follows state health requirements. That’s pretty simple, isn’t it? The would-be customer started a lengthy argument— and one of the owners took the bait and let himself be drawn into it. This was a time when it was absolutely not worth engaging, but it can be hard to stop.

It turned out that this was the same woman who, not long before, had walked into the business and wandered around without a mask, so that she had to be told to leave.

My question is, what did she get out of this behavior? Is this sort of thing, which has become sadly common, simply a bid for attention? A need to feel important or significant? Is it some kind of crusade, battled one store or flight or meeting at a time? Does it come from the same corner of the psyche as the “Karen” behaviors? Is it a need to take out her overwhelming frustrations on someone? A symptom of a diagnosable mental illness?

I can come up with understandable motives for each of the people I described in the conversations above. To some extent I can put myself in their shoes. This one I just don’t get.  If you do, please comment.

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Filed under health and healing, politics, psychology, science, the unexplained

Reblogged: The Authoritarian Personality and the National Divide

This post from 2017 could not possibly be more relevant, still, so I’m repeating it.  I have no idea how we will ever change the underlying insanity that puts human societies in this kind of bind.

In particular, with regard to the pandemic, this: ‘Then there are those who reject established authority but believe in “alt” authorities without question. It’s easy and seductive to see oneself as part of a persecuted minority, a group that’s in the know and smarter than all those “sheeple.”‘

The original post:

‘In talking to right-wing authoritarians (RWAs) — in any situation — the first and greatest challenge is to reduce the level of fear and increase the level of trust. They cannot hear or see you at all until this happens.’ — Sara Robinson

I think it’s fair to say that a majority of Americans are completely boggled that so many of our fellow citizens are willing to believe so much crazy crap that is so utterly disconnected from reality. Just saying that they’re nuts is not helpful. Strangely enough, there is actual research to help explain why and how they are able to continue living in their alternative reality and steadfastly fend off any facts that might attempt to intrude. And it’s been around since before the last period of far-right fantasy hegemony.

I came across a very useful set of posts by Sara Robinson, who was raised fundamentalist and closed-minded but was able to transcend her upbringing, and who has a lot of understanding about how to communicate with those who are still inside the “Wall” of insulated post-factual unreality. So much became clearer for me. (Scroll down for links.)

Robinson was summarizing the work of John Dean— yes, that John Dean, from Watergate— who wrote Conservatives Without Conscience, which is based on the work of social psychologist Robert Altemeyer.  Although Robinson’s posts pertain to right-wing Americans, certain evangelical Christians in particular, the dynamics of authoritarianism are the same across cultures and religions.

“Research into ‘authoritarian personalities’ began in the aftermath of WWII, as scientists tried to figure out how otherwise civilized people succumbed to the charisma of Hitler and Mussolini and allowed themselves to be willingly led into committing notorious atrocities. The inquiry continued through Milgram’s famous experiments at Stanford in the early 60s; later, some of it became subsumed in the work of The Fundamentalism Project convened by Martin Marty at the University of Chicago in the 1980s and early 90s. Long story short: there is now over 50 years of good data on these people coming from every corner of the social sciences; but since almost none of this has been common knowledge outside the academy, nobody on the progressive side has really been putting it to use.”

The bully leads

The description of authoritarians who are on the leader side of the equation sounds eerily familiar in our present environment:
“High-SDO [social dominance orientation] people are characterized by four core traits: they are dominating, opposed to equality, committed to expanding their own personal power, and amoral. These are usually accompanied by other unsavory traits, many of which render them patently unsuitable for leadership roles in a democracy:
“Typically men
Intimidating and bullying
Faintly hedonistic
Vengeful
Pitiless
Exploitative
Manipulative
Dishonest
Cheat to win
Highly prejudiced (racist, sexist, homophobic)
Mean-spirited
Militant
Nationalistic
Tells others what they want to hear
Takes advantage of ‘suckers’
Specializes in creating false images to sell self
May or may not be religious
Usually politically and economically conservative/Republican”

“Dean notes: ‘Although these collations of characteristics…are not attractive portraits, they are nonetheless traits that authoritarians themselves acknowledge.’ In other words, these guys know what they are, and are often quite unabashedly proud of it.”

But these leaders wouldn’t get very far unless there were legions of authoritarian personalities on the follower side, and unfortunately there are. It seems that there are all too many people who want to be told what to think and what to do.  Robinson postulates that while the bullying leader types may be beyond the possibility of redemption, a lot of followers may have some openness to communicating across the divide.

I can easily sympathize with the desire to be given simple answers and clear directions. The world is so overwhelmingly complex nowadays, and our path forward seems so uncertain. Sadly, I expect that fundamentalism and authoritarianism will continue their ascent in the near future as climate change and population growth create even more conflict and pressures for water and other resources. They may even provide some sort of genuine protection against chaos, at least temporarily and in limited areas. However, this kind of mindset works against the innovative drive and mental agility that is needed most under fast-changing and stressful conditions.

Dedicated to the cause


“RWAs are sadly accustomed to subordinating their own needs to those of their superiors; in fact, one of the struggles we often see in recovering fundies is a complete inability to even acknowledge that they have needs of their own, let alone identify them, let alone act to meet them. They simply don’t know where to begin. Also, because their own authorities use guilt and shame to control them, they’ve seldom been allowed to see themselves as truly good and moral people.
“Giving an RWA permission to recognize, give voice to, and take action to satisfy his or her own needs is a powerful act. In affirming that they are not just allowed, but entitled (in the name of fairness) to feel their own emotions, own their own goodness, indulge a few harmless appetites, enjoy themselves, assert their boundaries, or stand up and say ‘no’ to overweening authority, you are being an enlightened witness to their true self — something many of them have seldom if ever had. In the process, you are also giving them a direct view over the wall. Often, it’s a view that they never forget, and will keep coming back to until they’re persuaded to go over it for good.”

Red Family, Blue Family

“The best writing on this I’ve seen comes from Unitarian writer Doug Muder, who has taken George Lakoff’s model of ‘strict father’ versus ‘nurturant parent’ politics one step further, and uses it to explain precisely how the right wing came to believe this preposterous notion…. Muder asserts that, while Lakoff’s right that family models are the right frame, the real dialectic is between families of ‘inherited obligation’ versus those based on ‘negotiated commitment.’ Go read the article, then come on back. We’ll be here.”

Here’s the article: “Red Family, Blue Family” https://www.gurus.org/dougdeb/politics/209.html
I strongly recommend that you read this. In fact, I implore you to read it. Lights will go on for you. For example:
 “The Inherited Obligation model, on the other hand, is ambivalent about the social safety net. On the one hand, it is good that people don’t just die when they have no one to take care of them. But on the other hand, the safety net weakens the network of familial obligations. A young adult who moves to the big city to seek his fortune doesn’t come home when he fails, he draws unemployment. Social Security and Medicare may provide an excuse not to take care of aging parents.
“…The Inherited Obligation model is likewise ambivalent about freedom. Freedom to fulfill your obligations according to your best judgment is a good thing. But the kind of freedom that releases people from their obligations is not. In the Negotiated Commitment model, a life without commitments is empty, and there can be no commitment without freedom.”
“Their demonic liberal is a person with no moral depth or seriousness. Convenience is his only true value. Words that we revere, such as freedom and choice, rebound against us: We like these words because we want to be free of our obligations and choose the easy way out.
“Just as married people sometimes imagine the single life as far more licentious and libidinous than it ever actually is, so people born into life-defining obligations imagine a life free from such obligations. The truth about liberals – that we more often than not choose to commit ourselves to marriage, children, church, and most of the other things conservatives feel obligated to, and that we stick by those commitments every bit as faithfully, if not more so – easily gets lost.”

Sometimes those on the left are accused of attempting to control and tyrannize others in the same way that the right does. That isn’t really characteristic of liberals, with their tendency toward fluidity and emphasis on choice:
  “As a final point: Dean’s book puts to rest once and for all the right-wing shibboleth of ‘liberal fundamentalists’ and ‘liberal authoritarians.’ Altemeyer and his colleagues have found, through decades of research, that authoritarians almost universally skew toward the far reactionary right on the political scale. This very much includes Stalinists and other ‘left-wing’ totalitarians: though these men used socialist rhetoric to create ‘Communist’ political orders, they’re classic examples of high-SDO leaders taking control by whatever means they had at hand, and using them to create archetypal far-right authoritarian states. Dean and Altemeyer make it clear that authoritarianism is, by long-accepted definition, overwhelmingly a right-wing personality trait.
“Dean is also emphatic that authoritarianism, in all its forms, is completely antithetical to both classical conservatism (he still considers himself a Goldwater conservative), and to the founding ideals of America. We must be clear: when right-wingers threaten liberals, they are directly threatening the seminal political impulse that created our nation. An operative democracy depends on having a populace that is open to new ideas, able to think for itself, confident in its abilities, willing to take risks, and capable of mutual trust. America was founded as the world’s first radically liberal state. History has shown us that the nation’s best moments, past and future, are created by people with a strong liberal orientation.”

(Note that standing up strongly for principles, such as equality of opportunity in jobs and housing, does not constitute tyranny.)

“Alt” authoritarians

Then there are those who reject established authority but believe in “alt” authorities without question. It’s easy and seductive to see oneself as part of a persecuted minority, a group that’s in the know and smarter than all those “sheeple.” Robinson’s “A Short Detour” section is about them:
“I’ve known way more than my share of these guys, since Silicon Valley is one of their primary native habitats. And my take is that they’re at least as driven by their burning desire to fit in as any other RWA. In fact, their feelings of victimization may be rooted in the belief that they were promised an acceptance in liberal intellectual circles that they intensely wanted but never really found. The most extreme ones were frighteningly bright and well-read, and usually also from very religious family backgrounds. Those two qualities alone guaranteed that it was going to be hard to find a niche among the better-rounded, more secular big city liberals. So they decided that, if they were going to be outcasts anyway, they could at least claim moral superiority. I may be a nerd, but I am RIGHT — the possessor of Ultimate Truth! — and that’s what really matters in the end.”

Why so many of them?

I’ve wondered why the authoritarian-follower trait has been so persistent in the human population, being that it involves so much unwillingness to face facts and thus to deal with real and immediate threats. There must be some advantage, or it wouldn’t exist. Authoritarians do know how to organize and come to agreement, for good or ill, and perhaps that confers an ability to respond more quickly to danger than a dithering, contentious group could, despite their propensity to live inside their imaginary constructions. (Even more than the rest of us, I mean.) Black and white thinking is faster and easier than taking all the grey into account. Perhaps group cohesion has been historically favored over innovation under adverse circumstances?

(Since to be a Christian is to see everyone as your neighbor, and to love your neighbor as yourself, it’s particularly perplexing to me to see that right-wing fundamentalists are so invested in being part of an in-group and demonizing everyone else.)

The most depressing thing about all of this is that Robinson wrote it back in 2006, so hopefully, but nothing seems to have changed, except to get worse. At least, that’s how it looks. I would love to see evidence to the contrary. Please tell me if you’ve got some.

Sara Robinson’s posts:

Cracks In The Wall, Part I: Defining the Authoritarian Personality
http://dneiwert.blogspot.com/2006/08/cracks-in-wall-part-i-defining.html

Cracks In The Wall, Part II: Listening to the Leavers
http://dneiwert.blogspot.com/2006/08/cracks-in-wall-part-ii-listening-to.html

Cracks in the Wall, Part III: Escape Ladders
http://dneiwert.blogspot.com/2006/08/cracks-in-wall-part-iii-escape-ladders.html

Tunnels and Bridges, Part I: Divide and Conquer
http://dneiwert.blogspot.com/2006/08/tunnels-and-bridges-part-i-divide-and.html

Tunnels and Bridges, Part II: Nothing to Fear But Fear Itself
http://dneiwert.blogspot.com/2006/08/tunnels-and-bridges-part-ii-nothing-to.html

Tunnels and Bridges, Part III: A Bigger World
http://dneiwert.blogspot.com/2006/08/tunnels-and-bridges-part-iii-bigger.html

Tunnels and Bridges, Part IV: Landing Zones
http://dneiwert.blogspot.com/2006/09/tunnels-and-bridges-part-iv-landing.html

Tunnels and Bridges: A Short Detour
http://dneiwert.blogspot.com/2006/09/tunnels-and-bridges-short-detour.html

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Filed under history, politics, psychology

“Angel Mode” and Insect Visitors

A couple of weeks ago a patient was telling me how sensitive she is to picking up other people’s distress. She lives with someone who is dealing with anxiety and depression, and that person’s struggles add greatly to her own. I’m no stranger to the difficulties of being a natural empath, and I’ve never found a way to entirely shield myself, but I have learned a few tricks that help.

I think at one time I told you about “Angel Mode,” a phenomenon that showed up spontaneously in 2009, when I had taken a devastating empathic hit and was desperate to keep that from happening again. Suddenly, while doing energy work for a patient, I saw myself as turning into a golden angel with huge fluffy white wings. Seriously. That may sound like I was a bit full of myself, but it happened totally without my intending it and was quite a surprise. The image was vivid and persistent, and I felt expansive and much stronger, able to serenely rise above whatever was going on in the moment. It turned out that I was able to engage the angel image whenever I needed it, and for months I used that method pretty much every time I treated anybody, until eventually I didn’t feel so vulnerable anymore and gradually stopped.

The funniest part was that a number of patients mentioned seeing me as an angel. I hadn’t told any of them what I was trying to do.

So I suggested to this lady that we could try shifting her system into angel mode, if it was willing. She agreed. While working on her painful areas, I visualized wings sprouting from her back. Right away they did— lacy, shimmery dragonfly wings! A new kind of surprise.

“Your wings look different from mine,” I told her. “You have dragonfly wings.” She replied that dragonflies were very important to her. They had been her mother’s favorite, and she thought of them as symbolizing her. She used them all the time in her visual art. I was delighted to find that I had seen this accurately and that it was so meaningful for her.

As we continued to observe, a strongly delineated image of a complete dragonfly came into focus over the whole length of her body. A giant insect might seem disturbing to most people, but she was excited and pleased to think of it. She told me that she loves insects and wasn’t at all frightened by the idea that the dragonfly was covering her body. It seemed helpful and protective to me, too. I wondered whether it was a spirit animal manifesting itself, or simply an imaginary picture we were sharing. I didn’t have a sense of an actual entity being present.

This brought up a memory for the patient, though. When she was a child, she said, she often had dreams of giant grasshoppers who would come and take her away with them. They always went to the same place, a room she described as “gauzy.” The dreams were frightening, but the grasshoppers never hurt her, and she had the feeling they were trying to help in some way.

This gave me a start, because she seemed to be describing a common type of alien abduction experience (or what people commonly consider to be an alien abduction— not that anyone truly understands the nature of these things). I wasn’t sure if I should push for details, and I didn’t want to contaminate her memories, but I was so curious, I couldn’t restrain myself from asking.

“Um, could they possibly have looked more like mantises?” I asked.

 “Yes,” she replied, “mantises or grasshoppers.”

She confirmed that they were tall, like the insectoid types often reported in the UFO literature. But here’s the thing: she had never heard of anyone else having this kind of experience. She didn’t know that anyone else had memories of being taken somewhere by giant insects and having mysterious procedures done to them. She had never read or seen anything about abductions at all.

“I’m thinking those may not have been dreams,” I told her, gently. “If someone had looked for you, I wonder if you would have been in your bed.” Which is an open question. In some cases people who claimed to have had an abduction experience were observed to stay in one place the entire time, while psychologically they were being put through a major trauma. In others, they were verifiably, physically gone.

My patient seemed more fascinated than frightened by these concepts. I wonder if any more memories will come up for her, now that she’s been reminded of her childhood encounters. She has not had any such experiences as an adult, at least none that she knows of consciously.

The whole sequence, from the dragonfly wings through the insectoid visitors, was completely unexpected.

I have begun to wonder whether we create artistic representations of angels, humans with wings, because at some level we are all aware of our own invisible wings, just as we represent the subliminal glow of a powerful person with a halo. I’ve never figured out what angels “really” are, though I’ve met beings who were presented as angels or seemed like they must be such. I’ve never seen them with a clear image of wings, only felt them as energies or had a mind’s-eye sense of a person-sized patch of light and color. Usually I don’t see things as clearly as I did that dragonfly anyway. But the feeling of my own wings can be a lot like sensation of a physical body part. It feels like I can extend them or fold them, maybe even flap them a little.

I can hardly describe how exquisite it is to blossom into this powerful, glowing creature that is so much more than I usually am. I believe this phenomenon tells us something about our true nature. If we would pay better attention to it, perhaps it would help us to get past the pathetic pettiness of our daily interactions.

The angel mode experience is one reason I became such a fan of the Lucifer series. The gigantic, gorgeous, ultra-fluffy wings of the angel characters touched a chord in me. To manifest their wings, Lucifer and his siblings sort of shrug their shoulders, and the wings suddenly pop out. Each celestial being has an individual color and style of feathers; I note again that Lucifer’s wings are pure white, which makes total sense once you think about it for a moment.

In an episode of the final season, Lucifer suddenly gets a bout of alar erectile dysfunction, where he shrugs and shrugs and nothing happens. It has to do with doubting himself and his abilities. At about the same time, by coincidence (?) I found that my left wing was unwilling to show itself— apparently for a totally different reason, a musculoskeletal problem that blocked up the area. It was odd, another unexpected aspect of Angel Mode. Maybe it had occurred in the past as well and I hadn’t been paying attention. I think this deserves more study.

In the show, you can’t see the celestials’ wings until they intentionally unfurl them, but they’re always there in potential, just as ours appear to be. Why don’t you see if your own wings will show up? Let me know what you find.

Thanks to the late Babette Saenz for the dragonfly art; I don’t know the name of the artist.  I would like to acknowledge that person and the creator of the wings graphic if I can discover who they are.

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Filed under art, health and healing, mythology and metaphor, psychology, spirituality

In Which Medicare Covers, but Also Does Not Cover, Acupuncture

Executive summary: Medicare sort of covers acupuncture for low back pain, but coverage is so limited as to be meaningless for most patients unless they have certain Medicare Advantage plans.

Every year, the fine folk at Medicare send out a thick book about coverage to all beneficiaries. The 2021 book contained extremely misleading wording about coverage for acupuncture. A person who didn’t know better would come away with the impression that they could get at least 12 covered sessions of acupuncture for chronic low back pain.

Except that’s not really the case.

Quite understandably, lots of people have called acupuncture offices trying to set up treatment and expecting to pay only small copays. Sometimes, when the office staff explain that we can’t make that happen, they get really upset. Sometimes they call Medicare, get further wrong information, and come back even more upset. A colleague in another state reported recently that a patient became loud and violent in her waiting room, abusing the staff and insisting that the acupuncturist had fraudulently taken his money when she treated him.

I think we can all agree that having violent tantrums in health care offices is generally not OK. It’s also not OK for a major government agency to give people totally wrong information, and I don’t blame anyone for being annoyed at that.

This mistake is likely not intentional, though. The regulation is written in such a mystifyingly nonsensical way that the people promulgating the information may have honestly failed to understand it. I’m willing to give them the benefit of the doubt to a certain extent.

Here’s what’s really going on:

In early 2020, a decision was made by the Powers That Be at Centers for Medicare & Medicaid Services (CMS) to add Medicare coverage for acupuncture for one well-studied condition, chronic low back pain. I don’t know precisely what the tipping point was that made this happen, but over many years there had been agitation from our profession and popular demand from patients, numerous positive studies, and recommendations from other government entities such as NIH to promote the use of non-opioid treatments for pain. Whatever it was, Medicare finally budged, and it even specified that those wielding the needles had to be licensed to do acupuncture. That is, such providers as physical therapists doing dry needling would not be included.

Here is the CMS decision memo describing the new coverage and the reasons it was chosen:

https://drive.google.com/file/d/1hoSyfCBMSXrjbIQRNA29S1NQmfFuLEzP/view

I must say that it’s a carefully and clearly written document. Some of the conclusions in it are astonishing, however, such as the contention that there is no convincing evidence for the use of acupuncture for osteoarthritis.

The trouble is that acupuncturists are not Medicare providers. We are essentially invisible to the Medicare system. There is no pathway for us to sign up to be providers, so we cannot bill for our services. In order to do this supposedly covered low back pain treatment, we must be supervised by a Medicare provider such as an MD or NP, with our treatment being “incident to” their care, and we must have billing done under that person’s name and get reimbursed through them.

This means that only acupuncturists who work in hospitals or mainstream medical clinics have any chance of this actually getting coverage to happen. It means, therefore, that there are hardly any acupuncturists who can provide treatment under Medicare. And I hear it’s been very difficult for even those few to ever collect payment.

This is an insane and completely unsustainable situation, but while we’ve been focused on the pandemic, it has gone on for nearly two years without any improvement that I know of. (And Medicare members who need help for something other than low back pain are out in the cold entirely.) Acupuncturists cannot become Medicare providers without Congress changing the law, something our profession has been trying to get them to do for a couple of decades now. So that is where our efforts are directed, but it does nothing to help patients in the near term.

Insurance companies have responded in some cases by adding similar coverage that allows patients to go to regular acupuncture offices. Different plans use different strategies, so if this includes your insurer, I can’t tell you anything about your specific plan. I can tell you that in central New Mexico, Presbyterian Senior Care has long covered acupuncture (though a limited number of sessions per year and with low reimbursement) for most if not all conditions, and Blue Cross Blue Shield and United also have some plans with reasonable or even quite good coverage. Presbyterian also now covers 12 sessions for dual eligibles, people with both Medicare and Medicaid, who are among the most vulnerable in our population. In most cases Medicaid gives no coverage at all for acupuncture— mostly because the lack of Medicare coverage means no federal dollars are available— so this is a small but significant step forward.

Despite its severe limitations, that CMS decision early last year was a sea change, much more than the baby step it has been in practical terms. Only a few years earlier, there was a petition to the federal government asking for Medicare coverage of acupuncture, which gained over 100,000 signatures and thus required a response. The response CMS gave was utterly dismissive, stating that acupuncture was not necessary or effective for any condition. This came from a milieu in which the government itself was sponsoring research on acupuncture and our work was becoming more and more common, accepted, and proven, so it felt like a painful and bizarre slap in our faces. And it made the sudden reversal at the beginning of 2020 all the more stunning.

(In contrast, the VA not only covers acupuncture but employs acupuncturists in its facilities, so you can see how far behind CMS is.)

Here is a memo from CMS to providers. This document doesn’t make it clear that acupuncturists cannot be Medicare providers, so it seems to me that it adds still more confusion. I suppose the providers to whom it is directed already understand this, though.
https://www.cms.gov/files/document/mm11755-national-coverage-determination-ncd-3033-acupuncture-chronic-low-back-pain-clbp.pdf

And here is a benefits summary for 2022 for a group of Presbyterian plans, which a number of my patients have:
https://contentserver.destinationrx.com/ContentServer/DRxProductContent/PDFs/177_0/2022%20Senior%20Care%20HMO%20Plans%20Summary%20of%20Benefits.pdf

You can see that there is a listing for “Medicare covered” acupuncture as separate from “Routine” acupuncture, but zero explanation of what that means or how many visits are allowed under that section. I assume that members receive a more complete description of their coverage as well, but this almost guarantees that they will be confused.

(You can also see that there are two tiers for chiropractic treatment. This, too, reflects what is covered by Medicare and what is not, but the typical reader would never know that from the way it’s worded.) 

I doubt you’ll be surprised to hear that we Doctors of Oriental Medicine were never told that Presbyterian was allowing any extra “Medicare covered” sessions— or even that the allowed “Routine” sessions had been increased from 20 to 25. A patient of mine found out about it quite recently and let me know. For those with severe, chronic problems, 25 treatments a year may not be enough, so this could be a real help.

I’m cautiously optimistic about the future of acupuncture access, but when people talk about Medicare for All, I advocate for Something Better than Medicare, for All.

You can help acupuncturists to become Medicare providers by learning about HR 4803, the Acupuncture for Our Seniors Act, and contacting your representative. Much more will be going on with this in the coming year.

https://www.asacu.org/wp-content/uploads/Medicare-Recognition-H.R.-4803.pdf

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Delta Blues, or how I spent my summer not being able to take a vacation

We still need all of these layers.

When I started writing this post, I was planning on a straightforward update on the current situation with the delta variant (sorry, I couldn’t resist the obvious title). And then a 13-year-old killed a classmate at a local middle school for no discernible reason. And then the Taliban took back Afghanistan.

The murdered boy was trying to talk his killer out of continuing to bully his friends. He stood up to him with words, doing exactly what most of us would teach our kids to do, what my daughter would do, what I would do. The right thing.

Going into Afghanistan was never the right thing. I remember writing “Can you say ‘quagmire’?” back then. Three quarters of Americans thought this war was a great idea. I was part of the other quarter. I take no pleasure in being right in this case. Afghanistan continues its reputation as the “graveyard of empires.”

In order to avenge the deaths of 3000 Americans, we killed or maimed tens of thousands more, plus tens of thousands of Afghans and then Iraqis, naturally including myriad children. We spent 20 years and a couple of trillion dollars and we accomplished what looks right now to be little or nothing.

And to begin with, the perpetrators of 9/11 were Saudis, and we never gave Saudi Arabia the slightest grief over that. We always fought the wrong battles for the wrong reasons. For so many years we, that is, our leaders knew we were failing and we just kept on going, perhaps in the belief that whenever we left things would be exactly as bad as they are now. And things were always worse than we realized.
https://www.washingtonpost.com/investigations/2021/08/10/afghanistan-papers-book-dick-cheney-attack/

I suppose I should not be surprised that instead of effectively fighting this pandemic and its wide-ranging ills, we spend so much of our energy fighting each other.

Pulling the Fangs Back

Anger at the unvaccinated and the irresponsible among us is real. While a more-transmissible strain like delta was bound to come along, wider uptake of vaccines and more stringent adherence to public health common sense would have helped limit the damage, and would still damp down the development of newer variants. Our US deniers and anti-vaxxers are only one aspect of this; many governments have been too poor or too inefficient to get vaccines out to the majority of their people. But seeing Americans die or cause others to get sick because they haven’t taken the most obvious steps to avoid it is maddening.

Dr. John Lapook said, on the Stephen Colbert show on 8/16, “We come into these conversations coiled.” He suggested “pulling the fangs back” when trying to convince someone that getting vaccinated would be a good idea. I didn’t realize how “coiled” I was until I ran into a certain friend at an outdoor event in July. She announced that she wasn’t hugging anyone because she wasn’t vaccinated, which she said was because of her health condition. She really does have a condition in which it’s reasonable to be extremely cautious about medications, but it could just as easily be said that she needs the vaccine all the more because of it— her situation is honestly a bit fuzzy and it’s not crazy that she has hesitated. She has also fallen for a lot of the misinformation, though, and that has been frustrating to deal with. Anyway, I lit into her. Without knowing I was going to do it, I snapped at her. That is, I snapped. She reacted just as badly. Not a productive exchange.

A doctor in Alabama has even refused to see patients who are not vaccinated. ‘“If they asked why, I told them covid is a miserable way to die and I can’t watch them die like that,” wrote Valentine, who has specialized in family medicine with Diagnostic and Medical Clinic since 2008.’ Alabama has the lowest vaccination rate in the US and a high number of residents hospitalized with COVID.


Summer Non-Vacation— Why Is This Happening?

What did you want to do this summer? I wanted to have the party I didn’t get for my 60th birthday last year. (Oh, well— at least I was alive to have another birthday!) It’s very unclear what to do now. Nothing involving a large group of people, certainly. Is it OK to have a small outdoor gathering with vaccinated family and friends? And should we stop attending any non-crucial indoor events of any kind, even with masks and good ventilation? How much have things changed now that delta has taken over?

Amanda Mull wrote a compassionate piece about where we stand with these questions, “Delta Has Changed the Pandemic Risk Calculus.”
‘Assessing risk pre-vaccination was often bleak, but at least the variables at play were somewhat limited: ventilation, masks, crowds, local spread. Now the number of additional, usually hyper-specific questions that people must ask themselves is itself a barrier to good decision making, says Jennifer Taber, a psychologist at Kent State University who studies health risk assessment. “When people feel like things are uncertain, they engage in avoidance,” Taber told me. That can manifest in disparate ways. An unwillingness to acknowledge that many new things are safe for the average vaccinated person is avoidance. So is a refusal to continue taking even minor precautions for the benefit of others.’
https://www.theatlantic.com/health/archive/2021/08/delta-variant-pandemic-risk-safety/619798/

A big part of my job as a clinician is helping patients to sort through all the available information to answer health questions like this, and it’s not easy these days. Just as we’ve been through the entire pandemic, we’re still flying by the seat of our pants, trying to keep up with ever-changing conditions and advice. The rise of delta has been a predictable but chaotic and confusing development that hit us with a bait and switch just when we thought we were getting our lives back. It’s still new and we’re still figuring it out.

What I mean by predictable is that this is normal virus behavior. A more transmissible variant will obviously outcompete others, and it would have been a surprise had we not seen a variant like this eventually. Viruses “want” to produce as many copies of themselves as possible, and any mutation that leads to more chances to replicate is great for them.

In general, causing less illness and death is also good for viruses, because having hosts walking around spreading viral particles results in far more replication than having hosts lying isolated in hospital beds, or in graves. So over time a viral species is likely to become more transmissible but less deadly. Sadly, delta seems to cause at least as much and as severe disease as earlier forms of COVID, maybe more.
https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html

We had some small hope of getting enough people vaccinated quickly enough, as a planet, to limit the possibility of worse new variants popping up. We didn’t make it, and that too was predictable. Viruses can adapt much faster than we can. We can still hope to escape without a far more dangerous variant coming along, but time is not on our side. The more humans there are who cannot access or will not accept vaccines, and the more who refuse to take other precautions, the more opportunities the virus has to mutate.

Here’s a good way of putting it:
‘You might think of viral replication as buying lottery tickets, in which the virus accumulates random mutations that very occasionally help it spread. And the fewer lottery tickets the virus has, the less likely it is to hit the mutation jackpot. The appearance of troubling new variants may slow down.’*

The now-famous Provincetown outbreak around the 4th of July has taught us a great deal.
https://www.washingtonpost.com/health/2021/08/05/provincetown-covid-outbreak/
The area population was so highly vaccinated that the tens of thousands of visitors who descended on the place didn’t worry about getting sick. They even packed cheek by jowl into indoor venues, without a mask in sight. No one expected to need them. Here you can get a sense of just how packed together the revelers got:
https://theboatslip.com/tea-dance
Then some folks noticed they were feeling unwell or had lost their sense of smell. By that time it was dawning on us all that delta was different and that we had been wrenched into a yet another new reality where we had to learn the rules all over again.

The misinformation mill has seized on Provincetown’s experience as an example of vaccines not working. That’s not remotely the case. Yes, 74% of the infections were in vaccinated people, but with over 900 infections, there were only 7 hospitalizations and zero deaths. An unvaccinated population would have a very, very different outcome. This article explains everything you need to know about the outbreak and what it means for the rest of us:
https://www.factcheck.org/2021/08/scicheck-posts-misinterpret-cdcs-provincetown-covid-19-outbreak-report/

You could just read the article, and you should, but I’m going to summarize some key points:

— Imagine a population that was 100% vaccinated. Vaccines are not perfect, so there would be some infections, and 100% of them would occur in vaccinated people.
— Infections in vaccinated people are rare, but since the vaccinated population consists of hundreds of millions of people, a significant number of people do get infected.
— The most important thing: With current strains of the virus, even if one does become infected, vaccination means essentially no chance of dying and very little chance of becoming severely ill.
— It looks like vaccinated people may harbor as much viral material in their noses as unvaccinated ones if they get infected, but infection doesn’t get as far into the body and the viral load goes down quickly as the immune system responds.

Research is ongoing to try to determine how likely an infected vaccinated person is to transmit the virus. That may be less than some studies suggest. From the same article:
‘For one, these sorts of PCR tests are good at identifying viral RNA, but they can’t tell whether that genetic material is in an intact, infectious virus particle or not. That becomes especially relevant for vaccinated people, Deepta Bhattacharya, an immunologist at the University of Arizona College of Medicine, said.
‘“Antibodies from a vaccinated person can coat the released virus and keep it from infecting other cells,” he told us. “And T cells can kill infected cells, releasing viral genetic material but not infectious particles.”
‘Second, the tests are only looking for RNA present in the nose and throat, not the lungs — even though vaccines are likely to have more of an impact there, according to previous research.
‘“Though it isn’t entirely clear how much of transmission comes from the lungs vs. the nose and throat,” Bhattacharya said in an email, “it is almost certainly some.” That would also suggest a vaccinated person with a similar cycle threshold as an unvaccinated person would be less infectious.
‘Vaccinated people also likely aren’t infected as long, since their immune systems are quicker to respond to the virus, which would also make them less likely to infect as many people as an unimmunized person.’

Here is a similar explainer, with data from the UK, where delta has run rampant:
https://theconversation.com/covid-the-reason-cases-are-rising-among-the-double-vaccinated-its-not-because-vaccines-arent-working-164797

Another highly vaccinated place that’s weathered a recent surge is Iceland.
‘Iceland, the experts say, is providing valuable information about breakthrough infections in the fully inoculated. Yet it also remains a vaccine success story.’
https://www.msn.com/en-us/news/world/iceland-has-been-a-vaccination-success-why-is-it-seeing-a-coronavirus-surge/ar-AANl2dx +

As with the surge in England, soccer was involved. ‘The country’s top health officials linked most of the cases to nightclubs and to residents who traveled to London to attend Euro 2020 soccer matches that some warned would be “a recipe for disaster.”’

Epidemiologist Brandon Guthrie gave some perspective in the Iceland article:
‘“We’ve handicapped ourselves in what the definition of success is,” he said. Scientists originally hoped for vaccines that were 50 percent effective, he said, and the goal was to prevent death and severe disease — not to provide blanket protection against any chance of infection.’
That is, the current reduced effectiveness of the vaccines is about as good as we hoped vaccines would be in the first place. Keep that in mind whenever you feel like despairing.

Even if it’s been quite a while since you were vaccinated, and you don’t have a lot of antibodies circulating in your blood, your T and B cells still remember how to recognize and fight SARS-CoV-2. Infection won’t get into your lungs because it will have been fought off by that time. It may take as much as 5-6 days for the body to marshal a good crop of antibodies, but generally it would take 10 or more days for a COVID infection to get as far as the lungs.

But meanwhile, kids are getting sick and being hospitalized, and some of them are dying of this disease that too many adults insist is no big deal for them. Vaccines for the under-12 cohort are on the way, but at this point the behavior of adults is the only real protection younger kids have, and in too many places adults are doing a crappy job.

“This new variant is a major contributor, but a major issue is that people’s behavior has changed,” said Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security. “I don’t think we can absolve people and leaders of responsibility for this because it gives them a pass. The reason kids are getting infected is because we don’t have those precautions and parents and households are getting infected.”
https://www.nbcnews.com/news/us-news/kids-sick-covid-are-filling-children-s-hospitals-areas-seeing-n1276238

‘Kline said it is unclear what kind of long-term effects babies and children will face.
‘Specifically, Kline referenced the brain fog adults see after contracting the virus.
‘”How does that affect a baby who is still having a developing brain? We just don’t know.”
‘Kline said another concern is cardiac issues in children.
‘”It worries me a lot that people say sure, kids can get COVID-19 but most of them recover uneventfully,” said Kline. “We know almost nothing about what those infections could produce down the line. I think there is a real risk that a proportion of these kids will have some long-term effects.”’
https://www.wdsu.com/article/new-orleans-louisiana-children-sick-covid-19-unvaccianted-adults-responsible/37259391

And all this is before school starts in a lot of the country.

Conspiracy Theory Roundup

For the sake of readers who live in a bright future where this craziness is forgotten: Droves of parents are currently following right-wing leaders and fighting requirements to wear masks in schools, sometimes with physical violence against teachers, principles, health care providers, and other parents.

As far as I’m concerned, there is no excuse for willful failure to protect children; I suppose it relates to that tendency toward avoidance when things feel uncertain. Yet, even the parents who give the most insane reasons for refusing to let their kids wear masks believe they are doing their best for them. Some may have thought things through and come up with vaguely rational justifications, but most have surely spent too much time in the conspiracy-verse, where they find an endlessly creative cornucopia of crap being produced every day.

The funniest example going around is the claim that vaccinated people will grow tails. My first reaction to that was Cool!  Unlike the claim that we become magnetic, this one cleverly avoids being immediately disproven by saying that the tails will grow at some point in the future. At least that’s how I heard it. I hope it doesn’t take too long….

For a while we were hearing that women would become infertile if they were vaccinated. Now the same scary disinformation is being aimed at men.
https://www.factcheck.org/2021/06/scicheck-research-rebuts-baseless-claims-linking-covid-19-vaccines-to-male-infertility/

Oddly enough, sperm counts have actually been found to increase after vaccination! The reason is unclear, but it’s been a consistent effect.
https://jamanetwork.com/journals/jama/fullarticle/2781360
“Sperm Parameters Before and After COVID-19 mRNA Vaccination”

President Former Guy rejected masks and publicly visible vaccinations as making him look less manly, but hey, maybe vaccines make for more manliness. I think we should really hammer on this selling point!

(Stephen Colbert pointed out that the conspiracy theory that vaccines cause a drop in fertility must be true— all those elderly people were vaccinated first, and sure enough none of them have had kids since.)

A more insidious claim is the one that COVID is being brought in by people coming over the border from Mexico; this is in line with centuries of blaming “foreigners” for disease. And of course it neatly deflects blame from the GOP fearmongers and unvaccinated Americans who are actually driving the high case counts. But this too is easily disprovable. We know that the bulk of transmission is coming from people within the US, not those coming from elsewhere, because we can track the genomes of various strains of the virus and see who is carrying which and where those strains are prevalent.

The lieutenant governor of Texas, Dan Patrick, added further venom to this trope by disgustingly blaming Black Texans for the state’s horrific rise in COVID illness and deaths. Patrick is the same guy who last year said people over 70, like him, should be willing to sacrifice their lives in order to keep the economy going. And he’s only doubled down in the face of criticism of his racist statements, which again are easily disproven.
‘Patrick acknowledged Texas’ public-health crisis — rising cases, hospitalizations, and fatalities — and said he’s aware of the criticisms of the state’s Republican leadership. But the lieutenant governor insisted the blame be directed at unvaccinated African Americans, not the GOP officials who remain passive toward the pandemic.
‘”The Democrats like to blame Republicans,” Patrick said. “Well, the biggest groups in most states is African Americans who are not vaccinated. Last time I checked, over 90 percent of them vote for Democrats in their major cities and major counties.”’
‘…In fact, the latest data suggests unvaccinated White Texans outnumber unvaccinated Black Texans by a roughly three-to-one margin.’
https://www.msnbc.com/rachel-maddow-show/dan-patrick-falsely-blames-covid-surge-unvaccinated-black-texans-n1277307

Meanwhile, Patrick’s cohort Governor Greg Abbott continues to interfere with requirements for masks around the state in the name of “freedom.” He’s getting plenty of pushback, but why should anyone have to use up their energy— or money— fighting for the right to protect their or their children’s health? Meanwhile taxpayers’ funds are drained away in court battles the state need never have started, instead of meeting real human needs. If only we could immunize against stupidity and self-serving political posturing.

One way out of the mess is to make masking voluntary, but as pediatrician Dr. Danny Benjamin said, a voluntary masking policy is “like having a no-peeing section in a pool.”

Onward with Delta Force

A major development just occurred: the FDA approved the Pfizer vaccine, so it is no longer being given under an Emergency Use Authorization. Moderna was later to submit data but its approval will be coming along soon. Many of the vaccine-hesitant have said this would make a difference in their acceptance of the shots.

The biggest question among my patients right now is when and where boosters will be available. I’m in the camp that wonders whether large numbers of us privileged sorts should be getting a third dose when so much of the world hasn’t even had a first one. We’re told that there are plenty of doses to go around in the US and that we can both give extra protection to Americans and send vaccines to poorer countries, but I personally don’t feel great about using a dose someone else may desperately need, and I recognize that the only way to protect everyone is to protect everyone.**

Giving a third dose to organ transplant recipients on immunosuppressants and others who have not been able to mount a strong response to their original vaccination is a different matter and a clear benefit as far as we know. For the rest of us, we’re told that we should probably get a booster about 8 months after our second shot. For me and a lot of health care workers, that’s early October, so we’ll need to decide pretty soon.

Surprisingly, it appears that flu shots give some protective effect against a range of severe symptoms of COVID. I was figuring that since I would likely stay masked this winter, and that if pandemic limitations continued we might have little or no flu season last year, a flu shot would be pretty worthless. The risk/benefit calculation has changed again. The authors suggest that for populations that have not had access to COVID vaccines, flu vaccine might be better than nothing.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255541
“Examining the potential benefits of the influenza vaccine against SARS-CoV-2: A retrospective cohort analysis of 74,754 patients”

What about those who have already had COVID? Aren’t they immune? They do have some protection, though we aren’t sure how long it lasts. However, since the virus has ways to evade the immune system as part of its normal strategy, natural infection doesn’t confer immunity as well as the vaccine. If you have both a history of natural infection and the vaccine, you have the highest possible level of immune response. For you, a vaccine is essentially a booster. (Similarly, if you become infected despite being vaccinated, the disease has a booster effect.)
https://www.cidrap.umn.edu/news-perspective/2021/03/covid-19-survivors-may-be-able-skip-2nd-vaccine-dose

Last year when vaccines were being developed, there were breezy assurances that we would be able to tweak them to take new variants into account. Can’t we do that for delta? Well, yes, but no. The practical problem with creating vaccines against specific variants is that by the time studies are done and the product approved, that variant may be gone and another may be ascendant. If a variant comes along that completely evades current vaccines, though, we will need to meet that challenge.

Intranasal vaccines are being developed. Injecting a vaccine into the arm doesn’t teach the body to be on the lookout specifically for a respiratory virus. That is, giving a vaccine in the nose tells the body that the virus involved is going to enter through the nose and that’s where defenses need to be placed, so it’s a more efficient strategy. It should also be a bit easier on the needle-squeamish.

‘Charneau and a group of scientists in Paris have shown that natural SARS-CoV-2 infections trigger both systemic and mucosal immunity. But our current crop of COVID-19 vaccines offer only systemic protection. Developing vaccines that are sprayed up the nose, rather than injected into the arm, could change that, Charneau says. Mucosal immunity in our noses could be like a guard at the door, potentially helping stop even small infections of SARS-CoV-2 right where they start.’
https://cen.acs.org/pharmaceuticals/vaccines/Intranasal-nose-vaccines-stop-COVID/99/i21

I’ll leave you with another hopeful note, a story about former pastor Curtis Chang, who has been working within the vaccine-resistant evangelical community to dispel common myths.
https://www.motherjones.com/politics/2021/08/this-former-pastor-is-changing-evangelicals-minds-on-covid-vaccines/

‘Historically, the evangelical movement has baked into it a certain wariness of dominant secular institutions. And this can be captured in the saying that Jesus called us to be in the world, not of the world. We’re not of the world in the sense of just conforming automatically to the assumptions and beliefs the world. But what’s happened is that this orientation of being wary has gotten weaponized.

‘‘There’s been three main forces that I think have done that. One is that you can actually gain a lot of ratings by playing up those fears of what Washington is doing or what the left is doing. Christians are being bombarded by so much conservative media that they automatically just assume they’re out to get us. Another one is that conservative politicians have realized that you can gain a lot of votes by playing up these fears. And then the third is sort of outside conspiracy movements. QAnon, the anti-vaxxer movement—they have realized that evangelicals are fertile hunting grounds for their theories, because they are already primed to be distrustful of institutions, and so they can be easily kind of recruited into their deep conspiracies of distrust.’

Pastors, Chang says, are in a difficult position. Most of them are in favor of vaccination, but they risk backlash from their congregations if they speak too strongly about it— same problem GOP politicians have. (I would argue that both have helped create this problem.)

‘I understand that people are frustrated, that they’re losing patience, that they just want to make things via mandate, and give up trying to persuade these people. I think that’s short-sighted, for a couple of reasons. One, if you just resort to sheer coercion, it just confirms the narrative that they’re out to get us, that they are shoving things down our throat. You’re just laying the groundwork for a deepening divide. The second reason is that you have to realize that we’re still in the first or second inning of vaccine outreach, globally. You have to realize that parts of Africa and Asia are heavily influenced by Christian culture. A country like Uganda is like 90 percent Christian. Those churches, those places in Africa, they actually take their cultural cues to a great extent from American evangelicals, especially leading white evangelical voices. So America is—unfortunately, through evangelical culture—exporting its vaccine hesitancy. A lot of the same conspiracy theories and doubts and fears that we’ve been battling here, we are definitely seeing emerge and being replicated in the rest of the world. Changing American culture is not just about getting more American evangelicals to take the vaccine, it’s going to be critical to getting the rest of the world vaccinated. And ultimately, for all of us, if we don’t get the entire world vaccinated, we’re all at risk. ’

‘…What’s going to be really important is for Christians to convey to other Christians is that it’s okay to change your mind. The Christian virtues of grace and acceptance are going to be paramount here because people are going to be even more resistant if they think that in changing their mind they are going to be shamed.’

Grace and acceptance… those sure sound good right now.

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TAKEAWAYS for the Delta Era:
— You can still get infected even if you’re vaccinated, though most likely you won’t.
— Remember the Swiss cheese layer concept and take multiple precautions as reasonable and available.
— Be good to yourself and others and acknowledge the effects of the unrelenting pain and uncertainty of our time.
— WEAR THE DAMN MASK!

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Original source: https://www.washingtonpost.com/world/europe/iceland-covid-surge-vaccines/2021/08/14/bdd88d04-fabd-11eb-911c-524bc8b68f17_story.html

Data from the UK, May to July 2021: 
https://spiral.imperial.ac.uk/bitstream/10044/1/90800/2/react1_r13_final_preprint_final.pdf

*https://www.theatlantic.com/science/archive/2021/08/how-we-live-coronavirus-forever/619783/
“The Coronavirus Is Here Forever. This Is How We Live With It.”

***https://www.npr.org/sections/goatsandsoda/2021/08/04/1019780576/why-who-is-calling-for-a-moratorium-on-covid-vaccine-boosters
Meanwhile, Israel is not waiting and has already given third doses to around 600,000 of their citizens— while Palestinians next door in Gaza and the West Bank have had so much trouble even getting a first dose. Here’s part of that sad tale, in which they were offered nearly-expired doses, for which Israel would have received fresh replacements:
 https://mondoweiss.net/2021/06/we-returned-them-palestinians-axe-1-million-pfizer-dose-deal-with-israel/

A new examination of the possible origins of COVID-19:
https://science.sciencemag.org/content/early/2021/08/16/science.abh0117
“The animal origin of SARS-CoV-2”

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