New Mexico Needs a Paid, Professional Legislature

The Democratic Party Legislative Action Expo was held 1/7/23, in preparation for the legislative session that will start January 17. There were multiple breakout tracks, and I wish it had been possible to get to more of them. The one that seemed most important to me was “Modernizing the Legislature,” with Rep. Natalie Figueroa, Rep. Meredith Dixon, and Rep. Joy Garratt.

I’ve been painfully aware for years that the kinds of changes these representatives are proposing are needed desperately. The trouble is that for the most part, there is no incremental way to get from here to where we have to go. We need an abrupt transformation, and it’s hard to see how that can be made to happen. I was heartened to hear that there are some concrete plans and a plausible path.

In an effort to help inform everyone I can reach about this, my notes from the presentation follow, with some clarifications added:

***

Many people in our state, even very aware and educated people, don’t realize that New Mexico has the only unpaid legislature in the country. Salaries vary among the states, but only New Mexico expects senators and representatives to get by on nothing more than a small per diem that may not get even close to covering the expenses they incur in order to serve.

This is just one of the structural issues that is holding back our ability to create good and sufficient law and move our state forward. New Mexicans are realizing more and more that we can’t keep going the way we are. Our legislative branch was built for a much simpler time. When I think about how inadequate it is for the needs of the 21st century, I’m amazed that we’ve held together as well as we have.

Some of our legislators have been meeting for the past 14 months to discuss all this and craft a bill to fix it.

Legislators need time to research, read, meet with constituents, and they don’t have it.

Voters will have to make the change to paid legislators. Compensating legislators has been voted down 7 times in the past, with the last time being in 1992. There is more support for the idea this time.

The proposed bill covers three aspects of our predicament.

— Longer annual legislative sessions:
Our 60-day sessions alternating with budget-only 30-day sessions have become terminally overpacked. Annual 60-day sessions are being proposed. Bills would carry over to a second year (matching the 2-year terms of House members) so the process doesn’t have to be started over every time. No limit on the governor’s call (what bills she can have included).

Increasing the length of the sessions requires a constitutional amendment.

— Staffing:
Rep. Dixon was a congressional staffer so understands what the legislators need. She says we don’t have ways to make it easy for people to communicate with their legislators. There is only one staffer to two legislators during the session, and outside the session time there is no help at all.

Proposed $2.5 million in the feed bill (the bill that funds the legislature) this year to work on how to organize and pay staff. Where would they work? Who would manage them? What equipment would be needed or is already available?

HB 2 will include a stipulation for one staffer per legislator starting 7/1/24. This would cost $15-25 million.

Increasing staffing does not require a constitutional amendment and is probably the easiest of these to accomplish.

— Compensation:
A citizens’ group would decide, and could adjust legislators’ pay rate for changes in the economy. We were told that even a prominent Republican suggested $70,000-80,000 per year, though I am not clear which one. The figure of $50,000 has been suggested as a minimum. The idea is to have a professional legislature at rates that would attract competent people and keep them from needing to maintain another job.

Paying legislators, other than their present per diem, would also require a constitutional amendment.

***

What happens, and does not happen, between legislative sessions:
During the interim, the Legislative Council Service does event planning for 25 meetings, which reduces their time to help craft bills. They do research, but it takes a long time because “the caseload is incredible.”

Constituent Services in the House has only 5 staffers in the interim. The governor also has caseworkers. Even figuring out who should do a given task, in which branch or agency, takes a long time.

There are no year-round bill analysts as things stand now, even though billions of dollars are involved with their decisions.

The Legislative Finance Committee is year-round and does Fiscal Impact Reports. No one analyzes any impacts from bills, including their potential benefits, other than strictly fiscal impacts. FIRs can be wrong, so legislators and supporters of bills need to be vigilant. They get their information from state (executive branch) agencies. The dependence of legislators on FIRs is disproportionate due to all the problems listed above— they have no time to do the research themselves.

***

Talking points:
Saying “let the people decide” will help pass the bill. It needs wide support from us.

The state House is now majority women, whereas it was only 8 years ago that they even got a women’s restroom on the House side!

The percentage of the state budget that goes to the whole legislative branch is very small. The legislative branch is not coequal with the executive branch under present conditions.

An attendee pointed out the problem of bills being blocked by committee chairs, but that is not addressed in this bill.

Some of us asked why not even longer sessions, like 75 days. Longer than 60 days would be great, but if legislators are not paid, asking them to be present for longer sessions wouldn’t work out. One component of the bill may pass and not others, so their consequences must be considered separately.

People may not know that interim committees meet all year— being a representative or senator is really a year-round job. Many legislators feel that they are on too many committees, and more than one committee may meet at the same time in widely separated locations, so that the legislators can’t keep up. They do get a per diem for committee meetings.

There is a process for New Mexicans to repeal any law they don’t want.

The Legislative Council Service (staffed by lawyers) would still write bills as they do now. LCS is nonpartisan and can’t advise sponsors on the consequences of their bills.

Wealthy legislators could decide to go without their salaries.

Staffing issues are the “most universally embraced” aspect.

Point out that it costs to be in the legislature, including the time and energy of family members who have to help out with things like child care.

***

Comments from the audience:

An attendee who was a congressional staffer pointed out that even though staff pay is low, it’s a good jump-off point for a young person’s career— but child care is badly needed.

An attendee said that school boards or other authorities or businesses may frown on giving leave to serve in the legislature. There is no mechanism yet for this. (School board members don’t get paid and their per diems have been cut.)

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Lefts Don’t Make the Right

A while back I ran into a wall of bothsidesism from someone I respect and admire.  His contention was that we need to acknowledge the harm those of us on the left, where he also sits, have done through intolerance of those with different views.  He was speaking, particularly, about right-leaning persons being shouted down on a college campus in his state.  We need to look not only at the elephant in the room, he said, but the donkey too.

My friend is dedicated to bringing people together in the purple middle, and contends that most Americans are already living there and can agree on most everything that’s important.  That research says most Republicans are afraid of Democrats, as much as the reverse.  That we’re mostly wrong about each other and that the media are responsible for ginning up our conflicts, which we mostly wouldn’t have otherwise.

I thought and thought about how to respond to this. I could not see the shadow of the donkey being as big as that of the elephant.

I was still formulating a reply when the Club Q massacre took place.  And instead I wrote this:

Lefts Don’t Make the Right

Spare me your false equivalences
They want to kill us,
they have done it and will again
so spare me your false equivalences,
your tsks and tuts
at the failings of our folk.
A side-eye or call-out is not murder
A firing or shunning might violate,
but is not a plan for genocide,
so spare me.

To exclude is all too human,
and to be dense and oblivious,
that knows no limits,
but to exclude by design,
as a system for advantage,
to make it law—
that belongs to them,
so spare the false equivalences.
There are not very fine people
on both sides.

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

I will be returning to this subject soon.

*

For those reading this in the future when the event has faded from memory, the Club Q shooting was an attack on LGBTQ folk at a place where, until then, they had felt safe.  It happened in Colorado Springs, during a period when right-wing forces were intensifying their rhetoric against queer Americans and passing more and more laws to restrict our rights.  And in that way, it was not a surprise.  Here is one account:  https://www.cnn.com/2022/11/22/us/colorado-springs-nightclub-shooting-narrative-cec/index.html

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

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.”

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

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.

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.

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

Sorting Medical Fact from Fiction, Part IV: Vaccination, Variolation, and What Doctors Do Tell You

Will we see more of this?

I wrote most of this on 10/27, and the HHS update I’m referring to below happened on that date. By a couple of days later things looked massively worse, with a record one-day case count of 1082 and a real threat to our health care system and its exhausted workers. We knew fall was likely to be difficult, and it is, here and in so many places.

As I write on this scariest 10/31, I’m thinking of the Berlin Philharmonic’s concert earlier today. The full orchestra was on stage together for the first time in all these months; they had been using smaller ensembles only. More amazingly, the seats were packed with audience members, whereas last week they had been separated by empty seats in between. I was boggled and a bit jealous that they had managed this. Weren’t things a lot worse in Germany too? Then came the announcement at the end of the show telling us that the orchestra’s hall would be closed Nov. 2-30. It was fun while it lasted….

Last time I talked about the epic stupidity of the Great Barrington Declaration.  Then, a couple of days ago, I saw that someone I had long admired and followed, Lynne McTaggart, had endorsed it and was telling people to sign it.  I guess I should have expected that, but I was still in shock.

The reason I should have expected it is that Lynne’s long-term brand is What Doctors Don’t Tell You.  So when Doctors Do Tell You and what they say is actually true, if you have the point of view that doctors are always trying to deceive you, you can’t hear them.

I’m trying to come to terms with this and with the gigantic number of people who STILL, despite the catastrophic spike in COVID-19 cases across the country, refuse to understand that they need to change their behavior if we are ever to get through this.  It’s gotten to where we seem to be unintentionally running the experiment the Great Barrington people were advocating. And it’s not going well.

Something occurred to me this morning: Maybe the deniers and anti-maskers and open-everythingers are unwilling to believe the virus is really so bad because the truth is just too painful and hard to face.* I mean, every day at least once I experience a moment of shock when it hits me again that this is really happening. It’s been like a bad dream all along. Do you have that feeling, too, that you’re going to wake up any minute now, but then you never do?

If someone has that persistent feeling of unreality, and then they are bombarded with messages that the pandemic isn’t real, perhaps they can be forgiven— just a little— for trying to find refuge in the belief that it’s all a hoax, or at least the danger has been overblown, so that there’s no problem with their usual habits. Nothing having a beer with their friends in a crowded bar can’t solve.

Today [10/27] I attended the weekly web update from Dr. David Scrase, the head of the New Mexico Department of Health and Human Services. Dr. Scrase manages to inject some gentle humor into the march of facts, even when the numbers are looking as dire as they have lately, and he always speaks with compassion as well as honesty. I get to these meetings most Tuesdays, and whenever possible I also hang out with a bunch of infectious disease and public health experts on Mondays at a UNM ECHO session. These are good people, doing their best to navigate rough and uncharted seas. They are Doctors Who Do Tell Us— to the extent that anyone knows anything for sure.

I hope HHS won’t mind that I’ve grabbed a couple of today’s slides to show you. This one illustrates the dizzying rise in cases in the past couple of weeks. What I’d like you to look at here is the sharp upward swoop of the purple line, the one that shows cases in people ages 35-64. The green line showing those 18-34 is less dramatic, but it’s pretty substantial. And you can see that cases are also notably up in kids and teens as well. If you’re still thinking that only older people are vulnerable to this disease, well, you are wrong.

In some parts of the country the virus is considered to be out of control, including places like the Dakotas who hardly had it at all for so long. I hope New Mexico’s case counts don’t reach that level. I hope they haven’t already. But getting back to a better situation requires a population that is united in doing all the right things, and we aren’t seeing that.

Now for another denier contention, the idea that if you do get COVID you’ll just get over it and everything will be fine, no big deal. Uh-uh. The following slide makes it clear that long-term symptoms are not just happening to an unlucky few, but are actually very common even in “mild” cases.

Here’s more about the brain damage that can accompany all this unpleasantness:
https://www.reuters.com/article/health-coronavirus-brains-int/covids-cognitive-costs-some-patients-brains-may-age-10-years-idUSKBN27C1RN

Deniers also like to believe that if against all odds they somehow come down with the illness, it will be like the president told them, they’ll get the latest greatest treatments, which are miraculously effective. While I hope every patient will get the best possible treatments at the earliest possible time, the more patients need them at once, the less likely that becomes. The main limiting factor at this point is not so much hospital beds as skilled personnel to staff them. And one of the limitations on health care professionals being available is that some of them are getting COVID themselves.

Dr. Scrase told us that the health care personnel who get sick are usually not getting infected at work, but rather at social gatherings in the community— the same way that most of the laypeople are getting infected. The people who should know better are apparently doing the same dumb things as the rest.

At this point please imagine that I am shaking you and screaming that you don’t need to have a birthday party and invite 50 of your closest friends!

But pretty soon there is going to be a vaccine, you say, and we’re all going to be able to live our lives any way we want to again. Yes, in the next few months there is likely to be at least one vaccine that will be available to at least a few people, most likely front-line health care workers to begin with. That will start to help a little. But as you’ve probably heard, even in a best-case scenario of a very effective vaccine, it’s going to take ages to get shots to everybody who wants them. Not to mention the fact that many people will not want them. No matter how this goes, all that masking and distancing stuff that we hate is likely to be necessary for a very long time.

Now we’re going to look at how good a vaccine has to be in order to be useful, and how we can tell whether a vaccine candidate will meet that standard. What percentage of the time does a vaccine have to work in order to be considered effective? What percentage of the population needs to be vaccinated in order to create herd immunity (which is purely a vaccine-related concept, by the way)? There are formulas that can inform these decisions.

The following article is a month old, and that’s ages in COVID time. I’m including it because it gives a layperson-friendly explanation of how researchers decide whether a vaccine is working and whether it’s ready to be given to the public at large. Pfizer was supposed to have big news about its trial around the end of October, but that hasn’t happened as yet. Whether Pfizer’s effort pans out or not, this clarifies how to think about the process and what it all means.
https://www.propublica.org/article/a-real-vaccine-before-the-election-itd-take-a-miracle

I was surprised to see how few cases these momentous decisions may be based on. Especially with this unprecedentedly rushed research program, it’s hard to feel confident that we’re seeing real effectiveness, and even harder to feel confident about safety. About the same time that I read the ProPublica piece, I came across a September interview of Dr. Paul Offit by Dr. Eric Topol on Medscape, in which he expressed his own doubts. That really caught my eye. Dr. Offit has been a huge cheerleader of vaccines in general, very publicly gung-ho about them. If he is feeling cautious about COVID vaccines, I thought, there must really be something to be cautious about. He expressed some skepticism about both the drug companies’ promises and the politically compromised FDA.

“So you have this difficult-to-characterize, elusive virus that you are now about to meet with a handful of vaccine strategies for which you have no commercial experience,” he said. “I think you can assume that there may be a learning curve here.”

There are so many important points I wanted to quote in this interview that I have to ask you to go and read it for yourself. Honestly, you should. It’s a little unnerving, but it should also leave you with the feeling that there are some reasonable safeguards in place. Since it’s necessary to sign up with the Medscape site to read articles (although it is a free service), for your convenience I’ve parked a copy where you can get it easily:
https://app.box.com/s/rpammbltgrp4fbi9tmon1dzn1p6yhte0
‘Paul Offit’s Biggest Concern About COVID Vaccines’

If you don’t feel like going over to Box to grab that copy, this excerpt will give you some of the main points:

“[Offit:] We have two ways of stopping this virus: One is hygienic measures — face masks, social distancing, hand-washing — and the other is the vaccine. With those two, we will be able to bring this virus under control. But it will take both. What worries me is that if you had to pick which is the stronger of the two, I would go with hygienic measures. I mean, if I wear a mask and stand 6 feet away from you, and you wear a mask and stand 6 feet away from me, the chances that I’m going to get the virus from you or you from me is about zero. You have two things going for you. One, you have a mask, which is going to prohibit the virus’ small droplets from traveling very far. And two, even if I didn’t wear a mask and stand 6 feet away, the odds are also that you wouldn’t get it.

Topol: And by the way, if you do get it, you get a lower dose of virus, which is important.

Offit: That’s right. You might get more mild disease. On the other hand, if we have a vaccine and it’s 75% effective against moderate to severe disease, that means 1 out of every 4 people can still get sick, including very sick. It also means probably a larger percentage than that 25% could get mild infection, or asymptomatic infection, which they could still shed, even to the point of contagiousness. We’ve been asking these trials to look not only at whether they’re protecting against moderate to severe disease, but to what extent they are protecting against shed. I think that is important to know.
But people have such an unrealistic expectation of these vaccines that they see it as the panacea, as the magic bullet to make it all go away. [emphasis mine] If people have unrealistic expectations, such that they think “I’ve gotten the vaccine, I’m good. I don’t need to wear a mask. I don’t need to social distance. I can engage in high-risk activities,” then we’ve lost one of the important arms to bring this virus under control, arguably a more important arm. If, when we bring the vaccine up in terms of users, we move social distancing and masking down, we could end up having a sort of break-even effect.

Topol: Well, you’re bringing up a critical point and that is, the vaccine effect could actually increase the number of people who are asymptomatic carriers. Because they basically have protection from beyond their mucosa. But they still have the virus in their nose and their upper respiratory tract to spread. And that’s why this coupling of continued hygiene— masks, distance, and these other measures — is going to be important all the way through until we get a very dense immunity of the population, right?

Offit: There is a formula for this, actually. If you have a 75% effective vaccine against significant shedding, then you would need to immunize about two thirds of the American population to get the R0 to less than 1, meaning to stop spread, which is what you want.”

It may well be that a vaccine with 50% effectiveness will be the best we can do. It may be that there will be multiple vaccines available, with some being best for people of one age group or health status and others for other categories. Right now we don’t know much, so again I ask that everyone keep an open mind. No knee-jerk reactions, please! Whether you take every shot available or scrupulously avoid vaccinations, at this point you don’t have enough data to weigh risks against benefits. We have to have data, and we have to have clear messaging about it from the people in charge. That might be a tougher challenge than creating a vaccine to begin with.

In other sobering news this week, more evidence came in to show that immunity to COVID-19 does not appear to last very long— another blow against the Great Barrington mindset.
https://www.reuters.com/article/uk-health-coronavirus-britain-antibody-idUSKBN27C005
‘Antibodies against the novel coronavirus declined rapidly in the British population during the summer, a study found on Tuesday, suggesting protection after infection may not be long lasting and raising the prospect of waning immunity in the community.’

But all is not lost. Antibodies are not the entirety of the immune response. And with masking and distancing, those of us who don’t get sick may still be getting small doses of the virus as we go about our business, enough to teach the body how to recognize this pathogen and fight it to at least some degree. There is evidence that people who are exposed in this way tend to get infections that stay asymptomatic. Even if no really robust long-term immunity exists, some memory will develop in their immune systems, and they should be better off than they would be without any exposure. The author likens this to variolation, the strategy used to prevent smallpox before the vaccine was invented. The key would be small doses of the virus, not the uncontrolled onslaught of a big group event with no masks.
https://www.nejm.org/doi/full/10.1056/NEJMp2026913
‘Facial Masking for Covid-19 — Potential for “Variolation” as We Await a Vaccine’

So even if we have an effective vaccine, we’ll still need to do all this other stuff that we’re getting so tired of, and there’s no end to it in the near term. I’m sorry. I would like to be able to give you better news. We just have to keep muddling along as best we can. I implore you not to make the situation any worse! Don’t travel. Don’t get together with a bunch of people indoors, and be careful outdoors. No big Thanksgiving dinner with family from far and near. Wear the damn mask. Just do it. The more effort we make now, the sooner we can be done with all this.

I can’t remember where I saw this:
COMMUNITY
IMMUNITY
I’M UNITY

Unity. Let’s try it.

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

* Later I came across this:
 ‘Left to their own devices, people chart their paths based on their personality, how they see the world, and how they relate to risk. According to Geller, many people presented with a barrage of contradictory instructions just grow tired and give up. Others become hypervigilant, their behavior calcifying against new information that might let them ease up and enjoy life a little more. Still others simply choose optimism, no matter how dangerously misguided—such as the belief that “herd immunity” is near, or the assumption that catching the virus will have no long-term consequences for them. “People will gravitate to the positive message because it’s convenient, and it’s not scary, it’s not fearful,” Geller said.’


https://www.theatlantic.com/health/archive/2020/10/pandemic-safety-america/616858/

And still later, an interview update came from Dr. Offit, in which he discusses what may happen with an emergency use authorization, and what distribution of a vaccine may look like:
https://edhub.ama-assn.org/jn-learning/video-player/18555773
He also demolishes the Great Barrington argument:
 ‘So now suddenly herd immunity induced by natural infection has become the plan, right? But the premise is wrong. The premise is that a virus could can affect enough people in the population, that would provide immunity such that that essentially the virus would put itself out of business. That’s never happened. That’s never happened for any virus. So historically there’s no support for it. Secondly, if you had to pick the perfect virus for which it would happen, it would be measles. I mean, measles is 10 times more contagious then this virus and SARS-COVID-2. It has an [inaudible], you know contagiousness index of close to 20, where this is less than two. Two, measles induces lifelong sterilizing immunity. You are protected against all manner of infection, including asymptomatic infection, that’s not going to be this virus. And nonetheless, despite that, before there was a measles vaccine every year there would be about one to two million cases of measles. There would be 50,000 hospitalizations, and there’d be 500 deaths from measles. So there’s no such thing as this Great Barrington declaration. Plus, about 30% to 40% of the population is really at high risk.’


Sorting Medical Fact from Fiction, Part III: Give Me Liberty AND Give Me Death

Patients have been asking me about “herd mentality,” which they then quickly correct to “herd immunity.” Herd mentality we’ve got plenty of. Herd immunity, not so much. In fact, it’s unclear whether widespread, lasting natural immunity to COVID-19 is even a biological possibility. It may turn out to be only a mirage.

But as the pandemic drags on and we are all getting weary, some of us are worn down enough to entertain some pretty crazy notions– or to take cynical advantage of our weariness.

The Great Barrington Declaration came out on October 4, made a splash, and is still being talked about. This is a letter which calls for letting the virus essentially run wild among the younger and healthier members of the population, in order to bring about a theoretical herd immunity, while in some way protecting those who are at high risk. It’s named for Great Barrington, Massachusetts, where it was written, not because it is actually great in any way.

This declaration amounts to magical thinking. It has irresponsibly injected more confusion into an already uncertain situation. It has made the already impossible jobs of public health workers and health care providers that much harder. And yet, some people have been taken in, even some in my own profession.

Although I wouldn’t usually use Wikipedia as a reference, in this case they have an excellent overview of the document, the responses to it, and the issues involved.
https://en.wikipedia.org/wiki/Great_Barrington_Declaration

If that’s TL;DR, here’s a simpler summary:
https://news.yahoo.com/white-house-backed-great-barrington-142700156.html?guccounter=1

The declaration is such utter balderdash (insert less polite term here) in so many ways that it’s amazing it’s gotten as far as it has. You can read all about the objections to it if you wish. I’ll give you a sketch to save you some time:
— Many younger people are immune-compromised or have conditions like asthma, diabetes or obesity, putting them at higher risk of severe COVID-19. With moderate overweight now added to the list of underlying conditions that matter, it’s been estimated that about 72% of Americans fall into the high-risk category!

— It is unrealistic at best, and likely impossible, to try to separate younger and older people. Even in nursing homes, the staff is largely composed of younger workers, and obviously they must go home to their families and come back. More generally, a great many people live in multigenerational extended families. The latest figures I’ve found, from 2018, put the number at over 20% of the US population, and growing.

— Even if we have sufficient hospital beds to manage out-of-control numbers of cases, we don’t have enough skilled staff to provide care. The avalanche of cases that would be likely to result from the Great Barrington non-strategy would be impossible to care for.

If these points haven’t convinced you, listen to a group of virologists, starting here at about 50 minutes in:

https://www.microbe.tv/twiv/
https://www.youtube.com/watch?v=8IjXzadiNaA&feature=emb_logo

As I write this, New Mexico is reeling from an unprecedented surge in cases, bigger than anything seen last spring at what we thought was the height of the pandemic. Much of the world is in far worse shape than a month ago. No one is sure why this has happened, when only a few short weeks before we seemed well on the way toward beating this thing.

The doctor who was interviewed in the TWiV segment above expressed the theory that having schools open encouraged a premature feeling that everything could go back to normal. He described an 80-year-old woman in his hospital who had caught the virus at her grandson’s birthday party. It was bad enough that 20 kids and their parents got together at all, but then it rained heavily and everyone crowded inside. Without masks.

To the Great Barrington people, that birthday party would have been fine. They wouldn’t have invited Grandma, I suppose, but they would have let the kids and parents infect each other freely. One might wonder what the motivation would be for such shortsighted idiocy. It turns out that the declaration came from a libertarian think tank funded by the Koch brothers. But even if one sympathizes with the libertarian objection to any kind of government control, ending current restrictions makes no practical sense. The longer people go around spreading infection, the longer it will be till the virus is damped down and we can get back to our lives and livelihoods. Which is what libertarians and everyone else would seem to want.

But political philosophies will be moot if it turns out that lasting natural immunity doesn’t happen, and it’s looking like that is the case. Back in the spring, I was thinking more like the libertarians, that it might be ideal to catch a mild case, become immune, and move on. That was before anyone realized the potential for long-term damage— and before we started getting reports of reinfections.

While there are not many known cases so far, there are definitely people who have had COVID-19, recovered, and later been infected with a different strain. We know this because the genomes of various strains have been sequenced, so they can easily be distinguished from each other. Worse, some of the patients became more severely ill the second time, and one died. The previous infection appeared to offer no protection. We don’t know what factors influenced any of this. We aren’t yet sure of the role of innate immunity (not mediated by antibodies). We can’t yet predict how long antibodies to SARS-CoV-2 last. We’re pretty sure it’s not more than a matter of months, though.

This is terrible, vexing news, but it’s not unexpected. The common cold coronaviruses can return to torment us again and again. The same goes for flu. And those are diseases that our bodies already know how to recognize, not a new one that’s hit us out of the blue.

That leaves us in need of a vaccine.

I’m not thrilled to say that, since all vaccines entail some level of risk, and not all are very effective— and a vaccine, even if it’s an especially good one, is not going to solve all our pandemic problems. But I would like to ask you to think clearly about where we are in terms of a potential vaccine and what we are likely to get.

In our current low-trust environment, it’s understandable that a lot of people are leery of accepting a new vaccine that may have God knows what side effects. I don’t want to be among the first to try any kind of medication, myself; I’d rather let some time go by and see if problems crop up. But some people in my profession have been insisting that they aren’t going to take any COVID vaccine, no way no how. Although I’m not gung-ho about vaccines, I don’t see the logic in deciding for or against taking something before one has any information about it. A great many vaccines are in development. They have different characteristics. Some will no doubt prove to be safer than others, and some more effective than others.

More on that next time.