Archive for the ‘Medical’ Category
Andrew Briner writes at ThinkProgress:
Add attention deficit hyperactivity disorder (ADHD) to the list of ailments attributed to the popular painkiller acetaminophen. A new study in the journal JAMA Pediatrics found that more than half of mothers who took acetaminophen during pregnancy were more likely to have children with ADHD-like behavior or hyperkinetic disorder, a severe form of ADHD.
It’s unclear at this point whether acetaminophen use is actually causing these symptoms or if both are a sign of other unnoticed factors, as the Globe and Mail pointed out. And the long, shameful history of blaming and criminalizing pregnant women for pretty much anything they do during pregnancy means this news should be taken carefully. But even if proof of a causal link is demonstrated, the FDA’s record on regulating over-the-counter (OTC) drugs, specifically acetaminophen, shows it wouldn’t be up to the job of dealing with it.
And this news comes just as the Food and Drug Administration (FDA) announced it would berevamping its process for approving and regulating over-the-counter drugs, in response to just such concerns that it’s too slow to respond to new products and safety issues.
Acetaminophen is one such failure, as ProPublica extensively documented in September. The FDA convened a panel of experts to evaluate its safety in 1977, as the drug was first becoming widely popular. The panel determined it was “obligatory” to include a label warning that acetaminophen could cause “severe liver damage.” The FDA didn’t add that warning until 2009.
Acetaminophen is both one of the most commonly-used pain relief drugs in the United States and the primary cause of acute liver failure, nearly half of all cases. Overdoses kill an estimated 458 Americans each year, and are responsible for more than 56,000 emergency room visits and 2,600 hospitalizations.
No painkiller or drug is without risk. But for comparison, the entire class of drugs that includes ibuprofen, the Advil ingredient that is similarly popular to acetaminophen, was responsible for 15 deaths in 2010, according to CDC data as reported in ProPublica. In the same year acetaminophen killed 321, 166 of which were accidental overdoses.
The main problem is that the difference between a therapeutic dose and a life-threatening one is small. . .
Since the Federal government has already decided that marijuana has no medical benefit (and is highly addictive to boot), the FDA is unwilling to allow studies that might contradict the Federal position. (Marijuana is a Schedule I drug: those are drugs that have no medical benefit and a high potential for abuse.) April Short describes a 14-year effort to get approval for a study of marijuana’s effects on PTSD:
As a psychiatrist and physician focused on internal medicine, Sue Sisley of Arizona treats first responders and military veterans on a regular basis. Many of them suffer from some form of post-traumatic stress disorder (PTSD). After years observing and speaking with patients she learned that many were using an alternative medicine—cannabis—to successfully manage their symptoms.
“We ran these patients through the gauntlet of every FDA-approved medicine, and either nothing worked or it had really onerous side effects,” said Sisley. “So all these patients were gradually, on their own, starting to use cannabis as an alternative way to treat their symptoms, and talking to me about it.”
While Sisley describes herself as a lifelong Republican who has never tried an illicit drug and doesn’t drink, she became curious to know why and how cannabis was helping so many of her patients.
“This is a dire need, understanding PTSD, not just for combat vets but for all our citizens who are plagued by this,” she said, noting that 22 veterans kill themselves per day in the U.S. according to statistics from the Department of Veterans Affairs. “Any physician who’s also a human being can’t rest when we know that there’s something out there, in this case a plant, that has the potential to reduce human suffering.”
She began to look into studying the plant, but came up against the same wall that has blockaded any attempts at clinical research on cannabis outside of limited research by the U.S. government for the last 40 years. Due to the demonization of cannabis by drug war propaganda, the plant falls under Schedule I classification. This is the most restrictive possible scheduling, and means that officially, pot is considered dangerous and devoid of any potential medical use.
“I started asking more and more questions about why we couldn’t research this drug properly and why these studies were being suppressed,” she said. “[Cannabis] has proven itself over and over again in literally thousands, millions of patients across the country, and when you know that, you can’t rest and just allow this plant to be forced out. I think we have a duty as physicians to demand that this plant be rigorously studied.”
Her curiosity and determination led her to meet Rick Doblin, the executive director of MAPS (the Multidisciplinary Association for Psychedelic Studies). The California-based nonprofit organization has been trying for 14 years to complete federally sanctioned clinical research studies on cannabis. So far, however, the National Institute on Drug Abuse (NIDA)—which has a DEA-protected monopoly on the only legal supply of cannabis for use in FDA-regulated research—has refused to sell them cannabis.
Doblin and Sisley worked to develop protocols for a study that would look at cannabis’ effects on treatment-resistant combat veterans with PTSD, with Sisley as principal investigator. After years of back and forth, the study’s protocols were approved by the Food and Drug Administration three years ago. They were also approved by the University of Arizona Institutional Review Board (IRB), and the University of Arizona has agreed to play host.
There’s just one problem: they still need NIDA approval in order to purchase federally sanctioned weed, and NIDA won’t sell until a third review process is completed by the U.S. Public Health Service (PHS), as required by a 1999 guideline.
This additional review is not required for research on any other Schedule I drug, but was tacked onto the regular approval requirements and is governed by the U.S. Health and Human services department, under NIDA.
After the original study protocol was rejected by PHS in September 2011, MAPS resubmitted a revised protocol on Oct. 24, 2013. Ever since, the line has gone dead. Unlike FDA protocols which require a response within 30 days, there is no timeline requiring PHS to respond. The PHS guidance has effectively blockaded the study of cannabis by failing to respond.
Sisley called the PHS review process redundant, and said the only real reason for it to exist is to keep the war on drugs alive.
“If their motive is to suppress any research that might prove the benefits of marijuana, then it’s understandable they don’t want that data out there because that conflicts with their mission,” she said.
Brad Burge, communications director for MAPS, points out that President Obama has the authority to terminate the extra requirement at any time. The Secretary of Health and Human Services could also legally revoke the guidance as it was issued within HHS.
“We’re hoping with this pressure, with enough public attention, HHS will make a statement or Obama—especially given his recent statements on medical marijuana—will decide to eliminate the hold, and to eliminate the process,” he said.
Thousands of veterans nationwide swear by marijuana’s effectiveness in reducing their PTSD symptoms and advocate for better access to cannabis as an alternative to the pharmaceuticals they’re regularly prescribed. Perry Parks, a Vietnam combat veteran and decorated retired military officer called the limits on access to medical marijuana a “healthcare tragedy few people recognize.” Oaksterdam University has a new scholarship program to help train more veterans to grow their own plants and work in the cannabis industry.
Despite the vocal and increasingly recognized call for veterans’ access to cannabis, the study in question would be the world’s first-ever controlled clinical study on using the herb to treat PTSD in human patients. Burge notes that prior animal studies, among them a study using lab rats published in the scientific journal Nature, have shown that cannabis helps calm an overactive fear system. . .
Ariana Eunjung Cha reports in the Washington Post:
Standing in a Wisconsin State Capitol hearing room surrounded by parents hugging their seriously ill children, Sally Schaeffer began to cry as she talked about her daughter.
Born with a rare chromosomal disorder, 6-year-old Lydia suffers from life-threatening seizures that doctors haven’t been able to control despite countless medications. The family’s last hope: medical marijuana.
Schaeffer, 39, didn’t just ask lawmakers to legalize the drug. She begged.
“If it was your child and you didn’t have options, what would you do?” she said during her testimony in Madison on Feb. 12.
The representatives were so moved that they introduced a bipartisan bill to allow parents in situations similar to Schaeffer’s to use the drug on their children.
Emboldened by stories circulated through Facebook, Twitter and the news media about children with seizure disorders who have been successfully treated with a special oil extract made from cannabis plants, mothers have become the new face of the medical marijuana movement.
Similar scenes have been playing out in recent weeks in other states where medical marijuana remains illegal: Oklahoma, Florida, Georgia, Utah, New York, North Carolina, Alabama, Kentucky.
The “mommy lobby” has been successful at opening the doors to legalizing marijuana — if only a crack, in some places — where others have failed. In the 1970s and ’80s, mothers were on the other side of the issue, successfully fending off efforts to decriminalize marijuana with heartbreaking stories about how their teenage children’s lives unraveled when they began to use the drug.
Mothers have long been among the most powerful constituent groups in the United States, and the reason is clear. Groups such as Mothers Against Drunk Driving are able to draw so much public support because they tug at a universal human emotion: the desire to protect children from harm. And while national gun-control efforts after the Sandy Hook massacre faltered, mothers’ groups worked to keep the issue on the public radar, helping to get some new measures passed at the state level.
Today, mothers are fighting for access to the drug, and they have changing public attitudes on their side. For the first time, a majority of Americans in opinion polls say they support the full legalization of marijuana.
Last year, Colorado and Washington state made marijuana fully legal, and there has been a groundswell of support in several states for ballot initiatives or legislation to do the same, including some in the conservative South.
Medical marijuana is now legal in 20 states and the District of Columbia. The diseases and conditions for which it can legally be used are limited and vary by jurisdiction. Most states have additional requirements for children: Instead of one prescription, parents must get two from different doctors.
Even in states where marijuana is available for children, the mothers say it is often a challenge to convince physicians that the potential benefits outweigh the risks.
The drug the mothers are seeking is an extract that contains only trace amounts of the part of the plant responsible for the euphoric effect of the drug but is still high in cannabidiol, or CBD — a substance that scientists think may quiet the electrical and chemical activity in the brain that causes seizures. Instead of leaves that are smoked, it is a liquid that is mixed in food or given to a child with a dropper. . .
Continue reading. Video at the link.
Ian Millhiser notes at ThinkProgress:
A company called Marijuana Doctors, which connects medical marijuana patients with doctors who can prescribe the drug, claims that it is airing what it claims is the “first ever marijuana commercial on a ‘Major Network.’” The ad, which “draws a parallel between a ‘shady’ street dealer attempting to push ‘unsafe’ sushi to unsuspecting buyers, and medical marijuana patients being forced to obtain their medication in a similar fashion,” airs in New Jersey on several national networks — including A&E, Fox, CNN, Comedy Central, Food Network and the History Channel. . .
Although medical marijuana is legal in New Jersey — the state started issuing medical marijuana identification cards in 2012 — adult patients currently have greater access to the drug than children. Indeed, one family recently decided to move from New Jersey to Colorado to ensure their daughter would have access to the liquefied marijuana she uses to stave off potentially fatal seizures. Child marijuana patients in New Jersey are technically allowed to access edible marijuana, but marijuana in this form isn’t generally available at New Jersey dispensaries.
Gov. Chris Christie (R-NJ) recently rejected a bill that would have permitted families in a similar situation to buy marijuana in other states and transport it home to New Jersey.
Certainly not the patients. Tara Culp-Pressler writes at ThinkProgress:
Brian and Meghan Wilson don’t want to leave their home state of New Jersey. They would prefer to remain near their families and friends — and they want their two-year-old daughter to be able to keep seeing her nationally renowned neurologist, who’s an expert at treating her rare form of epilepsy.
But, since progress on New Jersey’s medical marijuana policy has stalled, the family is beingforced to relocate anyway. They’re going to Colorado to seek out treatment for their daughter, Vivian, who needs a liquefied marijuana strain in order to prevent her potentially fatal seizures.
The Wilsons have been fighting for policy reform in New Jersey for the past year. Although the state began issuing medical marijuana cards back in 2012, there were stringent limits for minors that prevented kids like Vivian from being able to take edible marijuana. “Please don’t my daughter die,” Vivian’s dad implored Gov. Chris Christie (R) in August, pressuring the governor to approve legislation that would have expanded access to several strains of marijuana.
Christie ended up approving a weakened form of that legislation. But it wasn’t enough. Although kids with conditions like Vivian’s are now legally allowed to access edible marijuana, the dispensaries in the state aren’t producing those type of products, and the state’s health department has no plans to begin testing them. Christie says he’s “done expanding the medical marijuana law,” and recently rejected a bill that would have allowed families like the Wilsons to buy edible strains in other states and transport them home to New Jersey.
The Wilsons have tried to navigate New Jersey’s restrictive medical marijuana law. But they say the state laws don’t go far enough to help two-year-old Vivian — who must wear an eye patch, avoid direct sunlight, and stick to a special low-carb diet in an attempt to prevent potentially deadly seizures — and they can’t afford to wait it out. Treatment for Vivian’s condition still remains out of reach.
“I’m just ready to start the next chapter. If we get medicine that helps Vivi, that’s great. Who the hell cares we had to move?” Meghan Wilson told the Star-Ledger as her family prepared to board their flight to Colorado.
The Wilsons will join a growing number of “medical refugees” who have moved to Colorado to seek a so-called “miracle strain” of marijuana that can help treat pediatric epilepsy. About 180 other children like Vivian are currently receiving treatment from the same dispensary in Colorado Springs. More than 100 families have moved from 43 states to pursue this optionfor their severely ill children.
The so-called “Charlotte’s Web” strain is named after Charlotte Figi, the first child who tried the treatment after her parents exhausted all of their other medical options. After she started taking this strain of medical marijuana, Charlotte’s seizures immediately stopped, and the seven-year-old is now feeding herself, walking, and riding her bike. Her case helped convince CNN Chief Medical Correspondent Sanjay Gupta to reverse his position on the medical benefits of marijuana, admitting that he was “too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.”
Lois Beckett has a good article in Pacific Standard:
Chicago’s Cook County Hospital has one of the busiest trauma centers in the nation, treating about 2,000 patients a year for gunshots, stabbings, and other violent injuries.
So when researchers started screening patients there for post-traumatic stress disorder in 2011, they assumed they would find cases.
They just didn’t know how many: Fully 43 percent of the patients they examined—and more than half of gunshot-wound victims—had signs of PTSD.
“We knew these people were going to have PTSD symptoms,” said Kimberly Joseph, a trauma surgeon at the hospital. “We didn’t know it was going to be as extensive.”
What the work showed, Joseph said, is, “This is a much more urgent problem than you think.”
Joseph proposed spending about $200,000 a year to add staffers to screen all at-risk patients for PTSD and connect them with treatment. The taxpayer-subsidized hospital has an annual budget of roughly $450 million. But Joseph said hospital administrators turned her down and suggested she look for outside funding.
“Right now, we don’t have institutional support,” said Joseph, who is now applying for outside grants.
A hospital spokeswoman would not comment on why the hospital decided not to pay for regular screening. The hospital is part of a pilot program with other area hospitals to help “pediatrics patients identified with PTSD,” said the spokeswoman, Marisa Kollias. “The Cook County Health and Hospitals System is committed to treating all patients with high quality care.”
Right now, social workers try to identify patients with the most severe PTSD symptoms, said Carol Reese, the trauma center’s violence prevention coordinator and an Episcopal priest.
“I’m not going to tell you we have everything we need in place right now, because we don’t,” Reese said. “We have a chaplain and a social worker and a couple of social work interns trying to see 5,000 people. We’re not staffed to do it.”
A growing body of research shows that Americans with traumatic injuries develop PTSD at rates comparable to veterans of war. Just like veterans, civilians can suffer flashbacks, nightmares, paranoia, and social withdrawal. While the United States has been slow to provide adequate treatment to troops affected by post-traumatic stress, the military has made substantial progress in recent years. It now regularly screens for PTSD, works to fight the stigma associated with mental health treatment, and educates military families about potential symptoms.
Few similar efforts exist for civilian trauma victims. Americans wounded in their own neighborhoods are not getting treatment for PTSD. They’re not even getting diagnosed.
Studies show that, overall, about eight percent of Americans suffer from PTSD at some point in their lives. But the rates appear to be much higher in communities—such as poor, largely African-American pockets of Detroit, Atlanta, Chicago and Philadelphia—where high rates of violent crime have persisted despite a national decline.
Researchers in Atlanta interviewed more than 8,000 inner-city residents and found that about two-thirds said they had been violently attacked and that half knew someone who had been murdered. At least one in three of those interviewed experienced symptoms consistent with PTSD at some point in their lives—and that’s a “conservative estimate,” said Dr. Kerry Ressler, the lead investigator on the project.
“The rates of PTSD we see are as high or higher than Iraq, Afghanistan, or Vietnam veterans,” Ressler said. “We have a whole population who is traumatized.” . . .
If the US is going to continue to make guns freely available to everyone, then it has a responsibility to ameliorate the resulting human damage.
Jerome Groopman has an interesting book review in the NY Review of Books. Just one quotation in the article:
To put it bluntly, marijuana works. Not dazzlingly, but about as well as opioids. That is, it can reduce chronic pain by more than 30 percent. And with fewer serious side effects. To be sure, some researchers think it’s too soon to declare marijuana and synthetic cannabinoids a first-line treatment for pain, arguing that other drugs should be tried first. But that may be too cautious a view.
Would a corporation deliberately harm the health of the public, including not merely illness but many deaths, merely for the sake of profit? Need I ask? (cf. cigarettes for a prime example—and it’s still going on)
Mark Bittman has a good column in the NY Times:
In the last few years, it’s become increasingly clear that food companies engineer hyperprocessed foods in ways precisely geared to most appeal to our tastes. This technologically advanced engineering is done, of course, with the goal of maximizing profits, regardless of the effects of the resulting foods on consumer health, natural resources, the environment or anything else.
But the issues go way beyond food, as the City University of New York professor Nicholas Freudenberg discusses in his new book, “Lethal but Legal: Corporations, Consumption, and Protecting Public Health.” Freudenberg’s case is that the food industry is but one example of the threat to public health posed by what he calls “the corporate consumption complex,” an alliance of corporations, banks, marketers and others that essentially promote and benefit from unhealthy lifestyles.
It sounds creepy; it is creepy. But it’s also plain to see. Yes, it’s unlikely there’s a cabal that sits down and asks, “How can we kill more kids tomorrow?” But Freudenberg details how six industries — food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive — use pretty much the same playbook to defend the sales of health-threatening products. This playbook, largely developed by the tobacco industry, disregards human health and poses greater threats to our existence than any communicable disease you can name.
All of these industries work hard to defend our “right” — to smoke, feed our children junk, carry handguns and so on — as matters of choice, freedom and responsibility. Their unified line is that anything that restricts those “rights” is un-American.
Yet each industry, as it (mostly) legally can, designs products that are difficult to resist and sometimes addictive. This may be obvious, if only in retrospect: The food industry has created combinations that most appeal to our brains’ instinctual and learned responses, although we were eating those foods long before we realized that. It may be hidden (and borderline illegal), as when tobacco companies upped the nicotine quotient of tobacco. Sometimes, as Freudenberg points out, the appeals may be subtle: Knowing full well that S.U.V.’s were less safe and more environmentally damaging than standard cars, manufacturers nevertheless marketed them as safer, appealing to our “unconscious ‘reptilian instincts’ for survival and reproduction and to advertise S.U.V.’s as both protection against crime and unsafe drivers and as a means to escape from civilization.”
The problems are clear, but grouping these industries gives us a better way to look at the struggle of consumers, of ordinary people, to regain the upper hand.The issues of auto and gun safety, of drug, alcohol and tobacco addiction, and of hyperconsumption of unhealthy food are not as distinct as we’ve long believed; really, they’re quite similar. For example, the argument for protecting people against marketers of junk food relies in part on the fact that antismoking regulations and seatbelt laws were initially attacked as robbing us of choice; now we know they’re lifesavers.
Thus the most novel and interesting parts of Freudenberg’s book are those that rephrase the discussion of rights and choice, because we need more than seatbelt and antismoking laws, more than a few policies nudging people toward better health. . .
The comments to the article are quite interesting, although not always well thought out.
It’s a structural reason, explained well by Paul Krugman.
I watch a lot of movies, and I note that in some bad movies the characters appear to be angry a lot, with nothing motivating their anger. (One title that in my mind is tagged with this characteristic is Showgirls, but I cannot now recall the specific instances—and I don’t want to watch it again.) My take on that is that the apparent anger is just a quick way to get emotion into a scene, even when the anger is unmotivated.
So I was interested in the study discussed in this article in Pacific Standard by Jesse Singal:
If there’s one thing American media does well, it’s outrage. Take a quick glance at your favorite news source, whether The O’Reilly Factor orPardon the Interruption, and you’ll see it: wide-eyed, incredulous, puffed-up outrage that anyone could be so stupid!
Despite our nation’s saturation with outrage, argue two Tufts researchers, we know very little about how the genre works. So Jeffrey M. Berry, a political scientist, and Sarah Sobieraj, a sociologist, assembled a research team and dove into the spittle-flecked world of outrage media. They listened to and read countless transcripts, coding it for content; interviewed fans of Rush Limbaugh, Glenn Beck, and other superstars; and examined the regulatory and business shifts in American mass media that led to our current screamfest.
In a recent interview, Sobieraj spoke with Pacific Standard about the formula of outrage media, why the right wing dominates it, and the weirdly intimate relationship between talk radio hosts and their listeners. The below transcript is edited for length and clarity.
So what exactly is outrage media, and how do you differentiate it from a regular lack of civility?
When we think about outrage, we think of political speech that is intended to provoke an emotional response. So fear, anger, or moral indignation—that sort of thing. Most of the existing literature on incivility talks about interruptions or sighing or things like that, and what we notice is that outrage is such a muscular negativity that it’s not captured by those kinds of studies or questions. It’s just a whole different ballpark. The research on incivility tended to look at things like political advertisements, for example, and we were thinking about this whole other area, this genre where there is a mainstay of emotionally laden speech and behavior that is really designed to rile up the audience.
Emotion has a place in political speech. It’s actually quite important if you think about something like the civil rights movement or 9/11. People’s stories and the social problems they animate are often very important. But what’s different here are the calculated techniques that they use in an effort to evoke those emotions.
And it sounds like “calculated” is the right word, because you guys write that outrage media is pretty formulaic.
It is. It’s very predictable. In fact, sometimes when I’m having a better day or in a better mood or feeling more tolerant, I can find it in myself to find it amusing, the way that the techniques are so similar on the left and the right.
You know you could hear, for example, a host talk about the fringe far-left and if you’re on another network you can hear them talk about the fringe far-right, and so sometimes the language is literally the same. And not just the language, but the techniques, the things like misrepresentative exaggeration and belittling and conspiracy theories.
Are there any other big markers? Misrepresentative exaggeration, belittling….
Insulting language is another really important one. Calling people idiotic or pompous. Name-calling is definitely one too. I’ve heard, for example, bloggers refer to Obama’s supporters as “Obamatards,” things like that.
As for exaggeration, there is lot in political life, but this is a different level of a very dramatic negative exaggeration. For example, saying that something is intended to bring down capitalism. That would be a good example—very few things are actually designed to bring down capitalism. So I would say that misrepresentative exaggeration, mockery, definitely the ideologically extremizing language like “radical right-wing nut,” “socialist,” “fascist.” Those types of things are probably the most common.
I think a lot of people are skeptical of the claim that it’s as bad on the left as it is on the right, and you did a good job of pulling quotes from folks like Mike Malloy that really are angry and negative and out there. But you did find, overall, that there’s something about this sort of media that appeals more to folks on the right, and there’s a huge gap in the amount of outrage media between the two sides.
Yeah, so there are actually two different questions embedded in there. One is whether it’s the same or different in terms of the intensity and the volume and that sort of thing. Some people have suggested that when we point out that it happens on the left it’s a false equivalency. And that’s actually not what we’re doing at all.
What we notice is that the techniques are very similar on the left and the right. So something like belittling or exaggeration—you’re going to find that with Ed Schultz or Lawrence O’Donnell just like you’ll find it with Bill O’Reilly or Sean Hannity. But the volume is very different, in terms of the sheer number of platforms on the right. Talk radio is over 90 percent conservative so there’s just more of it.
Now the other question that you’re asking is whether outrage is more attractive to those on the right, and I think it is for a number of reasons. It’s actually kind of complicated—there are a lot of things going on. One is that the left is less distrustful or more accepting, depending on how you want to say it, of conventional news. So the right has historically been less comfortable with the major networks or The New York Times, for example, and the left is more comfortable in those spaces.
Another thing that comes into play is that there is some research that suggests that conservatives have a personality type—this is, of course, not all of them—and that there’s a greater propensity for comfort with black-and-white argumentation, which is very common in the outrage genre. There are good guys and there are bad guys. You are with us or you are against us. So there is that type of appeal.
But also, and I think probably most interestingly, since the rise of multiculturalism, with words like “tolerance,” “inclusion,” and “diversity” being viewed as good and important, for those who are conservative, to share your political views on things like same-sex marriage or immigration—those views can be viewed as intolerant and you can feel as though you are being judged and stigmatized. So we think that these shows, or what we hear when we talk to fans, are that these shows and blogs really become a safe space where their views are validated and they’re not criticized.
That struck me actually, because I really did like the interviews you had with fans of Beck and Limbaugh and some other conservative hosts, and there was this genuine fear that I found surprisingly easy to empathize with. They said they feel like they can’t talk about these issues or they’re going to be tarred as racist. . .
Emily Atkin writes at ThinkProgress:
There is an abandoned house in Alberta, Canada, where Alain Labrecque used to live. Tucked in the farming community of Peace River, it is a place brimming with personal history, rooted to his grandfather’s land where his parents and eight aunts and uncles grew up, and where Alain’s own children were born. Now, Alain’s property and the surrounding area are primarily home to large, black cylinders of oil.
The oil is from Alberta’s much-famed tar sands, a large area of land that contains clay, bitumen, and a good deal of sand. Inside the tanks, heavy crude from the sands is heated, until it becomes viscous enough to transport. Many of those tanks currently vent freely into the atmosphere.
As the third-largest proven crude oil reserve in the world and the key ingredient of the controversial Keystone XL pipeline, and with production value that is expected to nearly triple by 2018, the Canadian tar sands have become an unseen symbol in America. For some, that symbol represents jobs, energy security, and economic prosperity. For others, it’s pollution, addiction to fossil fuels, and a threat to a livable climate. What generally is not conveyed, however, is an image of the families who live there, and who have been there long before the tar sands boom.
Though Alain once thought having the tanks on his property would be a blessing, he now describes them as a curse. After experiencing an unusual kind of sickness — fainting, weight loss, gray skin, strange growths — that he believes was caused by the tanks’ unregulated emissions, Alain and his family were eventually forced to move to British Columbia. They have pegged Baytex Energy, the owner of the tanks, as their enemy. Baytex has produced studies claiming innocence, but has also offered to buy the Labrecques’ land in exchange for their silence. So, taking their doctor’s own advice, the family decided to move, and fight the battle for their home from afar.
The doctor’s words to them? “He said, ‘You are just a small, little bolt in this huge robot, and you don’t matter. Move.’”
Prosperity in Paradise
As a family with a rich history of working for and benefiting from the oil industry, never in their wildest dreams did Karla and Alain think they would be the ones fighting this fight.
“You’ve gotta understand, I’ve worked for oil sands, I was a contractor,” Alain said in an interview with ThinkProgress. “I’ve never been negative toward oil. Never thought this would happen.”
The Labrecques’ large and long family history begins in 1929, when 18-year-old Joseph Labrecque homesteaded a piece of land near Peace River, Alberta, Canada — an oil-rich area that Baytex Energy Corp. now calls the “Reno Field.” Joseph cleared the land, and eventually settled down with a wife and nine children, seven boys and two girls.
As Joseph’s children grew up, five of his sons stayed in the area, taking up the land that surrounded their father’s. Even now, the Labrecques still largely make up the population of the one-by-five mile Reno Field.
Oil came into the picture in 2004. Representatives for Koch Exploration, a company owned by notorious billionaire brothers Charles and David Koch, approached one of Joseph’s sons, Mike, asking for permission to drill. Mike was in favor and Koch Exploration drilled the land, eventually selling it to Prosper Petroleum in 2008. Prosper continued to drill wells until the land was finally purchased by Baytex in February 2011.
But for the Labrecques, ownership was not really an issue — in fact, there were no issues. Their environment was clean, their kids were healthy. Drilling added value to their land and cash to their pockets.
One of Mike’s nephews, Alain, was happy with the royalty payments he received from the oil. They paired nicely with the fact that 2010 was his best farming year yet. “It was just no thought of negative thing, period,” Alain testified under oath before the Alberta Energy Regulator . “Things were just starting to click.”
Just as things were becoming comfortable for Alain in December of 2010, he began experiencing some minor health issues. He also owns a logging business, and was busy trying to get the trucks ready for the season. As he was working on the engines, he began to get headaches — nothing serious, he said, but big enough where he had to pop an Advil every few hours. As time went on, he gained a new ailment: eye-twitching, or as he says, a “quick little pull on the eyes.” The headaches persisted. And he was not the only one with problems.
“Why is the little girl always falling?” Alain recalled thinking of his then-two-year-old daughter. He assumed she was just clumsy. But then, in March 2011, his wife, Karla, fell down the stairs. She began to notice that she could make herself faint if she turned her head too far to the left. Around that time, Alain noticed his house smelled like gas — the same smell they would smell the evenings before outside, when Baytex would vent its simmering tanks of oil sands. He checked the furnace, the carbon monoxide monitor. Nothing.
The symptoms progressed. Every night, Karla said she would fall asleep to popping ears. She had sinus congestion, hot and cold flashes. She began to feel as if her arms were hollow. She developed “massive” headaches, like migraines, but different. “I get migraines; this is not like a migraine,” she said. “This is like somebody’s taking a two-by-four to your head.”
Their then three-year-old son, they said, started developing dark grey circles under his eyes, and struggled with constipation. Despite being put on laxatives, he would sometimes go a week without a bowel movement. He once went 12 days. As time passed, Alain developed a growth on his head, which was removed by a doctor.
Alain’s uncle Mike was initially annoyed at the complaining. “I guess in a way I thought I had a good job here, and I didn’t want anybody rocking the boat,” he said.
But then the symptoms started for him too. By winter of 2011, he was sweating through three pillows a night. His skin turned gray and he lost 45 pounds. His wife Leona, who lived in the city during the week for work, said Mike would go into “comatose sleeps.” His voice became hoarse, and his speech became slurred. He began to believe he had cancer.
Though Mike’s symptoms persisted, he continued to work. Since he lived right in the middle of the Reno Field, he was hired by Baytex to clear snow at the sites, and use his tractor to pull tanker trucks into and out of the sites whenever wet conditions or snow inhibited truck movements. In April 2012, he was called to go help another worker at a Baytex site. Feeling dizzy, Mike stopped at his office, and told his supervisor he was feeling too lightheaded to go the site, too dizzy to operate his tractor.
“I said the way I feel right now — I said, I — I can’t do it,” he recalled. “So I said, is there anything that you can do?”
A few phone calls later, Mike was fired.
Pinpointing the Problem
When Mike did work for Baytex, it was basically the same as it was when he worked for Koch and Prosper, the two companies that owned the site before. Except, he says, there was one change that he found peculiar. When Koch and Prosper operated the tanks, it would take nearly three hours to load the bitumen from the tanks into the tanker trucks. Now, with Baytex, it took only 30 to 45 minutes.
“[Mike] and the other landowners believe that Baytex increased the temperature of the tanks and possibly added chemical thinners to allow the heavy oil to be loaded faster,” a statement on the landowners’ “Stop Baytex” website reads.
Baytex spokesperson and director of stakeholder relations Andrew Loosely, however, told ThinkProgress that not only had the company not increased the temperature of the tanks, but that Baytex’s process for liquefying the tar sands is essentially the same as when Prosper Petroleum’s. “It’s untrue,” Loosely said. “Our process is no different than what was going down before. In fact, we’ve lowered the temperature that Prosper was operating their tanks at.”
When Prosper had owned the tanks, it operated them at 194 degrees, whereas Baytex operates them at 176, Loosely said. Prosper had also used an open venting system, he said, and no method of capturing its emissions. In fact, Baytex has more so-called “vapor recovery systems” that capture the emissions and turn them into usable fuel than Prosper did, he said.
Baytex’s process is called Cold Heavy Oil Production with Sand, or CHOPS. It is a radically different production process than conventional oil drilling, and is designed for the hard-to-extract tar sands — a thick mixture of heavy oil, sand, and water. To extract the most tar sands, the CHOPS process uses wider drill holes. The well is then “perforated,” meaning there are holes up and down the sides of the underground pipe. Those holes are able to suck in everything — the sand, the oil, and the water.
Then, the mixture is put into tanks and heated. The heating process separates the sand and the water, and the oil is ready to be transported to a pipeline or rail facility. The process, according to the Alberta government, should produce anywhere from 94 to 314 barrels of oil every day, per well, “in almost all cases.” Considering Baytex has 23 well pads in the Reno Field, that could mean more than 300,000 gallons of oil produced from the field every day. In September 2013, Baytex produced 53,550 gallons per day.
But inevitably, CHOPS doesn’t just produce tar sands. It also winds up creating a good deal of chemical- and bitumen-related waste product, according to the Alberta government. There is so much waste, in fact, that the government estimates waste management accounts for 15 to 35 percent of operating costs for the CHOPS process. The waste is considered “non-hazardous,” however, so while it can be noxious and smelly, it presents “no known health hazards” to the community.
After identifying the smell in their home as the same smell from the CHOPS tanks, Karla and Alain in 2011 asked Baytex to take steps to remedy the emissions. Baytex responded by shutting down its drilling operations, and hiring a company called Chemistry Matters, Inc. to conduct an air quality study. Chemistry Matters’ founder and sole proprietor, Dr. Court Sandau, describes his company on his LinkedIn page as providing “data validation services for contentious or litigious matters — when you need it to be right.”
That air quality study found that no health-based limits on emissions were exceeded in the area surrounding the Labrecques’ home. The bitumen produced in the area is rich in sulfur, which likely contributed to the foul smells, but levels of sulfur in the air did not violate regulated standards for human health, the report said. Baytex resumed its operations.
The Labrecques take issue with Baytex’s study, and believe it failed to monitor air quality at night — the time when emissions were released and when odors were strongest.
“They produce air quality studies that say, ‘No, everything’s all OK,’ trying to prove that we’re lying to them,” Karla said. “They make you feel like you’re the troublemaker — a ‘Why don’t you just shut your mouth’ type of thing.”
Indeed, Baytex has attempted to keep the Labrecques quiet. Before moving to British Columbia in 2011, after a year of complaining, the Labrecques entered into alternative dispute resolution with Baytex, where the company offered to buy their 160-acre farm for as much as it would have been worth before the environmental damage. No one else would have offered the Labrecques that much. But there was a catch.
According to the sale contract the Labrecques provided ThinkProgress, the sale of their land would have meant silence. No social media posts from them, their children, or their children’s children about Baytex. No more StopBaytex.ca, no more “Stop Baytex” group on Facebook — those would be turned over to the company. No communicating with government representatives about issues concerning Baytex. No talking to the media.
Karla and Alain did not sign the contract, and wound up finding a buyer for the farmland portion of their property. They still own the land on which their home sits. The same cannot be said for Alain’s next door neighbor and brother, who took the deal partly because his wife was pregnant when the emissions were at their most unbearable. He is unauthorized to speak to the media.
At a January hearing on Baytex’s emissions, an environmental health expert hired by the Alberta government testified that many Alberta doctors are afraid to speak out against the oil sands, and afraid to connect it to health issues. A family doctor for the Labrecques, Dr. John O’Connor, agrees. He was threatened with having his license taken away for talking about cancer rates near the oil sands in 2006.
“My experience … strongly suggests to me that government does not want to know [and] is not interested in knowing what’s going on,” Dr. O’Connor told the Vancouver Sun.
Solutions and Regulations
In the eyes of the Canadian government, Baytex is operating within the rule-book. CHOPS operators are not obligated by current regulations to install odor-reduction or vapor recovery systems.
But from their new home, the Labrecques are calling for regulatory reform. . .
And yet this crime against humanity is common in our penal system. And it causes physical change, reports Nicole Flatow at ThinkProgress:
Solitary confinement has been called a “living death,” cruel and unusual, and torture. Studies of the prison practice of placing inmates in a solitary, often concrete windowless cell for 23 hours a day with almost no human contact, have found that the psychological impact is dramatic after just a few days.
A University of Michigan neuroscientist suggested Friday that the physical impact on the brain could be just as significant if not moreso, and could “dramatically change the brain” in just a matter of days. Speaking on a panel about solitary confinement, neuroscientist Huda Akil said inaccess to inmates has prevented much formal study on brain changes while held in confinement. But she said a number of other studies have documented how each of the factors involved in solitary confinement change the physical shape of the brain. The lack of physical interaction with the natural world, the lack of social interaction, and the lack of touch and visual stimulation alone are each “by itself is sufficient to dramatically change the brain,” Akil said at the American Association for the Advancement of Science annual meeting.
She said particular parts of the brain that are subject to extreme stress can “actually shrink,”including the hippocampus, which is responsible for memory, spatial orientation, and memory.
Robert King, a member of the “Angola 3″ who was held in solitary confinement for years before his conviction was overturned in a racially charged murder case based on flimsy evidence, said his eyesight and physical orientation are permanently impaired. “My geography is way off,” he said. “I get lost sometimes in my own neighborhood. I believe that this is a result of my solitary confinement.” Two of King’s fellow defendants remained in solitary, one until just days before his death in October.
Other psychological impacts documented by psychology professor Craig Haney include“extreme paranoia, self-mutilation, hypersensitivity to sound, light and touch, and severe cognition dysfunction among prisoners.”
One recent psychological study concluded, “The restriction of environmental stimulation and social isolation associated with confinement in solitary are strikingly toxic to mental functioning.” And prisoners, many of whom are later released, have described developing rage and violent tendencies while confined.
“To me, the separation of the mental and physical is highly artificial, because there are definitely physical consequences of these experiences,” said Akil.
The prolonged, isolated confinement of inmates has been held unconstitutional as applied to the mentally ill, and at least two courts have now held that indefinite, unreviewed confinement is also unconstitutional. But the practice remains common, and has not been invalidated outright. At least 80,000 U.S. prisoners are held in solitary confinement by some estimates, and it is frequently used not to segregate dangerous prisoners, but as a means of social control, or mental health treatment. In California, more than 500 inmates have reportedly been kept in confinement for 10 to 28 years.
I continue to believe that, judging by actions, the GOP actively hates lower-income people. Tara Culp-Ressler reports in ThinkProgress:
During a political fight over Medicaid expansion in Arkansas on Tuesday, one Republican lawmaker admitted that he doesn’t want to educate uninsured residents about their new health care options because it’s simply too expensive to provide them with insurance.
State Rep. Nate Bell (R), who offered an amendment to Arkansas’ proposed Medicaid expansion bill that would prevent the state from using federal funds to promote Obamacare, acknowledged that his policy would result in fewer people signing up for health care. He noted that “without active marketing, you probably get declining enrollment.” But in his mind, that’s not a problem — that’s the whole point.
“We’re trying to create a barrier to enrollment,” Bell explained, noting that lower enrollment ultimately translates to lower costs. “In general, as a conservative, if I have the opportunity to reduce government spending in a program from what’s projected… I’m probably going to take that deal.”
Bell’s amendment would prohibit Arkansas from advertising Obamacare plans through television, radio, print, or online ads. It also prevents the state from using federal funds to conduct direct mailing campaigns — which, as the Arkansas Times’ David Ramsey notes, has been critical in getting out the word about the state’s Medicaid expansion. Since Arkansas is pursuing a “private option” for Medicaid, which essentially gives residents a subsidy to purchase private insurance, the process for enrolling in a Medicaid plan is very similar to the process for signing up for a plan on Obamacare’s new state-level exchange.
Preventing Americans from getting all the facts about the health reform law is a popular method of undermining Obamacare, particularly in red states. Republicans have repeatedly targeted “navigators,” the people tasked with helping Americans enroll in new plans, to prevent them from being able to easily do their jobs. And conservative states that are opposed to Obamacare have allocated considerably less money to promote it. It’s no surprise, then, that the people who live in GOP-led states are less likely to understand how to sign up for health care.
Those states are also more likely to have higher populations of low-income people who lack insurance. In Arkansas specifically, the uninsurance rate is among the highest in the nation. Efforts to expand health care in the state are actually projected to save money in the long run because they’ll cut down on the cost of uncompensated care; the Medicaid expansion could save taxpayers as much as $90 million this year.
Nonetheless, Arkansas lawmakers are currently debating whether to kick thousands of low-income people off of their new Medicaid plans. Even though the state began implementing its “private option” last year, and an estimated 83,000 people have already enrolled, the legislature is currently debating whether to approve the policy. And if lawmakers like Bell have their way, even the move to preserve Medicaid expansion may still come at a significant cost.
Cannabis Catch-22: Marijuana has no proven medical benefits and medical studies of the effects of marijuana are not allowed.
Nicely played by the head-in-the-sand crowd, but unfortunately that keeps us from realizing any significant benefits—as reported at ThinkProgress by Tara Culp-Ressler:
New research suggests that THC, the main active ingredient in marijuana, could help prevent the HIV virus from spreading throughout the body. When the study’s authors first presented their “groundbreaking” findings at a conference in 2011, they were excited about the potential implications. But they also knew that, thanks to the U.S. government’s restrictions on research related to marijuana, they probably won’t be able to test it out on humans.
Led by Dr. Patricia Molina, a team of Louisiana State University researchers arrived at theirconclusions after studying a group of monkeys infected with an animal form of the HIV virus. They administered a daily dose of cannabis to the primates for 17 months, and eventually saw a dramatic decrease in the damage to the monkeys’ stomach tissue — as well as an increased population of normal cells around that damaged tissue.
Since the stomach is one of the most common areas in the body for HIV to spread, the results signal that cannabis could help prevent HIV from infecting and killing off healthy cells.
“It adds to the picture and it builds a little bit more information around the potential mechanisms that might be playing a role in the modulation of the infection,” Molinaexplained to Leaf Science.
This isn’t the first study to report a correlation between cannabis and HIV. Last year, a Philadelphia researcher found evidence that THC could help suppress infected cells from entering the brain. Harvard researchers report that cannabis could help protect the brainfrom a toxic protein created by the HIV virus that often leads to brain injury. According to a 2012 study, cannabis can help fight the HIV virus in patients that are already in advanced stages of AIDS. And several different studies have demonstrated that marijuana can alleviatesome of the common side effects, like loss of appetite and pain, that result from HIV drugs.
Nonetheless, Molina knows that it will be virtually impossible to conduct large-scale clinical trials on humans, even though that has the potential to benefit the approximately 1.1 million Americans who are living with HIV.
Since the federal government continues to classify marijuana as a Schedule I drug — the most restrictive of the five categories under the Controlled Substances Act — it’s difficult for scientists to get funding for any research in this area. The government controls access to a small legal supply of marijuana for research purposes, and often refuses to back projectsthat could lead to important treatments simply because they require cannabis. Researchers have repeatedly complained that drug prohibition stifles scientific innovation.
Even though President Obama has acknowledged that he believes marijuana is less dangerous than alcohol, he still refuses to commit to reclassifying it, ensuring that the federal government will continue treating cannabis as a bigger threat to public health than cocaine and opium.
This isn’t the only area of scientific research that’s hampered by outside influences. There’s also been a dearth of federal studies into gun violence, thanks to the National Rifle Association’s successful efforts to strip funding from the Centers for Disease Control’s gun research programs. Some scientists who want to study the effects of gun policy have beenforced to resort to crowdfunding to get their projects off the ground. Unlike marijuana, however, the White House has publicly committed to working to undo these restrictions.
It should be noted that the White House could reschedule marijuana at the stroke of a pen. Obama claims to want that to happen, and yet he somehow feels powerless to make it happen. I don’t get it.
This sort of facility seems like an excellent idea, and apparently it results in improved happiness and health for its residents. I bet it’s a more pleasant place to work than the usual assisted-living home. With Baby Boomers aging, this would be a good thing to initiate as publicly-owned (taxpayer-supported) facilities. This is exactly the sort of thing you do NOT want to run on a profit motive, which inevitably leads to cuts in quality of service and higher prices over time due to the inexorable drive to grow profits.
What happens when you use a good single-payer healthcare system. Note that the US hospital contrasted is Memorial Sloan Kettering, no slouch of a (US) hospital.
Interesting blog post by Paul Krugman pointing out the deja vu of watching the GOP once again declare that reports are skewed—first, it was polls and reports showing that Obama would win over Mitt Romney, now it’s reports showing that Obamacare is working. The problem with denying reality is that reality is always around and thus, in effect, patient.
Fascinating. Corporate greed seems to have a corrupting effect.
A very good look at Tim Armstrong’s obliviousness by Amy Davidson in the New Yorker:
How does one define “distressed”? Anxious, worried, upset in a slightly old-fashioned way, and somehow ragged. Damsels can be in distress, without being distressed ladies—blithely awaiting rescue, without a ribbon out of place. Fashionably scuffed dressers or jeans are said to be “gently distressed.” When the word is modified that way, it also calls to mind a baby, half woken up and wiggling, darting out a hand to see if someone is there.
When Tim Armstrong, the C.E.O. of AOL, talked about “distressed babies” a few days ago, though, there was nothing gentle added, in either the language or the intent. He was explaining, in a conference call with employees, why the company was making their 401(k) plan worse. “In 2012,” he said, in a transcript that Capital New York got first,
We had two AOL-ers that had distressed babies that were born that we paid a million dollars each to make sure those babies were OK in general. And those are the things that add up into our benefits cost. So when we had the final decision about what benefits to cut because of the increased healthcare costs, we made the decision, and I made the decision, to basically change the 401(k) plan.
In other words, don’t blame us for cutting back on retirement benefits; it was two babies we had to keep alive who took your money.
But what did Armstrong mean when he said “we paid a million dollars”? This does not represent an act of charity on the part of a struggling company. AOL is profitable, and just had a very good quarter; it has done well enough to pay Armstrong twelve million dollars, a number that does not seem to distress him. And, as Deanna Fei, the rightly distressed mother of one said baby, wrote in a piece for Slate, she and her husband, who works for AOL, had paid their premiums for the company’s health-insurance plan. This is what they bought, with that money and her husband’s labor: an agreement that, in the event that something bad happened with their health or that of their child, they would be able to go to the doctor, and that they wouldn’t be bankrupted.
Something very bad did happen. Fei woke up with sudden pains when she was only five months pregnant with her second child. She was rushed to the hospital, and her baby girl was rescued with an emergency Caesarean section—one pound nine ounces, her skin all purple and blue the way no baby’s should be. (One doctor, Fei said, was “visibly shaken.”) She was put on a ventilator. “That day, we were told that she had roughly a one-third chance of dying before we could bring her home. That she might not survive one month or one week or one day,” Fei wrote.
For longer than I can bear to remember, we were too terrified to name her, to know her, to love her. In my lowest moments—when she suffered a brain hemorrhage, when her right lung collapsed, when she stopped breathing altogether one morning—I found myself wishing that I could simply mourn her loss and go home to take care of my strapping, exuberant, fat-cheeked son.
Except that the baby girl wouldn’t give up: “over the next weeks, she fought for every minute of her young life, as did her doctors and nurses, and we could only strive to do the same.” She was in distress, that baby, but she wasn’t going to wait like some damsel.
Fei doesn’t doubt that all of this—“blood transfusions, head ultrasounds, the insertion of breathing tubes, feeding tubes, and a central line extending nearly to her heart”—could have cost a million dollars. That is the point of insurance. AOL, which is apparently self-insured (while using Cigna as one of its plan administrators) made a bet that it wasn’t going to get the employees it needed without a decent health-care plan, and that this was the way to provide it. (It also, as some commentators have noted, appears not to have opted for a reinsurance policy as a hedge against big claims.) Armstrong also complained about Obamacare, which he said would cost the company millions; as Ezra Klein pointed out in a Bloomberg column, this suggests only that he and AOL haven’t looked closely at the law, and figured out how the company can now join a larger risk pool and protect itself from big swings. Or was his problem with Obamacare that it won’t let insurers tell people like Fei’s daughter that they’ve reached some “lifetime cap” before their first birthday, or keep her father looking for a job with a more sane employer because he’s worried that a “preëxisting condition” will keep her from finding a new insurer?
But wasn’t this about 401(k)s—retirement plans—and not about health care? Armstrong’s rationale is really just a riff on how much higher profits would be if you didn’t have to hire human beings. As Fei wrote, Armstrong “exposed the most searing experience of our lives, one that my husband and I still struggle to discuss with anyone but each other, for no other purpose than an absurd justification for corporate cost-cutting.” (She says she is doing so now because her husband starting getting queries from co-workers minutes after the conference call.) The change to the 401(k) plan was this: instead of matching contributions quarterly, the company would only pay its share for employees who were active on December 31st of a given year. If you were left or passed away or were fired on December 30th, you would get nothing, despite three hundred and sixty-four days as an AOL-er. With the “distressed baby” move, Armstrong removed the presumption that the company wouldn’t use this in bad faith. If someone complains to the entire company about how much trouble it is that a couple of babies were gravely sick, would you put it past him to fire employees who were about to be due a big contribution? Maybe in his next speech he’d be complaining about AOL-ers who had the temerity to die from heart attacks on New Year’s Day, instead of on Christmas.
That speech won’t be given now; Armstrong’s speech was so blatantly oblivious, so cheap in every sense of the word, that he has had to apologize (after a false start, in which he said he’d just been trying to show how much he cared) and also reverse the 401(k) change.
But we’re not done with this. There is more to be distressed about, on behalf of babies, parents, and the people who work with them.
For one thing, Fei pushed back at Armstrong from what was, within the terms of our discussions about parenting, an unassailable position. Armstrong, in his first non-apology, had referred to her pregnancy as “high-risk”:
But there was nothing high-risk about my pregnancy. I never had a single risk factor for a preterm birth, let alone one as extreme as this one. Until the morning I woke up in labor, every exam indicated that our daughter was perfectly healthy.
Her first pregnancy had been “normal”; this one had appeared to be, too. She is absolutely right to remind Armstrong that life itself is riskily uncertain, and of the shallowness of acting as if we make our own luck entirely, picking our circumstances from a store shelf.
But if there had been risk factors—so what? What if she had been older, or had her own health problems or struggles with infertility, or maybe even was single? What if she’d had a wife, rather than a husband? She should have just as much right in any of those circumstances not to be exposed and blamed, and for her baby to not be treated like a beggar.
Armstrong might have assumed there was some such factor at work, and that he had more resentment to play with—including his own. One item that emerged this week was . . .