The fight to save America

Heather Cox Richardson writes:

For weeks now, I have vowed that I would finish these letters early and get to bed before midnight, and for weeks now, I have finally finished around three in the morning. That was not the case two years ago, when I started writing these at the start of the Ukraine crisis: it was rare enough for me to be writing until midnight that I vividly remember the first time it happened.

I got to thinking today about why things seem more demanding today than they did two years ago, and it strikes me that what makes the writing more time consuming these days is that we have two all-consuming stories running in parallel, and together they illuminate the grand struggle we are in for the survival of American democracy.

On the one hand we have the former president and the attempts by him and his loyalists to seize control of our country regardless of the will of the majority of voters, while Republican Party leaders are refusing to speak out in the hopes that they can retain power to continue advancing their agenda.

Since the 1980s, this branch of the Republican Party has tried to dismantle the government in place since the 1930s that tries to protect equality in America, regulating business, providing a basic social safety net, and promoting infrastructure. Members of this faction of the Republican Party—the faction that is now in control of it—want to take the government back to the 1920s, when businessmen controlled the government, operating it to try to create a booming economy without regard for social or environmental consequences.

Although initially unhappy at Donald Trump’s elevation to the White House, that faction embraced him as he advanced the tax cuts, deregulation, and destruction of government offices they believed were central to freeing businessmen to advance the economy. Believing that Democrats’ determination to use the government to level the playing field among Americans would destroy the individualism that supports the economy, they had come to believe that Democrats could not legitimately govern the country. And so, members of this Republican faction did not back away when Trump refused to accept the election of a Democratic president in 2020.

Almost a year later, the leadership of the Republican Party, composed now as it is of Trump loyalists, is undermining our democracy. It has fallen in line behind Trump’s Big Lie that he and not Biden won the 2020 election, and that the Democratic Party engaged in voter fraud to install their candidate. This is a lie, but Republicans at the state level are using that lie to justify new election laws that suppress Democratic votes and put control of state elections into their own hands. If those laws are allowed to stand, we will be a democracy in name only. We will likely still have elections, but, just as in Russia or Hungary now, the mechanics of the system will mean that only the president’s party can win.

This attack on our democracy is unprecedented, and it cannot be ignored. Tonight, for example, Trump held a “rally” in Perry, Georgia, where, to cheers, he straight up lied that the recent “audit” in Arizona proved he won the 2020 election. And yet, to overemphasize the antics of the former president and his supporters enables them to grow to larger proportions than they deserve, feeding their power. Tonight, for example, Newsmax and OAN covered Trump’s rally live, but the Fox News Channel did not, and the audience appeared bored.

On the other hand, in contrast to the former president’s party, President Joe Biden and the Democrats are trying to demonstrate that democracy actually works. Rather than simply fighting the Republicans, which would permit the Republicans to define the terms under which they govern, they are defending the active government the Republicans have set out to destroy. Biden has been clear since he took office that he intends to strengthen democracy abroad, where it is under pressure from rising autocratic governments, by strengthening it at home.

To that end, he and the Democrats in Congress have aggressively worked to  . . .

Continue reading.

The bias that blinds: Why doctors give some people dangerously different medical care

Jessica Nordell writes in the Guardian:

I met Chris in my first month at a small, hard-partying Catholic high school in north-eastern Wisconsin, where kids jammed cigarettes between the fingers of the school’s lifesize Jesus statue and skipped mass to eat fries at the fast-food joint across the street. Chris and her circle perched somewhere adjacent to the school’s social hierarchy, and she surveyed the adolescent drama and absurdity with cool, heavy-lidded understanding. I admired her from afar and shuffled around the edges of her orbit, gleeful whenever she motioned for me to join her gang for lunch.

After high school, we lost touch. I went east; Chris stayed in the midwest. To pay for school at the University of Minnesota, she hawked costume jewellery at Dayton’s department store. She got married to a tall classmate named Adam and merged with the mainstream – became a lawyer, had a couple of daughters. She would go running at the YWCA and cook oatmeal for breakfast. Then in 2010, at the age of 35, she went to the ER with stomach pains. She struggled to describe the pain – it wasn’t like anything she’d felt before. The doctor told her it was indigestion and sent her home. But the symptoms kept coming back. She was strangely tired and constipated. She returned to the doctor. She didn’t feel right, she said. Of course you’re tired, he told her, you’re raising kids. You’re stressed. You should be tired. Frustrated, she saw other doctors. You’re a working mom, they said. You need to relax. Add fibre to your diet. The problems ratcheted up in frequency. She was anaemic, and always so tired. She’d feel sleepy when having coffee with a friend. Get some rest, she was told. Try sleeping pills.

By 2012, the fatigue was so overwhelming, Chris couldn’t walk around the block. She’d fall asleep at three in the afternoon. Her skin was turning pale. She felt pain when she ate. Adam suggested she see his childhood physician, who practised 40 minutes away. That doctor tested her blood. Her iron was so low, he thought she was bleeding internally. He scheduled a CT scan and a colonoscopy. When they revealed a golf ball-sized tumour, Chris felt, for a moment, relieved. She was sick. She’d been telling them all along. Now there was a specific problem to solve. But the relief was short-lived. Surgery six days later showed that the tumour had spread into her abdomen. At the age of 37, Chris had stage four colon cancer.

Historically, research about the roots of health disparities – differences in health and disease among different social groups – has sought answers in the patients: their behaviour, their status, their circumstances. Perhaps, the thinking went, some patients wait longer to seek help in the first place, or they don’t comply with doctors’ orders.

Maybe patients receive fewer interventions because that’s what they prefer. For Black Americans, health disparities have long been seen as originating in the bodies of the patients, a notion promoted by the racism of the 19th-century medical field. Medical journals published countless articles detailing invented physiological flaws of Black Americans; statistics pointing to increased mortality rates in the late 19th century were seen as evidence not of social and economic oppression and exclusion, but of physical inferiority.

In this century, research has increasingly focused on the social and environmental determinants of health, including the way differences in access to insurance and care also change health outcomes. The devastating disparate impact of Covid-19 on communities of colour vividly illuminates these factors: the disproportionate burden can be traced to a web of social inequities, including more dangerous working conditions, lack of access to essential resources, and chronic health conditions stemming from ongoing exposure to inequality, racism, exclusion and pollution. For trans people, particularly trans women of colour, the burden of disease is enormous. Trans individuals, whose marginalisation results in high rates of poverty, workplace discrimination, unemployment, and serious psychological distress, face much higher rates of chronic conditions such as asthma, chronic pulmonary obstructive disorder, depression and HIV than the cisgender population. A 2015 survey of nearly 28,000 trans individuals in the US found that one-third had not sought necessary healthcare because they could not afford it.

More recently, researchers have also begun looking at differences that originate in the providers – differences in how doctors and other healthcare professionals treat patients. And study after study shows that they treat some groups differently from others.

Black patients, for instance, are less likely than white patients to receive pain medication for the same symptoms, a pattern of disparate treatment that holds even for children. Researchers attribute this finding to false stereotypes that Black people don’t feel pain to the same degree as white people – stereotypes that date back to chattel slavery and were used to justify inhumane treatment. The problem pervades medical education, where “race” is presented as a risk factor for myriad diseases, rather than the accumulation of stressors linked to racism. Black immigrants from the Caribbean, for instance, have lower rates of hypertension and cardiovascular disease than US-born Black people, but after a couple of decades, their rates of illness increase toward those of the US-born Black population, a result generally attributed to the particular racism they encounter in the US.

Black patients are also given fewer therapeutic procedures, even when studies control for insurance, illness severity and type of hospital. For heart attacks, black people are less likely to receive guideline-based care; in intensive care units for heart failure, they are less likely to see a cardiologist, which is linked to survival.

These biases affect the quality of many other interactions in clinics. Doctors spend less time and build less emotional rapport with obese patients. Transgender people face overt prejudice and discrimination. The 2015 survey also found that in the preceding year, a third of respondents had had a negative encounter with a healthcare provider, including being refused treatment. Almost a quarter were so concerned about mistreatment that they avoided necessary healthcare. Transgender individuals can therefore face a dangerous choice: disclose their status as trans and risk discrimination, or conceal it and risk inappropriate treatment.

Even though medical providers are not generally intending to provide better treatment to some people at the expense of others, unexamined bias can create devastating harm.

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Chris was told that her symptoms, increasingly unmanageable, were not serious. Women as a group receive fewer and less timely interventions, receive less pain treatment and are less frequently referred to specialists. One 2008 study of nearly 80,000 patients in more than 400 hospitals found that women having heart attacks experience dangerous treatment delays, and that once in the hospital they more often die. After a heart attack, women are less likely to be referred to cardiac rehabilitation or to be prescribed the right medication. Critically ill women older than 50 are less likely to receive life-saving interventions than men of the same age; women who have knee pain are 22 times less likely to be referred for a knee replacement than a man. A 2007 Canadian study of nearly 500,000 patients showed that after adjusting for the severity of illness, women spent a shorter time in the ICU and were less likely to receive life support; after age 50, they were also significantly more likely to die after a critical illness.

Women of colour are at particular risk for poor treatment. A 2019 analysis of their childbirth experiences found that they frequently encountered condescending, ineffective communication and disrespect from providers; some women felt bullied into having C-sections. Serena Williams’s childbirth story is by now well known: the tennis star has a history of blood clots, but when she recognised the symptoms and asked for immediate scans and treatment, the nurse and the doctor doubted her. Williams finally got what she needed, but ignoring women’s symptoms and distress contributes to higher maternal mortality rates among Black, Alaska Native and Native American women. Indeed, Black women alone in the US are three to four times more likely to die of complications from childbirth than white women.

There’s also a structural reason for inferior care: women have historically been excluded from much of medical research. The reasons are varied, ranging from a desire to protect childbearing women from drugs that could impair foetal development, via notions that women’s hormones could complicate research, to an implicit judgment that men’s lives were simply more worth saving. Many landmark studies on ageing and heart disease never included women; the all-men study of cardiovascular disease named MRFIT emerged from a mindset that male breadwinners having heart attacks was a national emergency, even though cardiovascular disease is also the leading cause of death for women. In one particularly egregious example, a 1980s study examining the effect of obesity on breast cancer and uterine cancer excluded women because men’s hormones were “simpler” and “cheaper” to study.

Basic to these practices was an operating assumption that men were the default humans, of which women were a subcategory that could safely be left out of studies. Of course, there’s a logical problem here: the assertion is that women are so complicated and different that they can’t be included in research, and yet also so similar that any findings should seamlessly extend to them. In the 90s, the US Congress insisted that medical studies funded by the National Institutes of Health should include women; earlier, many drug studies also left out women, an exclusion that may help explain why women are 50%-75% more likely to experience adverse side-effects from drugs.

As the sociologist Steven Epstein points out, medicine often starts with categories that are socially and politically relevant – but these are not always medically relevant. Relying on categories such as race risks erasing the social causes of health disparities and may entrench the false and damaging ideas that are inscribed in medical practice. At the same time, ignoring differences such as sex is perilous: as a result of their exclusion, women’s symptoms have not been medically well understood. Doctors were told, for example, that women present with “atypical symptoms” of heart attacks. In fact, these “atypical” symptoms are typical – for women. They were only “atypical” because they hadn’t been studied. Women and men also vary in their susceptibility to different diseases, and in the course and symptoms of those diseases. They respond to some drugs differently. Women’s kidneys filter waste more slowly, so some medications take longer to clear from the body.

This dearth of knowledge about women’s bodies has led doctors to see differences where none exist, and fail to see differences where they do. As the journalist Maya Dusenbery argues in her book Doing Harm, this ignorance also interacts perniciously with historical stereotypes.

When women’s understudied symptoms don’t match the textbooks, doctors label them “medically unexplained”. These symptoms may then be classified as psychological rather than physical in origin. The fact that so many of women’s symptoms are “medically unexplained” reinforces the stereotype that women’s symptoms are overreactions without a medical basis, and casts doubt over all women’s narratives of their own experiences. One study found that while men who have irritable bowel syndrome are more likely to receive scans, women tend to be offered tranquilisers and lifestyle advice. In response to her pain and fatigue, my friend Chris was told she should get some sleep.

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The doctor who finally ordered the right tests for Chris told her that he’d seen many young women in his practice whose diagnoses had been . . .

Continue reading. There’s much more, and it’s infuriating. It seems to have its roots in that a disproportionately large number of medical doctors and researchers are white men, an unknown number of whom are misogynistic and/or racist. I think an interesting study would be to take a large randomized sample of medical practitioners and researchers and administer a psychological test to determine the degree to which each is misogynistic or racist. I’m also wondering whether medical schools reinforce or combat those attitudes, or instead just ignore the problem. (I suspect they ignore the problem.)

UPDATE: After sleeping on it, I see that this as an institutional and systemic failure, not just the failure of individual doctors (though they are, of course, a part of the system). But the systemic/institutional aspects make the problem deep-rooted and will require a systemic and institutional effort to correct.

Middle-Eastern Greens today: Spinach with things from the deli visits

Middle-Eastern Spinach after cooking

It was time to cook a new batch of Greens, and today those greens are spinach. I used the 4-qt stainless sauté pan.

• 1.5 tablespoons extra-virgin olive oil, drizzled over bottom of pan
• 1 large red onion, chopped
• 1 good pinch Diamond Crystal kosher salt
• about 1 teaspoon crushed red pepper
• 1 large head Russian red garlic, cloves peeled, chopped, and allowed to rest 15 minutes
• 4 enormous domestic white mushrooms chopped
• 2 300g packages frozen chopped spinach
• about 1 quart fresh spinach, chopped (from Costco run, left over after making salad)
• 3 spicy preserved lemons, cut into eighths (from the deli trip)
• 2 roasted red peppers, chopped (I have a jar of them from the deli trip)
• splash of brine from the jar of lemons
• splash of Bragg’s apple-cider vinegar
• splash of Red Boat fish sauce

I sautéed onions with the salt and crushed red pepper until onions softened, then added garlic and mushrooms and continued to cook, stirring fairly often, until mushrooms released their liquid.

I then added the rest of the ingredients and cooked covered at 225ºF for 25-30 minutes, stirring from time to time.

The Last Time Always Happens Now

David at Raptitude generally has a good thought to share, and I was struck by this one:

William Irvine, an author and philosophy professor I’m a big fan of, often tries to point people towards a little-discussed fact of human life:

You always know when you’re doing something for the first time, and you almost never know when you’re doing something for the last time.

There was, or will be, a last time for everything you do, from climbing a tree to changing a diaper, and living with a practiced awareness of that fact can make even the most routine day feel like it’s bursting with blessings. Of all the lasting takeaways from my periodic dives into Stoicism, this is the one that has enhanced my life the most. I’ve touched on it before in my Stoicism experiment log and in a Patreon post, and I intend to write about it many more times in the future (but who can say?)

To explain why someone might want to start thinking seriously about last times, Bill Irvine asks us to imagine a rare but relatable event: going to your favorite restaurant one last time, knowing it’s about to close up for good.

Predictably, dining on this last-ever night makes for a much richer experience than almost all the other times you’ve eaten at that restaurant, but it’s not because the food, decor, or service is any different than usual. It’s better because you know it’s the last time, so you’re apt to savor everything you can about it, right down to the worn menus and tacky napkin rings. You’re unlikely to let any mistakes or imperfections bother you, and in fact you might find them endearing.

It becomes clearer than ever, in other words, how great it was while it lasted, and how little the petty stuff mattered. On that last dinner, you can set aside minor issues with ease, and appreciate even the most mundane details. Anything else would seem foolish, because you’re here now, and this is it. It might even occur to you that there’s no reason you couldn’t have enjoyed it this much every time you dined here – except that all the other times, you knew there would be more times, so you didn’t have to be so intentional about appreciating it.

That’s an exceptionally rare situation though. Almost always, we do things for the last time without knowing it’s the last time. There was a last time – on an actual calendar date – when you drew a picture with crayons purely for your own pleasure. A last time you excitedly popped a Blockbuster rental into your VCR. A last time you played fetch with a certain dog. Whenever the last time happened, it was “now” at the time.

You’ve certainly heard the heart-wrenching insight that there’s always a last time a parent picks up their child. By a certain age the child is too big, which means there’s always an ordinary day when the parent picks up and puts down their child as they have a thousand times before, with no awareness that it was the last time they would do it.

Ultimately there will be as many last times as there were first times. There will be last time you do laundry. A last time you eat pie. A last time you visit a favorite neighborhood, city, or country. For every single friend you’ve ever had, there will be a last time you talk, or maybe there already has been.

For ninety-nine percent of these last times, you will have no idea that that’s what it is. It will seem like another of the many middle times, with a lot more to come. If you knew it was the last-ever time you spoke to a certain person or did a certain activity, you’d probably make a point of appreciating it, like a planned last visit to Salvatore’s Pizzeria. You wouldn’t spend it thinking about something else, or let minor annoyances spoil it.

Many last times are still a long way in the future, of course. The trouble is you don’t know which ones.

The solution, Irvine suggests, is to frequently imagine that this is the last time, even when it’s probably not. A few times a day, whatever you’re doing, you assume you’re doing that thing for the last time. There will be a last time you sip coffee, like you’re doing now. What if this sip was it? There will be a last time you walk into the office and say hi to Sally. If this was it, you might be a little more genuine, a little more present.

The point isn’t to make life into a series of desperate goodbyes. You can go ahead and do the thing more or less normally. You might find, though, that when you frame it as a potential last time, you pay more attention to it, and you appreciate it for what it is in a way you normally don’t. It turns out that ordinary days are full of experiences you expect will keep happening forever, and of course none of them will.

It doesn’t matter if the activity is something you particularly love doing. Walking into a 7-11 or weeding the garden is just as worthy of last-time practice as hugging a loved one. Even stapling the corner of some pages together can generate a sense of appreciation, if you saw it as your final act of stapling in a life that’s contained a surprising amount of stapling.

Irvine uses . . .

Continue reading. There’s more.

The on-going effort to overthrow the United States government

Heather Cox Richardson summarizes the situation:

On Monday, we learned that after last year’s election, John Eastman, a well-connected lawyer advising former president Donald Trump, outlined a six-point plan to overturn the outcome of the election and install Trump as America’s leader. They planned to cut the voters’ actual choice, Democrat Joe Biden, out of power: as Trump advisor Steve Bannon put it, they planned to “kill the Biden presidency in the crib.” This appears to have been the plan that Trump and his loyalists tried to execute on January 6.

That is, we now have written proof of an attempt to destroy our democracy and replace it with an autocracy.

This was not some crazy plot of some obscure dude in a shack in the mountains; this was a plan of the president of the United States of America, and it came perilously close to succeeding. The president of the United States tried to overturn the results of an election—the centerpiece of our democracy—and install himself into power illegitimately.

If this is not a hair-on-fire, screaming emergency, what is?

And yet, Republican lawmakers, with the notable exceptions of Representatives Liz Cheney (R-WY) and Adam Kinzinger (R-IL), have largely remained silent about the fact that the head of their party tried to destroy our democracy.

The best spin on their silence is that in refusing to defend the former president while also keeping quiet enough that they do not antagonize the voters in his base, they are choosing their own power over the protection of our country.

The other option is that the leaders of the Republican Party have embraced authoritarianism, and their once-grand party—the party of Abraham Lincoln, the party that saved the United States in the 1860s, the party that removed racial enslavement from our fundamental law—has become an existential threat to our nation.

Democracy requires at least two healthy parties capable of running a government in order to provide oversight for those currently in control of the government and to channel opposition into peaceful attempts to change the country’s path rather than into revolution. But Republicans appear to believe that any Democratic government is illegitimate, insisting that Democrats’ calls for business regulation, a basic social safety net, and infrastructure investment are “socialism” that will destroy the country.

With Democrats in charge of the federal government, Republicans are cementing their power in the states to support a future coup like the one Eastman described. Using “audits” of the 2020 elections, notably in Arizona but now also in Pennsylvania and Texas, Trump loyalists have convinced their supporters to distrust elections, softening the ground to overturn them in the future. According to a new poll by NORC at the University of Chicago, 26% of Americans now believe that “[t]he 2020 election was stolen from Donald Trump and Joe Biden is an illegitimate president,” and 8% believe that “[u]se of force is justified to restore Donald Trump to the presidency.”

Arguing that they have to stop the voter fraud they have falsely claimed threw the election to Biden, Republican lawmakers in 18 states have passed more than 30 laws to cut down Democratic voting and cement their own rule. Trump supporters have threatened election workers, prompting them to quit, and have harassed school board members and local officials, driving them from office.

Although attorneys general are charged with nonpartisan enforcement of the law, we learned earlier this month that in September 2020, 32 staff members of Republican attorneys general met in Atlanta, where they participated in “war games” to figure out what to do should Trump not be reelected. The summit was organized by the Rule of Law Defense Fund, the fundraising arm of the Republican Attorneys General Association (RAGA), which sent out robocalls on January 5 urging recipients to march to the Capitol the following day “to stop the steal.” In May, RAGA elevated the man responsible for those robocalls to the position of executive director, prompting others to leave.

In states where Republicans have rigged election mechanics, party members need to worry about primary challengers from the right, rather than Democratic opponents. So they are purging from the party all but Trump loyalists, especially as the former president is backing challengers against those who voted in favor of his impeachment in the House in January 2021. Last week, one of those people, Representative Anthony Gonzalez (R-OH), announced he was retiring, in part because of right-wing threats against his family. 

Trump loyalists are openly embracing the language of authoritarianism. In Texas, Abbott is now facing a primary challenger who today tweeted: “Texans deserve a strong and robust leader committed to fighting with them against the radical Left. They deserve a leader like Brazil has in Jair Bolsonaro…..” Bolsonaro, a right-wing leader whose approval rating in late August was 23%, is threatening to stay in power in Brazil against the wishes of its people. He claims that the country’s elections are fraudulent and that “[e]ither we’ll have clean elections, or we won’t have elections.”

Representative Marjorie Taylor Greene (R-GA) today used language fascists have used in the past to stoke hatred of their political opponents, tweeting that “ALL House Democrats are evil and will kill unborn babies all the way up to birth and then celebrate.” Yesterday, the leader of Turning Points U.S.A., Charlie Kirk, brought the movement’s white nationalism into the open when he told a YouTube audience that Democrats were backing “an invasion of the country” to bring in “voters that they want and that they like” and to work toward “diminishing and decreasing white demographics in America.” He called for listeners to “[d]eputize a citizen force, put them on the border, give them handcuffs, get it done.”

Today, we learned that the 2022 Conservative Political Action Conference (CPAC) will be held in Budapest, Hungary, where leader Viktor Orbán, whom Fox News Channel personality Tucker Carlson has openly admired, is dismantling democracy and eroding civil rights. When former vice president Mike Pence spoke in Budapest earlier this week at a forum denouncing immigration and urging traditional social values, he told the audience he hoped that the U.S. Supreme Court would soon outlaw abortion thanks to the three justices Trump put on the court.

Establishment Republicans who are now out of power are . . .

Continue reading. The US is swirling the drain and most politicians are simply watching.

Solstice and Edwin Jagger

I would have used this on the Equinox if I had remembered. I do love this fragrance, and this Kokum Butter formula from Phoenix Artisan is very nice. The PA Green Ray brush is a favorite, for both appearance and performance, and the lather this morning was excellent.

This Ediwn Jagger head rides on a stainless steel handle, and the more I use the EJ head, the more I must recognize its excellence: extremely comfortable but withal highly effective.  Three passes left my face as smooth as it’s been after any shave this week.

A good splash of Solstice aftershave, and the weekend is launched.