I thought the thread was dead, but apparently not. I’m glad, because I want to share my story. I started this email almost three weeks ago with my adopted five-day-old son on my lap, but then I saved it in my drafts folder thinking that I couldn’t write about my miscarriages or the adoption. Now that the 15-day waiting period has ended and our son can no longer be taken back by his birth mother, I’m ready to talk about my experience.
I read the New Yorkermiscarriage piece with horror a few weeks ago because we were anxiously awaiting the birth of our baby. The birth mother is a healthy young woman, and I was pretty sure the baby would turn out OK. What I wasn’t so sure about was whether or not she would change her mind and close the door on our dream.
My husband and I experienced our first miscarriage in fall of 2004. My last, the twelfth, occurred in January 2012.
U.S. Speaker of the House John Boehner (R-OH) answers questions during a press conference in Washington, DC on December 12, 2013. When asked if he would press ultra-conservative groups to tone down their criticism of a pending budget deal, Boehner said, “I don’t care what they do.” By Win McNamee/Getty Images.
Reviving the thread, a reader sighs, ”I should have set a timer for how long it would take a physician to tell me my weight will kill me”:
My original letter prompted this predictable response:
As a physician I am dismayed by one of your readers’ quotes: “I am healthy despite my weight.” That’s the equivalent of saying I’m healthy despite my heart disease or I’m healthy despite my colon cancer.
It is that global belief, which is quickly being undermined by research, that puts doctors outside the reality of the lives of their patients. Recent studies have shown that in the absence of heart disease, diabetes, high blood pressure or other chronic illnesses that can correlate with obesity, but do not always, obesity itself may not be the risk it is assumed to be. The blunt instrument of weight, or the specious BMI, as an absolute indicator of health does not square with the actual experience of many people. The prescription to lose weight – a “losing” proposition in the long run for most people – does not recognize the reality that doing as prescribed – eating healthily and exercising regularly – doesn’t always result in weight loss, but it may result in health.
Another is more blunt:
By insisting on continually recommending weight loss to their fat patients instead of emphasizing healthy habits for all, doctors like your reader do real harm.
Earlier this week, Sy Hersh’s questioned whether Assad launched the Syrian chemical weapons attack. Eliot Higgins pushes back:
Hersh … discusses the possibility that the sarin was produced by Jabhat al-Nusra, the al Qaeda-affiliated group that’s fighting Assad. I asked chemical weapons specialist Dan Kaszeta for his opinion on that. He compared the possibility of Jabhat al-Nusra using chemical weapons to another terrorist attack involving sarin: the 1996 gassing of the Tokyo subway by the Aum Shinrikyo cult.
“The 1994 to 1996 Japanese experience tells us that even a very large and sophisticated effort comprising many millions of dollars, a dedicated large facility, and a lot of skilled labor results only in liters of sarin, not tons,” Kaszeta said. “Even if the Aug. 21 attack is limited to the eight Volcano rockets that we seem to be talking about, we’re looking at an industrial effort two orders of magnitude larger than the Aum Shinrikyo effort. This is a nontrivial and very costly undertaking, and I highly doubt whether any of the possible nonstate actors involved here have the factory to have produced it. Where is this factory? Where is the waste stream? Where are the dozens of skilled people — not just one al Qaeda member — needed to produce this amount of material?”
Matthew O’Brien wishes Congress would deal with long-term unemployment:
It’s been over four years since the recovery officially began, but it still feels like a recession to most people. Maybe that’s because with three unemployed people for every job opening, things are still as bad as they ever got last recession. Not that Washington has paid much attention the past few years. It’s been too preoccupied with short-term deficits to care about long-term unemployment. That was obvious when a Congressional hearing in April about people out of work for six months or more drew all of … one senator at the start. And it is even more obvious now with the latest budget deal.
People derive so much of their identity and of their moral core from being able to work. It’s how people provide for their families, express creativity, gives you a sense of purpose. There are all these moral and spiritual and psychological benefits to working. So if you want to ask how society is doing broadly, certainly the economics are important, but more important is whether this society is functioning in a way that people can live the fullest life possible and can maximize their potential. And right now, for these 4 million folks, we’re failing.
Fresh off a Nobel win, biologist Randy Schekman launches a high-profile boycott of the most prestigious academic journals, including Science, Nature, andCell:
While they publish many outstanding papers, they do not publish only outstanding papers. Neither are they the only publishers of outstanding research. These journals aggressively curate their brands, in ways more conducive to selling subscriptions than to stimulating the most important research. Like fashion designers who create limited-edition handbags or suits, they know scarcity stokes demand, so they artificially restrict the number of papers they accept.
A paper can become highly cited because it is good science – or because it is eye-catching, provocative or wrong. Luxury-journal editors know this, so they accept papers that will make waves because they explore sexy subjects or make challenging claims. This influences the science that scientists do. It builds bubbles in fashionable fields where researchers can make the bold claims these journals want, while discouraging other important work, such as replication studies. In extreme cases, the lure of the luxury journal can encourage the cutting of corners, and contribute to the escalating number of papers that are retracted as flawed or fraudulent.
Any scientist will tell you that Nature and Science publish a lot of excellent work. And Dr. Schekman is perhaps not the most disinterested observer: as he mentions in the article, he is the editor of eLife, an “open-access” journal (that is, one that does not charge readers) with ambitions to rival the top dogs. But working researchers will also tell you, perhaps after a few drinks, that Dr. Schekman is far from alone in thinking that the relentless focus on publishing in “high-impact” journals causes big distortions in how science is done. Many are reluctant to speak up, fearful of the damage they might cause to their careers by rocking the boat.
Going a big step further, Michael Eisen, co-founder of the open-access publisher PLOS, would do away with journals entirely:
In today’s video from Doblin, he explains how his own experiences with psychedelic drugs have influenced him and his work:
In a followup, he explains what his family makes of his work as a psychedelic researcher, including a moving story about doing MDMA while visiting his grandmother and a funny story about his daughter’s experience with the DARE program:
McArdle believes that the budget deal is good for the GOP:
[T]actically, I think this is a clear win for the Republican Party. The last thing they need right now is to take the focus off the Patient Protection and Affordable Care Act and revive Obama’s flagging poll numbers with an ill-timed budget battle. Their best shot at a budget they really like is, after all, to retake the Senate in 2014.
Republicans are way over-estimating the extent to which Obamacare will be a liability for Democrats.They assume the problems of the first two months will extend indefinitely into the future—that they’re structural (flawed conceit) rather than mechanical (flawed website)—when the evidencesuggests implementation is improving by the day. By contrast, the state of the economy is typically the biggest driver of the public mood. If the economy is humming along next fall, the Democrats’ prospects (and those of incumbents generally) could look pretty damn good.
If YouTube began as America’s Funniest Home Videos, it has now become Saturday Night Live — including the commercials. The platform’s biggest hits are all produced by professionals.
The change in the way that the most popular YouTube videos are produced parallels the professionalization of blogging that has occurred in the last decade. At one point, many of the most popular blogs were run by single individuals, just because. But media companies responded by creating blogs of their own, or simply hiring bloggers or purchasing blogs. So, after a brief flowering of user-generated online media rivaling the scale and reach of professional online media, we’ve seen a retrenchment of traditional media structures.
(Video: How Animals Eat Their Food by MisterEpicMann, YouTube’s #3 video for the year with over 89 million views.)
[T]op Democratic pollster Stan Greenberg – having just done extensive polling in 86 competitive House districts — is advising Dems they should go on offense over the Affordable Care Act. The key finding: Even though voters in the battlegrounds have extreme doubts about the law, they still prefer implementing it to the GOP stance of repeal. And after a month of crushingly awful press for Obamacare, opinions on this matter in the battlegrounds have barely budged since October.
Going on the offensive would be long overdue and desperately needed. Tomasky predicts that “HealthCare.gov is going to be a net plus for Obama and the Democrats”:
The Ryan-Murray deal will likely pass, despite opposition from the professional conservative movement, because it’s tiny enough to be uncontroversial while helping Republican leaders avert serious internal problems with the budget process. Ryan has given it his blessing, and as one Republican leadership aide puts it, “Paul Ryan is the Jesus of our conference.”
Albert R. Hunt sees the deal hurting Ryan’s chances for the presidency:
Howard Gleckman parses the bill that the House will vote on today. He notes that it “effectively would do nothing to reduce the deficit—the stated goal of many Republicans—or stimulate economic growth—the wish of many Democrats including President Obama”:
However, it would break—temporarily at least– the cycle of fiscal brinksmanship that has largely paralyzed Washington. The constant threat of government shutdowns—and the reality of one last fall—created uncertainty in the business community, made it impossible for the Federal Reserve to begin slowing its bond buying program, and completely disrupted other policymaking. If this deal is accepted, there will be no more shutdowns until at least October, 2015.
[P]erhaps the most stark reminder of how things have changed in Washington over the past few years is to look at the revised spending figure for discretionary spending in fiscal 2014—the one agreed upon by Ryan and Murray, which includes the give-backs from the sequester. It’s $1.012 trillion. (This number doesn’t include mandatory spending on Medicare, Social Security, or interest payments on the national debt.) That’s slightly more than the Republican negotiators wanted. But as Stein and Linden point out in a chart accompanying their analysis, it’s twenty-seven billion dollars less than Ryan proposed in his 2011 budget, which, at the time, was widely agreed to be so draconian it was unrealistic.
Yesterday, as we noted in our FOTD, India’s Supreme Court overturned a ruling legalizing gay sex, leaving it to Parliament to decide on the issue. Sonal Bhadoria’s reaction:
The verdict has been shocking on many levels. Firstly, landing a major blow to India’s claim of being a country with a modern outlook, the fact a law made by Britishers in the 1860′s has been upheld in 2013 makes for a strange sentence. Secondly, with many countries now equating gay equality with the rights for same-sex marriage, the Supreme Court ruling puts India back in the company of most nations in the Islamic world and many African countries which criminalise homosexuality. The only country in South Asia where gay sex is now legal is Nepal. “It is highly embarrassing for the country because now we will be among the dirty dozens of the world,” said Narayan, the lawyer from the Alternative Law Forum.
Gwynn Guilford notes that an “obvious factor keeping homosexuality illegal in many of these countries is Islam”:
Take for instance the countries that punish gay sex with death: Mauritania, Sudan, Saudi Arabia, Iran, Yemen, and parts of Nigeria and Somalia. Some—Nigeria, Sudan and Somalia—inherited British colonial anti-gay laws. But they too instituted the death penalty long after independence—most in the last 40 years—in line with Islamic sharia law. Many of the other 76 countries with severe anti-gay laws are also Islamic states.
India, however, isn’t. And before the British invasion, it was much more tolerant of homosexuality. So why would India and so many other ex-colonial countries cling so tightly to the moral whims of Victorian Englishmen that were never their own?
One reason might be that morality codes give governments a way to build a national identity around shared values, often as a foil to permissive Western countries. But a more prosaic one is that anti-gay laws are also a handy way to fortify state control (as is now happening in Russia).
Erik Voeten made the above chart showing that India is now the most gay-friendly country where homosexuality is criminalized:
One concern is, of course, that if international precedents indeed matter, then other courts may use the Indian case as a precedent for their own decisions to preserve criminalization or overturn previous decisions to decriminalize.
TNC defends Mandela’s refusal to denounce necessary bloodshed:
Offered the chance to be free by the avowed white supremacist P.W. Botha if he would renounce violence, Mandela replied, “Let him renounce violence.” Americans should understand this. Violent resistance to tyranny, violent defense of one’s body, is not simply a political strategy in our country, it is taken as a basic human right. Our own revolution was purchased with the blood of 22,000 nascent American dead. Dissenters were tarred and feathered. American independence and American power has never rested on nonviolence, but on the willingness to do great—at times existential—violence.
The first thing that jumps out is that the nine states with the highest enrollment by share of population all run their own exchanges — which, in general, have been working much better than Healthcare.gov, the federally-run exchange. The 14 states running their own exchanges are indicated in red on the graph.
Vermont has, by far, the highest rate of sign ups as a share of its population: 0.8%. It’s followed by Connecticut, Kentucky and California. Because of its large population, California accounts for about 30% of total Obamacare sign-ups, at 107,087. New York, another state running its own exchange, has provided more than 45,000 enrollments.
Nationally, only 0.12% of Americans signed up for private health insurance made available by the Affordable Care Act between Oct. 1 and Nov. 30; that figure must rise to 2.2% for the Obama Administration to reach its goal of 7 million sign-ups by March 31.
[T]here is wide disparity across states — and a lot of that can be traced to HealthCare.gov’s problems. California (107,087) has enrolled almost as many people in private coverage as the 36 states served by the federal site combined. Kentucky (13,145), which built its own site, has enrolled almost as many people as Texas (14,038), which relied on the feds.
Jennifer Kirby explores the motivations and challenges of American would-be parents who seek to conceive using surrogates in foreign countries:
India is one of a few countries, though perhaps the most popularized, where commercial surrogacy is legal. The country emerged as a “hotspot” in part because of lower costs and laws passed in 2002 allowing commercial surrogacy. In the U.S., surrogacy can cost between $80,000 and $150,000, while in India it ranges from $20,000 to $60,000, depending on the types of services and the clinic. That amount rarely includes unforeseen expenses like surrogate hospitalizations, or the basic travel costs such as flight and hotel stay. Yet those “savings can be the difference between being a parent and not being a parent for a lot of people,” says Kathryn Kaycoff Manos, founder of Global IVF, a resource for fertility tourists…
William R. Polk provides an in-depth explanation of the origins of the crisis, connecting it to the food shortages that preceded it:
Four years of devastating drought beginning in 2006 caused at least 800,000 farmers to lose their entire livelihood and about 200,000 simply abandoned their lands, according to the Center for Climate & Security. In some areas, all agriculture ceased. In others, crop failures reached 75 percent. And generally as much as 85 percent of livestock died of thirst or hunger. Hundreds of thousands of Syria’s farmers gave up, abandoned their farms, and fled to the cities and towns in search of almost non-existent jobs and severely short food supplies. Outside observers including UN experts estimated that between 2 and 3 million of Syria’s 10 million rural inhabitants were reduced to “extreme poverty.”
As they flocked into the cities and towns seeking work and food, the “economic” or “climate” refugees immediately found that they had to compete not only with one another for scarce food, water, and jobs, but also with the existing foreign refugee population. Syria was already a refuge for a quarter of a million Palestinians and about 100,000 Iraqis who had fled the war and occupation. Formerly prosperous farmers were lucky to get jobs as hawkers or street sweepers. And in the desperation of the times, hostilities erupted among groups that were competing just to survive…
Reviewing a new biography of chemist and writer Primo Levi, William Giraldi attempts to understand how the man could stoically survive the Holocaust yet ultimately cut his own life short:
Levi had a difficult time fully trusting the chrysalis of civilization after Auschwitz. He was a man of unflinching probity who never succumbed to the cutthroat Hobbesian conception of human striving, or to that toxic strain of bitterness which contaminated and ultimately ended the writer Jean Améry (also a Shoah survivor and suicide). But there is sometimes in Levi’s work the itchy suspicion that the hell could happen again, or that it never really ended. Beneath that unperturbed and almost placid prose creeps a fatalism, a capitulation before the vastitude and depravity of what he named “the demolition of man.” The stupefied silence before this vastitude and depravity is part of why his work remains ever pregnant and never born, because “our language lacks words to express this offense.”
What Levi would never understand was the willing remove of the Germans from their fellow humanity. The ability to look—for years on end—at a human being and see not a person but a thing became and remained for Levi the crime of crimes. Yet for this, he very nearly blamed not the Germans but life itself. After all, if thousands upon thousands of people were capable of not seeing themselves in others, could this capacity be anything other than innate? Life itself, he concluded, was to be pronounced guilty for having made possible such a monstrous divide within the human organism. This pronouncement became the unyielding indictment—enlarged upon many times in books, essays and stories—that made Primo Levi one of the greatest of the Holocaust writers.