Author: Andrew Sullivan

Otherwise known as Extracorporeal Membrane Oxygenation. Daniela Lamas investigates the fortunes of the medical process that “siphons blood out of the body and runs it through a machine that temporarily assumes the lung’s work—oxygen in, carbon dioxide out—and gives the injured lung time to heal,” avoiding the problems associated with respirators. The backstory:

Building on the principles of the heart-lung bypass machine used in cardiac surgeries, the first ECMO machines for lung failure came about in the nineteen-seventies. In an early, publicized case, a young man in California was dying after having injured his lung severely. His doctors put him on ECMO—the machine was the size of a car—for three days. He survived and his story was published in the New England Journal of Medicine, in 1972. The ensuing enthusiasm led to a medical trial in the seventies with the goal to test whether patients with lung failure did better with ECMO or with a respirator alone. In both groups, more than ninety per cent of patients died. The excitement about ECMO for adults with lung failure “fell back to earth,” Daniel Brodie, who directs the medical ECMO program at Columbia University Medical Center, told me.

But lately there’s been an ECMO “revival” – aided by much improved technology – and it began with a butt augmentation gone awry:

In the fall of 2008, a twenty-seven-year-old woman was admitted to the Allen Hospital after receiving silicone injections to enhance her buttocks. The silicone had leaked into her vessels and travelled to her lungs, causing massive bleeding. Even with a respirator at its highest settings forcing air into her lungs, she was, literally, drowning in her own blood. The doctor caring for the young woman called Brodie, who suggested ECMO. “By all accounts, she was surely going to die. We felt we had nothing to lose by trying, and everything to gain,” Brodie said. She survived. “When it worked, even we were a bit surprised. That one case may not have changed a lot of minds, but it certainly opened them up to the ever-so-faint possibility this wasn’t crazy.”

Then, in 2009, the H1N1 virus swept the globe and left some previously healthy people with severely injured lungs—a condition called acute-respiratory-distress syndrome. For patients whose oxygen levels still teetered despite the highest settings on the respirator, doctors started turning to ECMO. In the same year, a smaller ECMO apparatus that could get patients up and walking—older versions required patients to remain supine and sedated—won approval from the Food and Drug Administration. The coincidental timing—a new pandemic, a new machine—“opened the floodgates,” said Jose Garcia, a cardiac surgeon at Massachusetts General Hospital. “We’re redefining death, to the point that somebody we thought for sure was dead two or three years ago, well, they’re not dead anymore.”

World War I began 100 years ago this month. Beinart marks the anniversary by remembering how the war spurred a major crackdown on civil liberties. He uses that history to consider how war changes the national psyche:

The problem is that the unity war breeds come at the expense of those Americans who become associated—either because of their political views or their religion, race or ethnicity—with the enemy. To avoid becoming targets of the fanatical patriotism that World War I sparked, many German Americans changed their last names. Unable to so easily conceal their ancestry, Japanese Americans during World War II were interned. For many Muslim Americans, 9/12 and the days that followed were marked not by fidelity to the “the values and principles of the greatest nation ever created” but by the government’s violation of those principles, as it surveilled and harassed vast numbers of Muslims purely because of their religion or country of origin. Since then, America’s invasion of two majority Muslim countries has fueled the paranoia that has led national politicians to warn that Sharia law is infecting the United States and local bigots to challenge the building of mosques.

As [progressive philosopher John] Dewey foresaw, wars do empower the state, a power that, in theory, could be used to redress social ills. But in the real world, argued Dewey’s protégé-turned-accuser Randolph Bourne, using war powers to achieve domestic reform is like using a firehose to fill a water glass. “War,” wrote Bourne, “is just that absolute situation … which speedily outstrips the power of intelligent and creative control.”

In another meditation on WWI, John M. Cooper insists that Wilson was right to send the US into WWI:

Wilson’s failure to educate the public about his design for peace and his permissiveness toward repression of civil liberties deservedly remain blots on his historical reputation.  But his greatest failings, particularly in shaping the peace settlement and in bringing the United States into a collective security system, stemmed from bad luck. His worst misfortune came when he suffered a massive stroke just after a belated and foreshortened speaking tour to sell the public on the League of Nations.  It left him a broken man, whose impaired judgment turned him into a major element in the spiteful stalemate that kept the America out of the League of Nations.

Would things have been different if Wilson had not decided to go to war in 1917? Yes, because Germany would almost certainly have won by the end of that year. Military disasters in Russia and Italy, grievous shipping losses inflicted by the submarines, and an untenable financial situation (the British had run out of credit in the U.S. to sustain their massive war orders), and no prospect of American troops eventually coming to their rescue—all these added up to a recipe for Allied defeat. Europe dominated by a victorious Germany would almost certainly have been more benign than the Nazi-conquered continent following the Fall of France in 1940. But how much more benign? The settlement imposed on the Bolsheviks at Brest-Litovsk in 1918 leaves the question open. Likewise, what impact would such a victory have had on the long march toward the end of colonialism that began with the League of Nations mandate system?

Michael Kazin disagrees with Cooper:

The consequences of the victory won by the U.S. and its allies led, in part, to an even greater tragedy. As Wilson feared, the punitive settlement made in Paris did not last. The president may have won Senate approval for the peace treaty, if he had accepted some of the reservations which Senator Henry Cabot Lodge and his supporters demanded. But American membership in the League of Nations would likely not have stopped the rise of fascism, Nazism, or the Communist International—which, together, sowed the seeds of the Second World War. The terrible irony is that U.S. entry into World War I probably made that next and far bloodier global conflict more likely.

As the historian John Coogan has written, “It was the genius of Woodrow Wilson which recognized that a lasting peace must be ‘a peace without victory.’ It was the tragedy of Woodrow Wilson that his own unneutrality would be a major factor in bringing about the decisive Allied victory that made a healing peace impossible.”

(Photo: Royal Irish Rifles in a communications trench, first day on the Somme, 1916. Via Wikipedia.)

Tomasky argues that it should be paid family leave:

In a nutshell, it’s popular. A survey commissioned in 2012 by a pro-leave group found that respondents supported the idea by 63 to 29 percent. Democrats were of course strongly in favor (85-10), but independents were at a still quite favorable 54-34, and even Republicans weren’t against it—they were evenly split at 47-48.

Far from being hammered by the right over such a proposal, I think Clinton could turn the tables. What percentage of women are going to be against this? In the pro-leave group’s poll, it was just 23 percent.

Of course the U.S. Chamber of Commerce and the Business Roundtable are going to go ape, but here we have facts, and the known facts suggest that in California paid leave has not been the nightmare that businesses feared. One study, by the Center for Economic and Policy Research, found that 89 percent of participating businesses reported a positive or no noticeable effect on productivity; 91 percent said the same about profitability and performance; 99 percent said the same about morale. Clinton will be able to find plenty of employers in California, and presumably New Jersey, who will sit in front of a camera for 30 seconds and testify that the law is just fine by them.

Cohn seconds Tomasky:

Of course, polling on an issue that hasn’t gotten much attention isn’t always reliable. Public sentiments could change if the Chamber of Commerce, which would spend heavily to fight such a plan, convinced Americans it would hurt the economy. And I plea totally guilty to political bias on this. I think paid leave is a great idea—an innovation that’s long overdue. But campaigns aren’t just about proposing what works politically. They’re also about laying the groundwork for a governing agenda. And while lots of people are skeptical that Clinton would take such a risk, if indeed she’s the nominee, I’m not. One reason is that she proposed such an initiative in 2007, the last time she ran for president.

Even though Qatar’s 2022 World Cup arenas are being built on the backs of abused South Asian laborers (like everything else there and in other Gulf states), Justin Martin makes a counterintuitive case for letting Qatar keep the Cup:

Without its World Cup and the microscopes it attracts, Qatar would have less pressure over the next decade to improve civil liberties and basic human rights.

And what happens in Qatar doesn’t stay there. Other countries in the region pay close attention to Qatar’s domestic and diplomatic moves. The country is the wealthiest nation in the Arab Gulf and, by many metrics, the world. Doha is the Dubai of yesteryear, albeit with less hedonism, and Qatar has invested more proactively in its country’s education, healthcare, and publicly available research than other Gulf countries. Qatar’s English-language Doha News is one of the most independent and outspoken domestic news organizations in the Arab world. These positives are available for other nations in the region to see partly due to coverage of Qatar’s World Cup preparations. …

Human rights improvements in Qatar are afoot, but the country will not—cannot—become Sweden overnight. I am not saying that postponing civil liberties is ever acceptable, and yes, “justice delayed is justice denied,” but the paradox surrounding the push to relocate the Qatar World Cup is that doing so would both delay and deny the very progress critics claim to support.