Author: Andrew Sullivan

A gay physician writes in:

Your reader estimates that under new FDA rules there might be two additional cases of HIV infection each year – and then concludes that this “unacceptable.” But where was the calculation of how many lives might be saved because of the new available blood? An entire side of the equation is missing.

Almost every decision in medicine involves judging risks versus benefits. Your reader appears to feel that for blood transfusions, our overriding principle must be that the “risk of giving a patient contaminated blood is as low as humanly possible.”  That would make sense if every hospital in the country was replete with usable donated blood.  However, last time I checked, the Red Cross was describing an “urgent need” for more donations.

A vivid recollection from my intern year: a middle-aged man with cirrhosis in the intensive care unit suddenly ex-sanguinating from his GI tract at two o’clock in the morning.  He likely would have died without massive blood transfusions. In that moment, the benefit of having available blood clearly outweighed any minuscule risk of contracting HIV.

Another expert weighs in:

I have written about biomedical research and policy for more than two decades. Even accepting that your writer’s assumptions and math are correct, what the comment lacks is a context.

Blood transfusion, like life, does carry risk. The FDA reports that 65 people died from blood transfusions in 2013. Often human error is a significant factor in those deaths. About 2-3 HIV infections occur each year in the US through blood transfusions, and that might increase by 1-2 if the policy is changed. But other serious and often fatal infections – sepsis, Hepatitis B, Hepatitis C, West Nile Virus – also are transmitted through transfusion, and at significantly higher rates. More about that issue here.

Additionally, a true risk/benefit calculation would have to factor in the impact of not having blood, particularly rare types, available for trauma victims and surgery. While the cost may be small, as with HIV transmission, it does exist. The discriminatory policy has negatively affected the ability to collect blood on college campuses. A growing body of research points to “young” blood as being more beneficial than that of an older person.

The experts who deal with transfusion medicine on a daily basis have studied these issues for many years and have concluded that lifting the gay blood ban is more cost-effective to society than keeping it in place. I trust their judgment more than I do that of some reader who cherry-picks issues and makes back-of-the-envelope calculations.

Another piles on:

Your reader argues that two additional deaths per year “simply for going to the hospital” is an unacceptably high risk.  He might be alarmed to know that, according to CDC estimates,  1 in 25 patients who simply walk into a hospital will contract an infection during the course of their stay, adding up to 722,000 infections in 2011.  About 75,000 patients with such health care associated infections die while in the hospital, although the presumably some of the patients might have died anyway.  Perhaps we should ban hospitals?  Or perhaps we should weigh benefits in addition to risks.

And another:

The math this reader laid out completely ignores the entire social context of this issue. The problem here is that the guidelines assume there is no way to make distinctions between gay men when it comes to risk of blood-bourne illnesses.  If you start from the presumption that there is no screening technique that could possibly give a more accurate picture than “any gay man who has had any sex in the last year is a potential disease vector,” then sure, that math makes sense.  By the same token, this map notes high incidence of HIV diagnosis (at least 428 per 100,000) among residents of NY, CT, NJ, DE, MD, DC, FL, SC, GA, and LA.  That’s almost a quarter of the US population.  In the absence of a ban on the residents of these states giving blood, we can assume (by the same very rough math used by that reader) that about 0.1% of donated blood is HIV positive.  The reason we don’t ban entire states from donating blood is that there are very simple questions we can ask that are only tangentially related to their place of residence which much more efficiently assess risk.

One more reader zooms out:

I think that one of the really wonderful things about the gay rights movement at this point in time is that the world is sort of opening up so quickly that everyone can be somewhat patient, and have faith in the progress to come.  It’s not necessary to dig in, and it’s easier not to get angry.  Your debate about the FDA guidelines is a great example.  If there is a bias in the blood donation policy, we can sort of unpack it and think about it clearly. I think it’s a pretty unusual place to be in a struggle for civil rights.

Selma, the new MLK film, has been criticized for its inaccurate depiction of LBJ. Last week, Yglesias defended the movie:

Both a Politico article by LBJ Library Director Mark Updegrove and a Washington Post article by former senior Johnson aide Joseph Califano charge the movie with serious historical inaccuracies. Like any biopic, Selma does condense and somewhat depart from the actual historical record. But Califano’s charge that the movie “should be ruled out this Christmas and during the ensuing awards season” goes well beyond standard-issue nitpicking.

But when you read these pieces closely, it seems that the big problem they have with the film is that it doesn’t cast LBJ as the hero of the Voting Rights Act. But the fact that Selma doesn’t do this is part of what makes it important. Hollywood too often gives us films about race in America where the real heroes are conveniently white. Selma doesn’t.

Bouie argues along the same lines:

[I]t’s wrong to treat nonfiction films—even biopics—as documentaries. Instead, it’s better to look at deviations from established history or known facts as creative choices—license in pursuit of art. As viewers, we should be less concerned with fact-checking and more interested in understanding the choices. …

Selma, simply put, is about the men and women who fought to put voting rights on the national agenda, and it engages history from their perspective. By hardening Johnson—and making him a larger roadblock than he was—DuVernay emphasizes the grass roots of the movement and the particular struggles of King and his allies. In the long argument of who matters most—activists or politicians—[filmmaker Ava] DuVernay falls on the side of the former, showing how citizens can expand the realm of the possible and give politicians the push—and the room—they need to act.

Ann Hornaday joins the debate:

The correct question isn’t what “Selma” “gets wrong” about Johnson or King or the civil rights movement, but whether we are sophisticated enough as viewers and thinkers to hold two ideas at once: that we’re not watching history, but a work of art that was inspired and animated by history. That we’re having an emotional and aesthetic experience, not a didactic one. That the literalistic critiques of historians and witnesses can co-exist — fractiously, but ultimately usefully — with the kind of inspiration, beauty and transformative power that the very best cinema such as “Selma” can provide.

But Josh Zeitz finds the film wanting:

[F]or a film about a pivotal moment in MLK’s life, it obscures too much of King’s political and personal genius. The events at Selma stood at the juncture of every theological and practical dilemma that King grappled with in his public career: The limits and utility of nonviolence. The balance between civil disobedience and civil society. How an activist stays politically relevant. Selma skims the surface of these questions, but it never gets to the core.

Gary May calls Selma “a flawed film”. However:

DuVernay has partly succeeded in presenting a more human King, warts and all. But ironically, this only increases King’s stature, making us admire him all the more for overcoming the political and personal problems that would have defeated a lesser man. Selma becomes a biopic in which the hero shines while those who worked beside him are overlooked or relegated to the sidelines. This is especially important because, as King often said, the essence of the civil rights movement was not one man’s actions but collective action, the work and sacrifice of many.

Prospero found it “hard to watch the film without thinking not just of the lead-up to the 1965 Voting Rights Act, but also of the unrest that followed recent fatal police actions in Ferguson, Missouri, and New York City.” National Review editor Rich Lowry rejects that comparison:

The protesters who faced off against the police in Selma didn’t shout abuse, although they would have been amply justified; they didn’t burn down local businesses; they didn’t randomly fire guns, or throw rocks or stones. The difference between demonstrators in Selma and Ferguson is the difference between dignity under enormous pressure in a righteous cause and heedless self-indulgence in the service of a smear (that Officer Darren Wilson shot Michael Brown as he surrendered).

Weigel puts Lowry’s criticisms in historical context:

This is a risky subject for National Review. William F. Buckley, the magazine’s founding editor, did not respond to the Selma marches by calling for universal voter rights. He wondered if immediately giving the vote to all black Alabamans would lead to racist vengeance, and cited Egypt, Ghana, and Algeria as despotisms “life for the dissenter is far worse than life for the Negro in Selma, if only because he has hope.” He also asked whether, if universal suffrage wasn’t possible, it made more sense to limit the franchise by education instead of race—to people with high school diplomas, possibly. …

From the vantage point of 2015, Selma looks like “as clear a conflict between right and wrong as we get” and a “righteous cause.” In the spring of 1965, it wasn’t so clear to everyone. Selma doesn’t do much with the doubters, though; it portrays the violence against the marchers as so heinous that it serves the Southern Christian Leadership Conference’s purpose in pushing the Voting Rights Act to the front of the national agenda. Critics of the march, such as Governor George Wallace, are shown to be obviously, humiliatingly defeated.

That’s the history everyone has come to prefer, even the people arguing that no current “civil rights” cause should be compared to Selma.

Not of the fist variety – though there are probably a lot of those going around:

Sam Wang measures it:

Since mid-December, President Obama’s net approve/disapprove numbers have shot up. This graph shows the median of the last 21 days of polling. The current level, a net disapproval of only 2%, reflects six pollsters (Gallup, Rasmussen, CNN, ARG, YouGov/Economist, and ABC/Post). These are his highest numbers since early 2013. What is going on?

He connects this uptick to Obama’s “newfound liberation from the pressures of the election cycle”

I’ll get out on a limb with a speculation: If this “real Obama” uptick lasts, it might demonstrate a benefit to Democrats if they act, with vigor, like Democrats. With a newly invigorated President and a Congress in full opposition, the coming year will be worth watching.

Meanwhile, Philip Bump notes that, “with the exception of a spike around the 2012 elections, President Obama’s approval rating has been unusually steady”:

If you look at the distribution of the most common approval ratings for presidents since Nixon (skipping Ford), you get a pattern that looks like this. The darker the bar, the more common that particular approval rating.

You’ll notice that the overall range of approvals for Obama has fallen in a fairly tight range — comparable to Presidents Reagan and Clinton. But that’s the total range. The most common approvals Obama has seen have been within a relatively narrow zone in the mid-40s.

He attributes this to consistent Republican disapproval:

By the end of his first year, Obama’s approval among Republicans had fallen to 16 percent; it’s rarely been above that since, settling into a general 7-15-point range. The fluctuations, then, have mostly been the result of Democrats embracing or ignoring the president — and independents getting more or less enthusiastic.

More than five thousand readers have voted and the results are in. This year’s Malkin Award, given for noxious, divisive and hyperbolic commentary from the right, goes to Dinesh D’Souza offering his intemperate worst on the legacy of American slavery:

Did America owe something to the slaves whose labor had been stolen? I think so, but that debt is best discharged through memory, because the slaves are dead and their descendants are better off as a consequence of their ancestors being hauled from Africa to America.

And when it comes to the year’s best window views, this shot from Eilean Donan, Scotland took top honors:

2014’s Yglesias Award, given for criticizing one’s own side and thus risking something for the sake of saying what one believes, goes to Charles Krauthammer for his statement on the notorious rancher and conservative cause célèbre Cliven Bundy:

It isn’t enough to say I don’t agree with what he said. This is a despicable statement. It’s not the statement, you have to disassociate yourself entirely from the man. It’s not like the words exist here and the man exists here. And why conservatives, or some conservatives end up in bed with people who, you know, he makes an anti-government statement, he takes an anti-government stand, he wears a nice big hat and he rides a horse, and all of a sudden he is a champion of democracy …

Look, do I have the right to go in to graze sheep in Central Park? I think not. You have to have some respect for the federal government, some respect for our system. And to say you don’t and you don’t recognize it and that makes you a conservative hero, to me, is completely contradictory, and rather appalling. And he has now proved it.

Camels can graze wherever they want if they keep stealing selfies like 2014’s Face Of The Year:

For the first-ever Beard Of The Year competition, this magnificent piece of work won in a landslide:

Meanwhile, Susan Elizabeth Shepard and Charlotte Shane have been crowned the year’s biggest poseurs for this pretentious mess:

69 confronts us with an unfortunate truth: it is a distinctly capitalistic, efficiency-emphasizing endeavor that erases the unique personhood of each participant by relying on a crude approximation of how human bodies fit together if human bodies are conceived of as identical, two-dimensional figures like the numbers of its name. … The position also echoes the service economy in its demand (mainly on women) of a convincing performance of pleasure. It’s not enough to simply be present and to competently do the job that’s asked of you by your lover, you must also appear to simultaneously enjoy said lover’s ministrations, regardless of the delicate balancing requiring to keep from suffocating him or breaking his nose. This is a form of emotional labor like that demanded from baristas, servers, and sex workers; not only do you have to do a good job, you have to like it.

Cattle weren’t the only ones to show up in support of 2014’s Mental Health Break Of The Year:

But a stoned Maureen Dowd might have considered that video a viral nightmare. She wins 2014’s top Hathos honors for her novel summary of what it was like to take too many edibles:

Then I felt a scary shudder go through my body and brain. I barely made it from the desk to the bed, where I lay curled up in a hallucinatory state for the next eight hours. I was thirsty but couldn’t move to get water. Or even turn off the lights. I was panting and paranoid, sure that when the room-service waiter knocked and I didn’t answer, he’d call the police and have me arrested for being unable to handle my candy. I strained to remember where I was or even what I was wearing, touching my green corduroy jeans and staring at the exposed-brick wall. As my paranoia deepened, I became convinced that I had died and no one was telling me. And then I wrote a column on Hillary.

According to the polls, more than 30% of you thought this powerful New Zealand PSA was the year’s Coolest Ad:

And Pavlina Tcherneva’s bar graph tracking America’s income growth disparity is the Chart Of The Year:

Finally, we also added maps to this year’s awards, and Dishheads chose Nik Freeman’s overview of where Americans don’t live as 2014’s best:

Thanks to everyone who took the time to channel their Dishness and vote. For our newer readers, you can find out more about how and why we nominate award candidates here. To recommend a new nominee, email us here.

It’s highly variable:

High-end gyms catering to individuals with intensity and ample disposable incomes are proliferating, particularly in urban markets. The infamous and fast-growing SoulCycle costs an eye-watering $34 a class. (If you buy a 30 pack, it works out to just $28.33.) Work out four times a week for a year, you’re facing a nearly $6,000 tab. Going to CrossFit looks cheap in comparison, at about $2,500 a year in Manhattan. Ditto for all those boxing gyms, Pilates and barre studios, and outfits offering massages and juice bars.

But amenity-lite, low-end gyms catering to budget consumers are proliferating too.

For the same price as a single one-off SoulCycle class, you could work out for a month and a half at a Blink Fitness outlet or for three whole months at the Planet Fitness in Brooklyn. “From 2010 to 2014, many small, low-cost gyms with few amenities and month-by-month contracts have fared well,” said an industry report by IBISWorld. “Poor economic conditions, coupled with many consumers continuing to be budget conscious over the period, have caused new trends to emerge.”

It is the middle that is growing more slowly, with some chains struggling to demonstrate their value to consumers — your Bally Total Fitness, now all but defunct, or Curves. It is the gyms with considerable but not intolerable monthly fees and decent amenities, but no sheen of luxury or promise of extraordinary results.