Category: The Dish

Charles Pulliam-Moore thinks many bisexual men need to be more open about the difference between their sexual and romantic desires:

Of all of the bi guys I’ve known over the years, the majority of them have been what I would describe as bi-sexual but hetero-amorous. That is to say that while they’d certainly get into some sweaty bro-on-bro action at the frathouse, guys simply couldn’t provide the kind of emotional satisfaction necessary for a romantic relationship.

From what I can tell from a handful of informal conversations my research, it would seem as if the bisexual/hetero-amorous thing is rather common but rarely articulated in those terms. It doesn’t seem to be unique to bisexual men, either. Whether people aren’t differentiating between their carnal interests and emotional needs or simply aren’t considering them as being distinct from one another is unclear. Either way, I think it’s a major source of much of the hostility that bisexual people tend to receive–particularly from gay men. …

Rather than being equally capable of loving and fucking equally I suspect that most bi-identified people find themselves leaning towards one sex/gender vs. the other for different kinds of fulfillment. That in and of itself isn’t a problem. It’s the not telling people that causes issues.

Dan Savage thinks this is spot-on:

I get letters every day from guys who tell me that they’re confused about their sexual identities. They go on to explain that while they enjoy fucking men and women, they only fall in love with women. Sex with men? Great! Relationships with men? No thanks. These guys are bisexual in the bisexual-but-heteroamorous sense. But these guys invariably go on to tell me that they can’t be bisexual—because aren’t bisexuals supposed to be capable of falling in love with men and women equally? Isn’t that what everyone says? Here’s an example:

I’ve been reading your calls to bisexuals to come out to their friends and families, and think it’s a great idea. Here’s my conundrum: I’m not sure I technically classify as a “bisexual.” I’m a 40-year-old guy who strongly prefers sex with women over men (percentage wise I’m 70/30). I’ve had sex with dudes in the past (five or six times), and loved it, though I’ve never had the same emotional attachment and attraction that I’ve had with women. Most people seem to think that bisexuals are equally attracted to both genders—sexually and emotionally—like they could decide by flipping a coin. So what do you think? Am I bisexual, “heteroflexible,” or just a juicy boner hobbyist?

This guy is bisexual, obviously, but heteroamorous. But the most popular definition of bisexuality circulating out there—someone who is equally attracted to both genders—doesn’t cover guys like him.

Check out the Dish’s long-running thread on bisexuality here.

Michael Lipkin attempts to pinpoint the German writer’s guiding philosophy through a reading of his third novel, Elective Affinities:

His great ambition, in his life and in his art, was to take the indefatigable work ethic of the bourgeoisie and apply it not to business, but to life itself, as only an eighteenth-century aristocrat could. [Elective Affinities characters] Eduard and Charlotte don’t bother composing music or writing novels. The object of their artistic aspiration—as their fascination with botany, landscape architecture, and tableaux vivants attests—is reality itself. Considering that by the novel’s end two of the main four characters are dead, it might be persuasively argued that Elective Affinities is a meditation on the vanity of our desire to mold reality to our liking. But no matter how grim the plot, Goethe’s narrators are never shaken in their values. There is no surer sign that we are to admire one of his characters than when we learn that, through tireless labor, they have restored some room or building that has fallen into disuse, or that, by applying their considerable expertise, they have revealed the beauty dormant in a grove of plane trees or a garden path.

The great mystery, then, is that despite its fixation on death, loss, and the inscrutability of fate, Elective Affinities never wavers in its optimism.

At no point does the narrator ever concede his claim to the final truth of life, which he offers to the reader piece by piece, in one brilliant aphorism after another. (To take just one example: Ottilie’s famous observation that no one is more fully a slave than when they believe themselves to be free.) It’s easy to confuse Goethe’s Stoic acceptance of life’s vicissitudes for a lack of feeling. But in his first work to his last, renunciation has always gone hand in hand with emotion—as when Ottilie, in a sign of devotion to Eduard, hands him the portrait of her father she wears around her neck. For Goethe, true happiness is not simply a religious or ethical abstraction, but something palpable and real. Art’s ambition, as Goethe saw it, was to still the rush of the world to reveal those vertiginous instants when all of eternity seems to be gathered into what is nearest at hand, and, no longer ruing the past or fearing the future, we finally feel at peace. The highest feeling in Elective Affinities is not ecstasy, but serenity.

In a review of Adam Begley’s new biography Updike, Hermione Lee describes the essence of the late author’s fiction:

In one of his last stories, “My Father’s Tears,” he quotes from Emerson: “Every natural fact is a symbol of some spiritual fact.” Emerson is there too at the front of Self-Consciousness: “We are persuaded that a thread runs through all things….” And it is the ordinary, banal things that Updike tenderly cherished and made fresh on the page. As he said of himself, and as Begley rightly emphasizes, he is the artist of middleness, ordinariness, in-betweenness, who famously wanted “to give the mundane its beautiful due.” For over half a century—even though his own life moved far away from “middleness”—he transformed everyday America into lavishly eloquent and observant language. This—even more than his virtuoso writing about sex, his close readings of adultery and husbandly guilt, his tracking of American social politics, his philosophizing on time and the universe—is his great signature tune. No wonder that some of the narrators in his stories are archaeologists, or that he’s so interested in vanished cities, ancient civilizations, and extinct species.

In another review of Begley’s book, Louis Menand defends Updike from his critics:

The most persistent and mindlessly recycled criticism of Updike’s work is that he was infatuated with his own style, that he over-described everything to no purpose—that, as several critics put it, he had “nothing to say.” But Updike wasn’t merely showing off with his style. He wasn’t, as all those critics were essentially implying, masturbating. He was transubstantiating.

There was nothing secret about this. He explained what he was up to many times. “The Old Testament God repeatedly says he wants praise, and I translate that to mean that the world wants describing,” he once explained to an interviewer. In the preface to the collected Rabbit novels, “Rabbit Angstrom,” he talks about “the religious faith that a useful truth will be imprinted by a perfect artistic submission.” “The world is the host,” he has a character say in one of his short stories; “it must be chewed.” Writing for Updike was chewing. You can dismiss this conception of the literary vocation as pious or old-fashioned, but, if you do, you are dismissing Joyce and much of literary modernism.

Elon Green asked Begley for his thoughts on Updike since completing the biography:

Did he ever suffer for his art? Was the process really as frictionless as it appeared?

I don’t think he suffered for his art. I think he worked for his art. It depends on how meta you want to get. There was a tragedy about Updike, in some ways, that was also the engine that fueled his work, which is that he lived his life behind a scrim of observation. He was a writer, observing, so whenever he was living he was also observing. And that’s great for the work and not so great for the life. So there are times when he suffers, if you will, from the consciousness that he will never be able to suffer without it being grist for his writerly mill.

Was there anything in Updike’s life that allowed him to turn off the detachment that was necessary for him to live and observe at the same time?

Volleyball, Sunday sports and maybe fucking. Obviously, on some level he observed the carnal act, because he spent a lot of time writing about it, but maybe what he liked so much about the carnal act to begin with was that it was a moment or two of switching off the old impression-gathering device.

Previous Dish on Updike here. The Dish has also featured poetry by Updike here, here, and here.

(Video: Updike offers advice to writers in a 2004 interview)

A reader quotes me reacting to Huyler:

“Blood money?” “Evil act?” I have to say I find that rhetoric appalling.

Wow, Andrew, you really started to move to the right lately. So you think $1,000 versus $10 is not blood money? Basically what you are saying is that it is OK for US to finance this whole drug business because based on all recently published facts we pay the most, double in most cases, than the rest of the world. So we are financing this with huge deficits and 30M+ uninsured who cannot get any of these life-saving drugs. And to you it just requires re-balancing? These prices make no sense.

And many drugs are not invented in the US by “starving” PhDs and CEOs; many come from Europe, and they still cost a whole lot more here. This is not about re-balancing. This is about our healthcare system that stinks and makes no sense. And you seem to defend it.

I wrote back: “I’ve always had this position. I’d be dead without the evil drug companies.” The reader follows up:

I certainly can appreciate the struggle you have been dealing with. I myself suffer from multiple sclerosis, and while MS is not as deadly as HIV, I have been taking three big drugs over the last 12 years and all of them cost at least $25K a year.

And then I look at prices in Europe, and they are half that. And two out of three came from Europe. This is why I strongly believe our healthcare system finances the world and CEOs bonuses, which are not that small. We are the only ones who continue to pay astronomical prices.

Are the companies evil? I did not say it. But what they do to the USA is evil. We basically have Medicare for the rest of the world and pay for the difference. And everyone but regular citizens make money. In return we get high insurance premiums. There is absolutely no relationship between prices here and Europe.

Another reader, who “works in consulting in health economic modeling,” also goes back and forth with me:

You say that Dr. Huyler’s outrage at the $1,000 a day pricetag is unjustified and that this revenue supplies future drug development. While I have mixed feelings on this argument (pharma companies throw out this response every time, I don’t know whether I believe it anymore), I have another question for you: what is a fair price? It’s currently $1,000 a day; what about $2,000? $10,000?

You get my point. Assigning a “fair price” requires assessing the value of the product, which I don’t see in these articles. And I believe this is something the UK health system gets right; the National Institute for Health and Care Excellence (NICE) performs reviews of pharmaceuticals and their potential value. The panels of experts review the data, including how cost-effective the drug is, and arrive at a decision whether to recommend the drug.  The FDA, on the other hand, only considers whether the drug is effective.

And how innovative is Britain’s drug sector? The engine for innovation is in the US private sector. The reader responds to those points:

Are these companies located solely in the US? No, they’re all multi-national. Yes, the original research to find it was done in the US (New Jersey, I believe), but how much of these profits go back to that specific step of the drug development process?

You also avoided the key question: why is it $1,000/day, other than “because they can charge that”? Without digging too deeply, it looks like California did something along those lines (pdf):

For many comparisons with the previous standard of care, we estimate that the incremental cost required to achieve one additional SVR [Sustained virologic response] with newer treatment regimens is greater than $300,000. While the cost per additional SVR” is not a common measure of cost‐effectiveness in the literature, the costs per SVR generated in this analysis are generally higher than those previously published for telaprevir versus PR ($189,000),118 alternative regimens of PR versus standard PR therapy ($17,000‐$24,000),119 and even highly active antiretroviral therapy in HIV patients ($1,000‐$79,000)

Another quotes me:

“But the trade-off is that the innovation that occurs outside the NIH – and the bulk of all drug research is done by the pharmaceutical industry – would inevitably suffer.” You are repeating “factoids” that you have apparently encountered somewhere – factoids that are dead wrong. I’m in the drug industry, so don’t dismiss me as a crank.

The reality is that much of the seminal work that leads to breakthrough drugs is not done by the drug industry but rather research supported by NIH. Just one example that is especially relevant to you – AIDS drugs. The fundamental work that resulted in the discovery of these drugs and their eventual development by companies such as Merck and Abbott was actually funded by the NIH. Where the US government screwed up was giving sweetheart deals so that drug companies that ended up doing the clinical development that resulted in a successful filing to the FDA. The US taxpayer should have gotten more in return.

Yes, the fundamental basic research was done by the NIH. But you think we’d have the variety and sophistication and constantly innovating treatments without the private sector’s profit incentive? Another combines two threads:

In this post, you say, “But the trade-off is that the innovation that occurs outside the NIH – and the bulk of all drug research is done by the pharmaceutical industry – would inevitably suffer.” But in a post also published that morning, you quote Madrick as saying:

Similarly, [economist Robert] Gordon called the National Institutes of Health a useful government ‘backstop’ to the apparently far more important work done by pharmaceutical companies. But Mazzucato cites research to show that the NIH was responsible for some 75 percent of the major original breakthroughs known as new molecular entities between 1993 and 2004.

So which is it? I warrant that NIH does little drug development work, which is quite expensive, but in terms of basic research and background work, NIH does the lion’s share (and removes a lot of the risk) for Pharma … and then government foots the bill for the massive costs of new pharmaceuticals.

Again: major original breakthroughs do not equal specific treatments for specific drugs through clinical trials to FDA approval. Both the NIH and the US private sector matter. Another adds:

The public interest doesn’t end with NIH’s basic research. Pharma ends up wasting R&D talent and money on heartburn or hair-loss that could otherwise go to cancer or diabetes research. If the US took the social good into account when negotiating a fair margin, we could use our considerable market clout to incentivize companies to produce far more cures for diseases like Hep C, and less in the way of new-and-improved Viagra, or some twisted-molecule version of Lipitor that has virtually the same clinical outcomes.

I think expecting the market to do all of this is as foolish as expecting the government to distort the market and get better results. I know I have a bias here, but it is the bias of someone with a major health challenge. This system has performed miracles in a manner not seen elsewhere in the developed world. I don’t want to change it much.